trauma care system and role of nurses in trauma fast track
TRANSCRIPT
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Trauma Care System and Role of Nurses
in Trauma “Fast Track”
Asst.Prof.Krongdai Unhasuta RN, Ed.D
www.slideshare.net/krongdai
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Trauma Care System
รปแบบของศนยบรบาลผบาดเจบ
ทรพยากรพนฐานและความรบผดชอบ
ศกยภาพและขด
ความสามารถ
รปแบบการบรหารจดการ
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1. Trauma Patient
2. Trauma Nurse
3. Trauma Care Environment
Key success of Trauma Care
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Trauma Patient The disease entity
resulting from physical injury
ICD 10 (WHO, TM); S00–T14 – Injury, T15–T98 Poisoning
and certain other consequences of external causes
• Unintentional injuries
• Falls
• Accidental
• Other and unspecified non-transport accidents
• Intentional self-harm
• Assault
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ICD-10 (Injury Diagnosis Codes)
IS00-S09 Injuries to the head
S10-S19 Injuries to the neck
S20-S29 Injuries to the thorax
S30-S39 Injuries to the abdomen, lower back, lumbar spine and
pelvis
S40-S49 Injuries to the shoulder and upper arm
S50-S59 Injuries to the elbow and forearm
S60-S69 Injuries to the wrist and hand
S70-S79 Injuries to the hip and thigh
S80-S89 Injuries to the knee and lower leg
S90-S99 Injuries to the ankle and foot
T00-T07 Injuries involving multiple body regions
T08-T14 Injuries to unspecified part of trunk, limb or body region
T15-T19 Effects of foreign body entering through natural orifice
T20-T32 Burns and corrosions [email protected]
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ISS Score Severity
1-9 Minor
10-15 Moderate
16- 24 Moderate/Severe
> 25 Severe / Critical
Trauma Patient
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ISS; Injury Severity Score
Region Injury Description AIS Square Top Three
Head & Neck Cerebral Contusion 3 9
Face No Injury 0
Chest Flail Chest 4 16
Abdomen Minor Contusion of Liver
Complex Rupture Spleen
2
5
25
Extremity Fractured femur 3
External No Injury 0
ISS 50
AIS Score Injury
1 Minor
2 Moderate
3 Serious
4 Severe
5 Critical
6 Survivable
ISS
1-8 Minor
9-15 Moderate
16-24 Serious
25-49 Severe
50-74 Critical
75 Maximum
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TRISS score Trauma Score-Injury Severity Score
• TRISS determines the probability of survival (Ps) of trauma patient from the RTS and ISS using the following formulae:
Ps = 1
(1+e-b)
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b = b0+b1(RTS)+b2(ISS)+b3(ageIndex)
AgeIndex = 0 if the patient is below 54 years
= 1 if 55 years and over
If the patient is less than 15, the blunt coefficients
are used regardless of mechanism.
Blunt Penetrating
b0 -0.4499 -2.5355
b1 0.8085 0.9934
b2 -0.0835 -0.0651
b3 -1.7430 -1.1360
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RTS REVISED TRAUMA SCORE
RTS = 0.9368 GCS + 0.7326 SBP + 0.2908 RR
GCS SBP RR Coded Value
13-15 >89 10-29 4
9-12 76-89 >29 3
6-8 50-75 6-9 2
4-5 1-49 1-5 1
3 0 0 0
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Trauma Nurse
focuses on identifying serious problems, and on stabilizing for further trauma treatment
Trauma Life Support
Traumatic Shock
Recognition
Trauma Resuscitation
Trauma Monitoring
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Access to Judge Good
V/S are stable and within
normal limits
Patient is conscious
and comfortable
Indicators are excellent
Fair
V/S are stable and within normal
limits
Patient is conscious, but
may be uncomfortable
Indicators are favorable
Serious
V/S may be
unstable and not within
normal limits
Patient is seriously ill.
Indicators are questionable
Critical
V/S are unstable
and not within normal
limits.
Patient may be
unconscious
Indicators are unfavorable
Dead
V/S are
persistently absent
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• apply their trauma specialized knowledge base
to care for and maintain trauma life support to
trauma patients.
• apply their trauma core competency base to care
• Cooperation
• Decision making
• Problem solving
• Leadership
• Teamwork
• Technical knowledge
Trauma Nurse
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Trauma Treatment Environment
Patient safety
Preventing harm
Reduce cardiac arrest
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Determine patient’s status CUPS
• Critical patients
• Unstable patients
• Potentially unstable
• Stable patients
• Adequate oxygenation
• Adequate perfusion
• Adequate cerebral perfusion
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Criteria for unstable trauma patient
Altered physiology
GCS ≤14
Pulse <60 or >120 BPM
SBP <90 mmHg after 2 L fluid
challenge
SBP >190 mmHg
RR <12 or >24 BPM
SaO2 < 90%
Temp <33C
Altered physical findings
Paralysis
Inability to talk
Labored respiration
Severe pain
External hemorrhage site
combative
Altered anatomic findings
Severe deformities
Penetrating wound from
head to popliteal fossa
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Trauma Treatment and Trauma Team Environment • look after life-threatening trauma patients
• close monitoring to keep physiologic functions
• higher specialist monitoring and caring for the severely trauma patients
• V/S are unstable and not within normal limits
• Patient may be unconscious
• Indicators are unfavorable
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Standard therapy central venous pressure between 8–12 mmHg.
a mean arterial pressure over 65 mmHg.
a urine output of at least 0.5 ml/kg/h.
Early goal-directed therapy
received the standard care, and
venous oxygen saturation measured
Trauma Treatment Environment
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Trauma Fact Track
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Trauma Fact Track
• เสนทางน าผบาดเจบ ทตองไดรบการรกษาอยาง
เรงดวน ไปรกษาจากทมการรกษาเฉพาะทางทม
ความช านาญหรอศกยภาพทสงกวา หากลาชาจะ
ท าใหผบาดเจบเปนอนตรายเสยชวตได
• เสนทางเรงดวน จะตองมเกณฑและแนวทาง
ปฏบตในการรบผบาดเจบทชดเจน
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ก าหนดการสงตอขอมล • แพทยทตองการ consult จะเปนผสงตอขอมลผบาดเจบ ตามข นตอนทระบเปนแนวปฏบต ท งนตองเขยนชอ-สกลผบาดเจบใหชดเจน
• หลงจากสงตอขอมลแลว แพทยทตองการ consult จะตองโทรศพทโดยตรงอกคร ง
Trauma Fact Track
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ก าหนดการประสานเพอการสงตอ • แจงเวลาการสงตอผบาดเจบ และเวลาทคาดวาผบาดเจบจะไปถง
• กรณทยกเลกการสงตอ จะตองแจงงดการสงตอผบาดเจบกอนลวงหนาเสมอ
• ประเมนผบาดเจบทหองฉกเฉนกอนสงตอทกคร ง
• ถาแพทยทรบปรกษาผบาดเจบรบผปวยไวในการดแลแลว จะมการแจงรบผปวยไวดแลรกษาตอ
Trauma Fact Track
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การดแลเมอแรกรบผบาดเจบ • เมอผบาดเจบมาถง ER แพทยและพยาบาลจะ
ประเมนผบาดเจบ
• หากผบาดเจบมอาการไมคงทหรอแยลงกวาเดม จะตองใหการชวยเหลอผบาดเจบจนกวาอาการคงท ดขน หรอตดสนใหการรกษา กอนการเคลอนยาย
Trauma Fact Track
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Fast Track System
• ใหการรกษาไดอยางเรงดวนทนท มประสทธภาพ สามารถลดอตราการเสยชวต
• ใหการดแลรกษาพยาบาลผปวยจากสถานบรการทางการแพทยทกระดบ ท งภาครฐและเอกชน
• มการตดตอประสานงานรวมกนของสถานบรการอยางท วถงและตอเนอง
• มการพฒนาระบบเชอมประสานระหวางสถานบรการแตละระดบในการสงตอผปวยใหมประสทธภาพ
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Fast Track System
• มการวางระบบการสงกลบเพอการดแลรกษาตอเนองอยางมระบบ
• ใชทรพยากรดานสขภาพของสถานบรการระดบตางๆ รวมกนใหเกดประโยชนคมคาทสด
• ประหยด ลดคาใชจาย และมมาตรฐาน
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Fast Track System
ผบาดเจบท Unstable
ประสานผานระบบเชอมประสาน
ประสานงานกบทมแพทยศลยกรรมอบตเหต
น าสงผบาดเจบมายงหองฉกเฉน
กรณตองไดรบการผาตดอยางเรงดวนทนท
ประสานงานกบหองผาตดและวสญญแพทย
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ATLS
• Triage • Multiple casualties • Mass Casualties
• Primary survey (ABCDE) • A : Airway maintenance and Cervical spine protection • B : Breathing and Ventilation • C : Circulation and Hemorrhagic control • D : Disability ( Neurologic evaluation) • E : Exposure / Environmental control
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การจ าแนกประเภทผบาดเจบ
ทางเดนหายใจอดก น ? ลกษณะการหายใจ ?
ชพจร ?
A Airway
B Breathing
C Circulation
Emergent จะเสยชวตถาไมรบชวยเหลอ
Urgent ถาชวยเหลอชา อาจเสยชวตไดใน 30 นาท
Non urgent ถาชวยเหลอชากวา 2 ชม. เกดอนตรายได
ER
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Triage
Emergent
Definite care
Urgent
Admit Observe
Non urgent
Discharge
“AHS” The American hospital association
Normal ER
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ESI triage
Trauma &
Emergency
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Primary survey • Airway with C-
spine protection • Breathing • Circulation • Disability
Resuscitation • ECG, Pulse Oximetry, IV, Lab • Identified life threatening injuries • Gastric, urethral cath.
Secondary survey • Head to toe exam • AMPLE history • Imaging
Definitive care • Surgery • Splinting • Medications • Consultants • Transfer
Tertiary survey • Repeat primary and
secondary survey within 24 hrs
• Problem list identification
Initial assessment and management
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Synergy model
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Digital Health Care
•แอพพลเคช นเพอการแพทย
•แอพพลเคช นมอถอส าหรบโซลช นเฮลทแคร
•แอพพลเคช นมอถอแบบเรยลไทม
•แอปพลเคช น SmartHealthCare ระบบบนทกและวเคราะหขอมลสขภาพรายบคคล
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Trauma Fast Track
Trauma Patient
ISS
ICD10
Trauma Nurse
Specific knowledge
Trauma Core Competency
Trauma Care
Environment
Trauma Team
Trauma Network
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