Dr M Bloch Consultant Anaesthetist RACH

Dr M BlochConsultant AnaesthetistRACH

Plan:

Why How

Persons Injured orKilled as a Result:

Date Fatal Serious Slight Total

2001 50 270 1277 1597

2002 49 274 1211 1534

2003 50 278 1149 1477

2004 44 275 1107 1426

2005 53 243 1261 1557

2006 62 214 1167 1443

Total 308 1554 7172 9034

Different equipment. Different education and training. Different perspective, pressures and pitfalls.

10% of 999 calls are for children, 5% of these require resuscitation (1997).

Commonest cause of death >1 yr = TRAUMA.

“When required, response needs to prompt and effective.” Prevent 20 injury and gather appropriate information (MOI / NAI). (Fiona Jewkes)

Risk : Benefit : Cost Effective emotions

Early recognition and initial management:

‘BIG SICK & little sick’

How?Systematic approach & attention to detail!

PHPLS / APLS / PHECC / PEPP / PHTLS

Immediate / Primary survey / Resuscitation phase: ‘Simultaneous assessment, identification and

management of any immediate life-threatening problems, with ongoing assessment of the potential for developing other life-threatening complications.’

Secondary survey / Focussed review / Emergency treatment

Continuing assessment, care and stabilisation.

D DANGER (scene, self, patient) 4 DIMENSIONS: up / down, front / back, left / right & time

R RESPONSE(Patient, Help)

RELATION(MOI, SAMPLE)

ReassureReassess

Ac AIRWAY with C-SPINE ‘do airway think spine’Safe O2, maintainable / at risk (position / manoeuvres / adjuncts),

unmaintainable (secure / definitive)Effort (signs of WOB esp. RR with TV, recession), Efficacy (depth / AE / O2 / CO2), Effect. (HR / LOC / colour / hyponia / FiO2), Exhaustion‘twelve FLAPS’ – open / expanding PTx, flail, HTx. NGT

A&B on scene – good 1st principles

B BREATHING

C CIRCULATION Assess: clinical vs. measured (cough, movement, LOC,pulse, CFT, RR, temp. difference [creeping proximally], colour [pink, pale, mottled], urine vs. SaO2, BP, ETCO2, BD, lactate)

‘On the floor and four more’.

Manage: Controllable vs. uncontrollable haemorrhage: arrest & fluids.

C en-route

D DISABILITY DRUGS:

analgesia, & sedation

appropriate antibiotics

DON’T

EVER

FORGET

GLUCOSE

AVPU (GCS + modifications), PEARL, focal, recurrent seizures, ‘protecting airway’ (prevent 20 injury)

E EMOBILISEEVACUATEEVALUATEEXPOSURE

10 20 survey vs. ‘time-critical’

Hypothermia

F ‘FEELING’ Pain, anxiety and fear

G GUIDANCE ‘ask for help’

H HARM e.g. NAI

I IMMUNE / INFECTION

(mbloch@nhs.net)

C-Spine:

Risks and benefits.Equipment and skills.Canadian and Nexus.

Conclusion: Systematic approach

A combination of knowledge, skill and understanding is required to make the appropriate clinical judgement decisions.

However non-technical skills are also required to optimise patient outcome including: Anticipating and planning. Appropriate team leadership. Effective communication & sharing mental models. Maintaining situation awareness and utilising appropriate

personnel and resources. Calling for help early enough.