Trauma Association of Canada Abstracts 2018

2018 Canadian journal of surgery  
Abstracts TAC ABSTRACTS S2 J can chir, Vol. 61 (2 Suppl 1), avril 2018 -Résumés Survivors of traumatic cardiac arrest. M. Azam Majeed. From the University Hospitals Birmingham, Birmingham, UK. Background: Traumatic cardiac arrest (TCA) carries high mortality and morbidity. Survival is poor. Recent studies suggest the rate of morbidity and mortality due to TCA is approaching the same as that due to any other cause of cardiac arrest. The common causes are head trauma, tension pneumothorax, spinal
more » ... in juries and hypovolemia. The commonly found rhythm in TCA is pulseless electrical activity (PEA) followed by asystole and then ventricular fibrillation (VF). This study identified survival rates and factors affecting them. Methods: A 5-year retrospective database review was conducted to identify trauma patients who had traumatic cardiac arrest. This study was conducted at the University Hospitals Birmingham, England, which is a Level 1 regional trauma centre. The primary outcome measure was survival to hospital discharge. The secondary outcome was to look at the factors affecting survival. Results: Forty patients had out-of-hospital cardiac arrest secondary to major trauma. The mean age was 50 years (16-84 years) and the male to female ratio was 32:8. The commonest mechanism involved was road traffic accidents and then falls. The mean injury severity score (ISS) was 37.5 (9-66) and the most commonly injured regions were as follows: chest 70% (28 patients), head 55% (22) , face 40% (16), spine 37% (15), abdomen 27% (11) and 15% (6) with pelvic injuries. Ninety-five percent (38 out of 40) of patients received adrenaline and all (100%) patients received CPR. Out of 40, only 60% (24 patients) received blood. The mean length of CPR was 46 minutes (2-90 minutes). Only 55% (22) patients got return of spontaneous circulation on scene and 35% (14) more patients while in the resus room. The commonest rhythm was asystole 78% (31 patients), PEA 18% (7 patients) and then 5% (2 patients) had VF. Only 4 patients (10%) survived to discharge. When we looked at these alive patients they had received CPR for a mean time of 4.5 minutes (2-7 minutes), and their mean age was 39 years (31-48 years). Among these 4 patients, 2 had sustained only rib fractures and lung contusions. One patient had renal contusion and liver laceration. The last patient was a case of drowning. Conclusion: The survival rates described are poor but comparable with (or better than) published survival rates for out-of-hospital cardiac arrest of any cause. Patients who have active bleeding on scene leading to hypovolemia have a poor chance of survival. Also, the survivors had a very short time of cardiopulmonary resuscitation. Most of the guidelines suggest a poor chance of survival with longer resuscitation. All-terrain vehicle serious injuries and death in children and youth: a national survey of Canadian pediatricians. Background: The purpose of this study is to determine if the introduction of a pre-arrival and pre-departure trauma checklist will improve clinical performance in a simulated environment. The trauma checklist was developed in response to quality assurance reviews of high-acuity trauma activations. It focuses on prearrival preparation and pre-departure review before patient transfer. We conducted a randomized controlled trial assessing the impact of the trauma checklist on time to critical interventions on a simulated pediatric patient. Methods: Emergency department teams composed of 2 physicians, 2 nurses and 2 confederate actors were enrolled in our study. In the intervention arm, participants watched a 10-minute educational video modelling the use of the trauma checklist before their simulation scenario and were provided a copy of the checklist. Teams participated in a standardized simulation scenario caring for a severely injured adolescent patient with hemorrhagic shock, respiratory failure and increased intracranial pressure. Results: Our primary outcome of interest was time measurement to initiation of key clinical interventions, including intubation, first blood product administration, massive transfusion protocol activation, initiation of hyperosmolar therapy and others. Secondary outcome measures included a trauma task performance score and checklist completion scores. We enrolled 14 multidisciplinary teams (n = 56 participants) into our study. There was a statistically significant decrease in median time to initiation of hyperosmolar therapy by teams in the intervention arm compared with the control arm (581 seconds v. 884 seconds , p = 0.03). Time to initiation of other clinical interventions was not statistically significant. There was a trend to higher Advanced Trauma Life Support (ATLS) task performance scores in the intervention group; however, this did not reach statistical significance (p = 0.09). Pre-arrival and pre-departure checklist scores were higher in the intervention group (9.0 [9.0-10.0] v. 7.0 [6.0-8.0], p = 0.17, and 12.0 [11.5-12.0] v. 7.5 [6.0-8.5], p = 0.01). Cognitive workload scores did not show statistical significance across all 7 domains of the NASA-TLX tool. Conclusion: Teams using the trauma checklist had significantly higher prearrival and pre-departure scores, with a trend to higher trauma task performance scores. However, use of the trauma checklist did not impact the cognitive workload scores of team participants. The impact of this checklist should be studied outside tertiary trauma centres, particularly in trainees and community emergency providers, to assess for benefit and further generalizability A survey of communication among team members during resuscitation of trauma pediatric patients in a tertiary care centre in North America. Deepak Choudhary, Jeremy Killion, Sarah Dipalma, Jeremy Walsh. From the Women and Children's Hospital of Buffalo, Buffalo, NY. Knowledge transfer: implementation of a clinical intervention guide to optimize and harmonize trauma care for patients with rib fractures in the emergency department. Nathalie Rodrigue, Nancy Tze. From the McGill University Health Centre, Montréal, Que. Background: Rib fractures are common trauma injuries and incidence increases with age, resulting in visits to the emergency department. Observing variability in internal practices, the Montreal General Hospital Trauma Program implemented over a year an evidence-based clinical intervention guide to optimize and harmonize trauma care for patients with rib fractures. The guide consists of 3 tools: an interprofessional algorithm including multimodal analgesia for pain relief, a nursing management care guide S6 J can chir, Vol. 61 (2 Suppl 1), avril 2018 -Résumés driving while using a cellphone were noted (10.9% and 8.5%, respectively). There were no instances of texting while driving, and driving while intoxicated was also very rare. Conclusion: Popular TV series model unsafe driving behaviours. Seat belts are very infrequently used. As well, drivers are often distracted, as they look away from the road to talk to other occupants in the car. Finally, drivers use cellphones while driving. Further study is required, but TV producers should be sensitive to modelling unsafe driving behaviours, particularly if the audience consists largely of young drivers.
doi:10.1503/cjs.004018 fatcat:uv2ccvgft5c4bgtx4l6af3uef4