My second day at Trauma Care this year was mostly spent in the Major Trauma in the ED stream. I took some notes, which I have expanded on and reported here, on the off-chance that someone might find it useful. Caution – If I have misrepresented anything, please do let me know and I will update. My notes on the first day are here.
Last week was the international Trauma Care Conference, based at Yarnfield, Staffordshire, UK. It ran for several days, with something for everyone in the management of trauma, from the moment of impact to the long difficult process of rehabilitation. I attended the PHEM/HEMS stream on the Thursday, and the Major Trauma in the ED stream on Friday. Below are my notes for the PHEM/HEMS stream. Some of these points I tweeted live from the conference, but much of it may be new. My notes from day 2 are here.
I was delighted to be asked to present a topic at the inaugural Alder Hey Children’s Hospital’s joint surgical and anaesthetic network meeting. It was a great day, with lots of speakers getting the message about joint working and sharing information, about clinical topics, good governance and human factors. I thought I’d share a few of my notes of the day in case any of it is helpful to you.
You are at the forefront of medical education, reducing the translation gap from research to practice from years to weeks. You amaze your colleagues with the latest up to date evidence based practice, and enjoy sharing your experiences with like-minded people.
But can you prove you have been doing it?
Trauma happens to anyone, at any time of day. It has no respect for hospital pathways, pre-existing medical specialties, or patient demographics. Inevitably, the trauma resuscitationist will encounter patients with more than one problem: the mature male with coronary artery disease leading to a “medical” cardiac arrest at the wheel, the patient with severe COPD with multiple rib fractures from a fall, or as I’m going to discuss today, a patient with a severe cocaine overdose who gets hit by a car.
The use of fluids prehospital has always been, and will likely continue to be a controversial topic. The simple notion that we should be replacing the fluids which have been lost is sensible and logical, but not necessarily logistical. The logistics of carrying blood products make it unfeasible for many services, and certainly on a large scale for widespread use within an ambulance service. Continue reading “Traumatic Brain Injury: Hypertonic Saline or Combination fluids?”
In the early days of our major trauma centre, when the network was in its relative infancy there was a noticeable lack of standardisation. Patients would be brought to us from distance as close as a few hundred yards, or over a hundred miles on ‘spinal boards’, with occasional use of scoop stretchers.
With time, effort, communication and education things have changed for the better. I would like to write this article to help provide some evidence to others who are passionate about getting the word out.
Recent years have seen some real thought put into major incident management in the UK, particularly after such high profile incidents such as the rail crashes at Paddington, Potters bar, and Selby, and large scale terrorist activity like the Glasgow and London bombings. The July 7 2005 bombing incident highlighted many areas which still needed urgent attention including command and control, and communication.
What do I do if I’m first on scene? Continue reading “Major incident management – in brief…”
A long while ago, I tinkered with blogging, before getting distracted with real life, getting a proper job and then the rapid responsiveness of Twitter.
My old blog http://drgreenway.blogspot.com was an attempt at explaining life as a junior anaesthetist. I tried writing a little clinical education work back then, well before the #FOAMed explosion, and found that those pages got the most comments and certainly the best realtime feedback from people wanting answers. One of my articles, “Pain relief in Labour” quickly made the rounds amongst anxious mothers when the great Kirstie Allsopp retweeted me. It was my first experience of helping others by sharing information digitally, and I was hooked.
For the last three years I have been working at a Major Trauma Centre, in the role of Consultant in Trauma Resuscitation Anaesthesia – a new role developed as part of a new system of front door trauma care, recently described in the British Journal of Anaesthesia. It has been a truly exciting time putting this system together and we have learned a great deal.
I also respond in the prehospital environment both locally for the charity North Staffordshire BASICS, and as part of the West Midlands Ambulance MERIT service.
My plan is to try to put some of the best that I find out there on the web here, along with my own thoughts and experiences in the new subspecialty that is Trauma Resuscitation Anaesthesia (TRA). It may take a few goes to try to get the format right, so bear with me!
Watch this space!