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Objectives 1) Pre-hospital trauma care – Regional trauma systems and triage 2) Hospital care 3) Post-hospital follow-up care. Where am I now? Why?. Espírito Santo - Brasil South-Eastern Region Territorial area – 46.000.000 km2 Population – 3.500.000 - PowerPoint PPT Presentation
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Objectives
1) Pre-hospital trauma care – Regional trauma systems and
triage
2) Hospital care
3) Post-hospital follow-up care1Nelson Elias, Brasil
Where am I now? Why?
Espírito Santo - BrasilSouth-Eastern Region
Territorial area – 46.000.000 km2Population – 3.500.000
More than 400km of sunny coast Natural Resources - oil, natural gasAgriculture - banana,bean,cocoa
coffee, cornSteel IndustryTwo harbors
2Nelson Elias, Brasil
Nelson Elias, Brasil 3
Tubarão Harbor Vitória Harbor
The Hospital
Private HospitalCity: Vila Velha – population ≅ 500.000
3,5 km from Vitória (capital- Metropolitan area)
Easy access! Near the most important highway (Sun highway)
4Nelson Elias, Brasil
Sun highway – Rodovia do sol
Vila Velha – Guarapari (beaches – touristic region)
Extension 67 km
5Nelson Elias, Brasil
1) Pre-hospital trauma care Regional trauma systems and triage
-SAMU – Urgency Mobile Assistance Service – Brazilian Health Ministry-Phone 192 – 24 hours service –ambulances -Transfer patients for orthopedic center reference after previous contact (our hospital is reference)
6Nelson Elias, Brasil
1) Pre-hospital trauma care Regional trauma systems and triage
Motorcycle in severe casesFaster
Only during the day (not at night and when raining) – to avoid accidents
7Nelson Elias, Brasil
1) Pre-hospital trauma care Regional trauma systems and triage
Helicopter rescue (special conditions) by fire department
8Nelson Elias, Brasil
2) Hospital care Elderly patient
- Multidisciplinary team (on-call hip fracture support team)
- Surgical priority- Majority – Operated within 48 hours
- Early mobilization (rehabilitation program)
- Geriatric evaluation - falls prevention - Osteoporosis investigation, treatment
and prevention of others fractures 9Nelson Elias, Brasil
2) Hospital Care Trauma patient
- Evaluation – trauma room
- Stable yes - ETC
if not - DCO (external fixation)
10Nelson Elias, Brasil
2) Hospital Care Adult patient
- After pre-operative evaluation the patients are operated as soon as possible
- If delay, more than 48 hours, the diaphyseal fractures of femur and tibia are fixed , temporary, with external
fixation
11Nelson Elias, Brasil
2) Hospital Care Pediatric patient - They are evaluated by a pediatric
and orthopedic surgeon
- Operated within 24 hours of trauma
12Nelson Elias, Brasil
2) Hospital care – Orthopedic department- Ten orthopedic surgeries / day
- Twelve orthopedic surgeons
- Eight orthopedic residents
- Trauma protocol
- Friday morning –clinical session
13Nelson Elias, Brasil
2) Hospital Care Rehabilitation
- All operated patients are referred to physiotherapy program as soon as possible
- Post operative treatment: the patients are evaluated and normally discharged on day 2 or 3 after surgery
14Nelson Elias, Brasil
3) Post-Hospital follow-up care- All patients, after discharge of hospital, are oriented to return to out patient department, according to the fracture -The patients without conditions to stay at home are transferred to chronic care hospital
-There is a special program for geriatric patients –Home care -The patients are monitored by phone calls of social service and by hospital infection commission
15Nelson Elias, Brasil
2) Hospital care – Orthopedic department- Residence in orthopaedic (Brazilian Society of Orthopedics)- Sub specialty program in spine and trauma- Sub specialties: - Arthroscopic - Articular reconstruction - Upper limb - Lower limb - Trauma - Hand and Microsurgery - Spine - Pediatric - Orthogeriatric
16Nelson Elias, Brasil
2) Hospital care- General hospital / 200 beds – All specialists
- Local research ethics committee
- ICU for 16 patients
- Emergency Department / CT scans / MRI
- Surgical center-10 operating rooms - 02 C arms
- Trauma room
17Nelson Elias, Brasil
Why ?
18Nelson Elias, Brasil