a structured trauma team approach to the initial management of trauma

A Structured Trauma Team Approach to the Initial Management of Trauma

Aims of Session

• Discuss a Structured Trauma Team Approach

• Practice a Structured Trauma Team Approach

• Familiarisation with clinical simulation

These slides remain the intellectual property of NSW ITIM & the SCSSC. V3: 2010

Outline

• Establish setting• Bat phone call• Discuss preparation in pause & discuss fashion• Bring in patient & commence scenario• Consider trying different ambo handover methods or

different 1* survey approaches to emphasise points• Practice team update if necessary to emphasise benefits

of team communication• Finish by debriefing with video playback


The Setting

• Metropolitan / Regional Hospital

• Facilities: – General surgery / orthopaedics / anaesthesia / ICU /

24hr OT all available– Neurosurgery / cardiothoracic surgery / interventional

angiography not available

• Investigations available– X-Rays, FAST, CT, pathology – 24hrs


Bat Phone Call

– I: 20 yr old male. – M: High speed MBA rider vs car– I: Unconscious– Hypotensive initially – responded to fluid– S: HR 90, RR 10, SBP 70 ↑ 90 after fluid– GCS 3, BSL 10, SaO2 92%RA– T: Intubated, Collar, 1000mls Hartmanns

– A: Unknown– M: Unknown– B: Unknown– O: Arriving in 10 minutes


Discussion Points

• Benefits of effective preparation• Benefits of IMIST whiteboard• Trauma Call• How do you organise the team?• How do you identify team members? • Do you establish an initial team plan?• Where should you do the Ambulance handover? • Who should do the Primary Survey?


Team Approach

• Rapid Primary Survey talking out loud

• Simultaneous assessment & resuscitation

• Summarise & confirm findings at end of 1* Survey

• Team Leader coordinates management decisions

• Communicate, communicate, communicate…


Team Updates & Decisions

• Summarise & confirm initial findings as a team in an ABCDE fashion…..– Team Leader talk to team– Confirm findings & get feedback & suggestions– LIMITS mnemonic checklist

• Clinical decision making as a team– Team Leader outlines management plan & gets feedback– Team Leader articulates final plan

• Re-evaluate ABCDEs regularly as a team – Throughout the resuscitation and particularly if patient condition

changes or after interventions


Organise Your Team…..

– I: 20 yr old male. – M: High speed MBA rider vs car– I: Unconscious– Hypotensive initially – responded to fluid– S: HR 90, RR 10, SBP 70 ↑ 90 after fluid– GCS 3, BSL 10, SaO2 92%RA– T: Intubated, Collar, 1000mls Hartmanns

– A: Unknown– M: Unknown– B: Unknown– O: Arriving in 10 minutes

Plan A?


Debriefing Questions

• What happened?

• How did you feel?

• How did the team function?

• What did you learn?

• What would you change?


Summary of Case

• High speed MBA

• Pre-hospital hypotension from splenic injury

• Pulmonary contusion & closed head injury

• Deterioration secondary splenic rupture


Key Points – Structured Approach

• IMIST Pre-notification on whiteboard• Preparation

– Roles– Identification– Initial patient specific plan - mental model

• Ambo Handover - on trolley unless moribund• Primary Survey by TL or delegate• Parallel ABCDE assessment & resuscitation• Summarise 1* findings & plan Mx as a team• Continually re-evaluate ABCDEs as a team• Early decision making if tertiary transfer required• Communicate, communicate, communicate…...


a structured trauma team approach to the initial management of trauma

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