Gangtok: Trauma is the number one cause of death in individuals between the age of 20 and 60. Economic development has resulted in more and more car accidents which are now the most frequent cause of trauma. Other causes of trauma include falls, earthquakes, and violence. Emergency departments now face a great challenge with such increases in the incidence and severity of trauma patients.
The lack of a high-quality nationwide database for trauma makes an accurate estimate of trauma epidemiology difficult. Recently introduced programs like iRAD (Integrated Road accidents Database) would help to get valuable reports on trauma-epidemiological data. Mass casualty events produce stress and challenge to every medical care system in every country.
The first 60 minutes following trauma are a crucial period for getting patients to a trauma centre and has been called the “golden hour”. This concept is deeply entrenched in trauma systems, field triage guidelines, emergency medical services, and emergency department management of trauma victims. Triaging is a vital part of managing multiple casualties and mass casualty events. A process by which patients are classified according to the type and urgency of their conditions.
Trauma comes in two varieties- blunt trauma and penetrating trauma. Nonetheless, major trauma patients should always be approached in the same way.
Primary assessment A, B, C, D, and E (A for Airway + Cervical Spine, Airway assessment) indicates that if blood, vomit or the patient’s saliva is blocking the airway which often occurs in unconscious patients, they will probably need suctioning and possible intubation (a process where a healthcare provider inserts a tube through a person’s mouth or nose, then down into their windpipe).
The tube keeps the trachea open so that air can get through. The tube can connect to a machine that delivers air or oxygen. Along with airway protecting the cervical spine from any posterior midline tenderness putting a Philadelphia collar would be the first management to stabilize suspected cervical spine injuries. Following that, B for the ‘Breathing In’, part examines the chest through inspection, auscultation and palpation looking for life-threatening injuries decreased breath sounds, subcutaneous emphysema (air becomes trapped under the skin causing serious discomfort and complications, Broken ribs, and tracheal deviation are concerning for a tension pneumothorax severe condition that results when air is trapped in the pleural space under positive pressure, displacing mediastinal structures, and compromising cardiopulmonary function. Early recognition of this condition is life-saving.
Bleeding is likely in one of four locations chest, abdomen, pelvis, and fractured long bones. Starting IV fluids or blood transfusion through two big intravenous lines if we suspect bleeding. D for Disability comprises a basic neurological assessment which helps you to calculate a Glassgow coma scale which evaluates an eye-opening max score of 4/4, verbal response max score of 5/5 and motor response max score of 6/6 which is universally understood on a 15-point scale. The highest possible GCS is 15/15 fully awake, while the lowest is 3 deep coma or death. This helps in assessing traumatic brain injury. E for ‘Exposure’. In this part, the patient should be completely undressed to look for all injuries.
Followed by Secondary Assessment Head to Toe Examination HEENT (Head, Eye, Ear, Nose, and Throat), Cardiac examination, Chest/Breast Examination, Abdomen/Back examination, Neurological examination and local examination. Along with secondary assessment, the major trauma patient often requires adjuncts events ECG, Abg, NG tube, Chest x-ray, pelvic x-ray Any Unstable Pelvis always applying a pelvic binder should be vital management, Urinary catheter, EFAST (Extended Focused Assessment with Sonography in Trauma) is a bedside ultrasonographic protocol designed to detect peritoneal fluid, pericardial fluid, pneumothorax, and/or hemothorax in a trauma patient. If blood loss exceeds the resuscitation with fluid and blood the patient will spiral into the classic triad of death Acidosis, Coagulopathy and Hypothermia.
Grading of trauma care, Trauma care training, Good ACLS Ambulance and emergency medical services would further benefit the health system in the country. Ultimately it will develop a trauma system which will integrate pre-hospital care with hospital care via a unified protocol.
Department of Emergency Medicine of Central Referral Hospital, Sikkim Manipal University has had abundant exposure to mass casualty incidents (MCIs), particularly over the past year. The emergency Medicine department had all the modern facilities including 30 beds segregated by Green zone, Yellow zone, and Red zone according to acuity with six bedded ICUs, hamilton ventilators, etc. Past two months we have successfully managed two MCIs of 30 patients each. Relevant departments have worked in tandem for these incidents.
This experience has led us to define practical strategies that emergency departments can use to activate disaster protocol. We have practised in hospital mock drills and attended National Disaster Management mock drills. We have discussed the importance of activation of disaster protocol as well as other lessons learned from our experience to maximize the preparedness of the emergency department to receive mass casualties. We have ensured a safe environment for our patients as well as our staff through our effective documentation and communication.
This article is written by Dr Farhan Abdul Vahab, a junior resident doctor at the Department of Emergency Medicine, Central Referral Hospital, SMU
Also Read | Scientists working on eye drops to treat cataracts sans surgery
Play real money online casino games at Pure Win, where everyone can win real rupee cash prizes! Not only does it have a wide selection of top-quality online casino games, but the Pure Win Trustpilot is also filled with top ratings from satisfied online casino India players and visitors.
EastMojo is a digital news media platform promoting north east India news. Led by a team of renowned journalists, EastMojo covers all the news from the 8 north-eastern states that are Arunachal news, Assam news, Manipur news, Meghalaya news, Mizoram news, Nagaland news, Sikkim news and Tripura news. The focus is always on bringing to the forefront Assam’s latest news, news live from ground zero, breaking news of Northeast, Assam news headlines, and quality stories that reflect the culture and ways of life of the people in the region.
Privacy policy Terms of Use Refund Policy Advertise with EastMojo Contact Us About Us Careers @EastMojo Grievance Redressal