Saturday, February 3, 2018

EMERGENCY TRAUMA MANAGEMENT - LIFE IN THE FAST LANE.


A 17 year old boy is wheeled in to the Accident & Emergency (A&E) after being run over by a truck. The patient is rapidly assessed, given essential life saving emergency care including blood transfusions and is immediately rushed in to the operation theater for a suspected pelvic (hip bone) fracture. Two weeks later, the patient is sent back home, alive and hearty - one of the many success stories where prompt emergency management saved a life.

So what does a person involved in a motor vehicle collision or a fall, a child who breaks a bone, and a physical assault victim should do? They all must seek emergency treatment for their trauma-related injuries.

Trauma refers to a bodily injury resulting from the application of an external physical force. It is the leading cause of death under the age of 45 years all over the world, with majority of victims being young males. Motor vehicle accidents are the major culprit of these types of fatalities; in children too under the age of 18, trauma is the leading cause of death above all other diseased conditions combined. Surprisingly, the number of years of life lost before the age of 65 due to trauma exceeds those lost from heart disease and cancer put together. There is a massive additional social burden from disability affecting survivors as well.

While the word may have a fairly simple and standard definition, when it comes to treatment of trauma patients, there is nothing uniform or standard about it. Traumatic injuries can range from minor isolated wounds to complex injuries involving multiple organ systems. The trauma can be blunt or penetrating - like a stab or a gun shot wound.

Majority of deaths occur either at the scene or within the first four hours after the patient reaches a trauma center. Relatively, fewer patients die after the first 24 hours have passed following the injury. Most preventable deaths are due to excessive blood loss.

Regardless of the cause or type of trauma, the ultimate goal of treatment is to minimize the disability and deaths associated with the injury. It involves reducing the deaths associated with the 2nd peak period which occurs in the hours shortly after the injury.

A systematic approach toward the trauma patient allows for rapid assessment and stabilization of the victim. This maximizes outcomes and reduces the risk of undiscovered injuries. Established protocols within an organization allow physicians to evaluate the patient in a logical, algorithmic (ATLS) manner and treat injuries in the order that has the greatest chance to prolong life and also minimizes long term consequences from the injury.

Dr. L. H. Hiranandani Hospital is a Level 1 trauma centre providing a multidisciplinary, extensive emergency medical service to trauma patients with the highest level of care, and is capable of offering definitive treatment for any type of injury. Apart from an Accident & Emergency (A&E) department which is manned by emergency physicians who specialize in this field of practice, it also boasts of availability of all surgical subspecialties and advanced imaging capabilities. The hospital operates on a “team approach” whose staff includes emergency physicians, general surgeons, orthopedic surgeons, neurosurgeons, reconstructive surgeons and anesthesiologists who are experts in treating trauma victims. We also have a 24 hour functioning blood bank and a NABL accredited laboratory, apart from a 24X7 Radiology department for carrying out emergency X-rays, Ultrasound, CT scans and MRI. The A&E also has an attached operation theatre equipped to carry out all life and limb saving emergency surgeries.

With our comprehensive trauma care and emergency medical services, we are able to care for the most life threatening emergencies at a moment’s notice.

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