Items tagged with 2019

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This guideline provides information on the resuscitative thoracotomy process in the Emergency Departments at Dunedin and Southland Hospitals.

Most patients with blunt thoracic trauma do not require surgery and are managed either with chest drainage and/or ventilatory support of some sort. Of those that do need an operation , the vast majority can be transferred rapidly and safely to the operating room.

Patients with penetrating trauma more commonly need surgical intervention but this should also be done in the operating theatre whenever possible.

Occasionally patients present in extremis with refractory shock or lose signs of life in, or just prior to arrival to, the Emergency Department. Some of these patients (notably those who have cardiac tamponade from a stab or other low energy penetrating wound) may survive if an Emergency Department thoracotomy is done and we need to be prepared for such an event, even though it is rare. An algorithm to guide decision-making is presented in Appendix 1.

Abstract Trauma and other disease registries have been used to improve patient care and outcomes at the system level. Paradoxically, registries have had little role in informing the care of any individual patient while that care is being determined and delivered. The lack of timeliness of useful data is a major barrier to the value of registries in improving individual patient care real-time. What do trauma and emergency care providers require from their trauma registries to inform real-time patient tailored improvements in trauma care? Research is urgently needed to improve the usefulness of disease registries, and to develop innovative processes and applications using patient data to inform patient care real-time, thereby improving patient outcomes.

Each year approximately 5 million people die from injury globally, accounting for 9% of all deaths. Injury causes more deaths than human immunodeficiency virus (HIV), malaria and tuberculosis combined. Road injury alone ranks fifth among the leading causes of death. In Australia, where injury is one of nine National Health Priority Areas, it is the leading cause of death before the age of 45, with more than 10 000 deaths per year. Disproportionately affecting young adults, injury is the major cause of longterm disability and lost productivity.

CID-10 Causa Externa:

1. V01-V09 Pedestre traumatizado em um acidente de transporte
2. V10-V19 Ciclista traumatizado em um acidente de transporte
3. V20-V29 Motociclista traumatizado em um acidente de transporte
4. V30-V39 Ocupante de triciclo motorizado traumatizado em um acidente de transporte
5. V40-V49 Ocupante de um automóvel traumatizado em um acidente de transporte
6. V50-V59 Ocupante de uma caminhonete traumatizado em um acidente de transporte
7. V60-V69 Ocupante de um veículo de transporte pesado traumatizado em um acidente de transporte
8. V70-V79 Ocupante de um ônibus traumatizado em um acidente de transporte
9. V80-V89 Outros acidentes de transporte terrestre
10. V90-V94 Acidentes de transporte por água
11. V95-V97 Acidentes de transporte aéreo e espacial
12. V98-V99 Outros acidentes de transporte e os não especificados
13. W00-W19 Quedas (mesmo nível por escorregão, tropeção ou passos em falso)
14. W00-W19 Quedas (todas as demais)
15. W20-W49 Exposição a forças mecânicas inanimadas
16. W50-W64 Exposição a forças mecânicas animadas
17. W75-W84 Outros riscos acidentais à respiração
18. W85-W99 Exposição à corrente elétrica, à radiação e às temperaturas e pressões extremas do ambiente
19. X00-X09 Exposição à fumaça, ao fogo e às chamas
20. X10-X19 Contato com uma fonte de calor ou com substâncias quentes
21. X30-X39 Exposição às forças da natureza
22. X60-X84 Lesões autoprovocadas intencionalmente
23. X85-Y09 Agressões
24. Y10-Y34 Eventos (fatos) cuja intenção é indeterminada
25. Y85-Y89 Seqüelas de causas externas de morbidade e de mortalidade
26. Outros
27. Desconhecido

Critério de Transferência para Centro de Trauma:

1. Escore na GCS ≥13
2. PAS < 90 mmHg
3. FR < 10 ou > 29 rpm (< 20 em bebês < 1 ano) ou necessidade de suporte ventilatório
4. Todas as lesões penetrantes na cabeça, pescoço, tronco e extremidades proximais (acima do cotovelo ou joelho)
5. Deformidade ou instabilidade da parede torácica (p. ex. tórax instável)
6. Duas ou mais fraturas de ossos longos proximais
7. Extremidade esmagada, desenluvada, mutilada ou sem pulso
8. Amputação proximal ao punho ou tornozelo
9. Fratura pélvica
10. Fratura exposta ou afundamento de crânio
11. Paralisia
12. Queda em adultos: > 3 metros
13. Queda em crianças: 3 metros ou 2-3 vezes a altura da criança
14. Intrusão do veículo, incluindo teto: 30 cm no compartimento da vítima ou 45 cm em qualquer local do veículo
15. Colisão com ejeção (parcial ou completa) do veículo
16. Colisão com óbito no mesmo compartimento da vítima
17. Dados de telemetria de acidentes (AACN) consistentes com lesões de alto risco
18. Atropleamento auto vs. pedestre/ciclista com arremesso ou > 30km/h
19. Colisão de motocicleta > 30 km/h
20. Para adultos > 65 anos, PAS < 110
21. Doentes em uso de anticoagulantes ou distúrbios hemorrágicos
22. Gestantes > 20 semanas
23. Avaliação da equipe de APH
24. Queimadura
25. Queimadura associada à trauma
26. Desconhecido

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1. Definition of TBI should include one of the following
   • Direct blow to the head or acceleration/deceleration mode of injury
   • Any head related injury (facial #s, mandible #, broken nose)
   • Significant mechanism (pedestrian vs car, bicycle struck or collision, RTC high speed – rollover, ejection, fall from height > 1m, thrown, head trampled on)
   • Patient has other major trauma injuries
   • Decreasing level of conscious at any time
   • Assault
   • Vague or no recollection of events pre or post injury
   • Active symptoms of concussion such as headache, blurred vision, sensitivity to light or noise, drowsiness, balance problems, nausea/vomiting, poor concentration, fatigue, poor sleep

2. **Discharge home criteria
   • No ongoing clinical indication for prolonged observation e.g no abnormal behaviour, severe post-concussive symptoms, no drugs and/or alcohol intoxication.
   • GCS 15/15
   • if has been tested A-WPTS 18/18
   • Responsible person at home
   • Patient or responsible person understands head injury instructions (provide printout MIDAS document 65632)

3. During assessment
   • Treat symptoms, hydrate and encourage rest and sleep between assessments

4. Referral to Concussion Clinic
   • Attach large patient sticker and patient’s ACC number to concussion clinic form (ACC883)
   • Sign and date form
   • Print clinical notes from EDIS
   • Email ACC883 form, clinical notes and Rivermead symptom evaluation to This email address is being protected from spambots. You need JavaScript enabled to view it.

5. Patients admitted to a ward prior to their concussion evaluation (eg for other significant injuries or illnesses)
   • These should have their assessment as an inpatient. Please document the need for this in patient’s notes and if possible let the admitting team know.