Volume 1 Issue 2 February\ 1996
Contents:
- Provide an overview of trauma developments in South Western Sydney
- Review interesting cases each month
- Identify challenges and opportunities for improvement
- Maintain an update on the latest in trauma from around the world
INTRODUCTION
Dr. David Sloane has retired as Director of Trauma Services at Liverpool
Hospital, five years after establishing one of Australia's first standalone
Trauma Services. Dr. Sloane established many firsts, including a multidisciplanary
trauma team and a computerised trauma registry in 1991. His commitment and
foresight will be missed and we hope that the department will build on its
strong foundation. James Boyden has left the Trauma Fellow position and
joined ICU. James will be missed, having developed strong links within the
area, in education and hospital feedback.
I have joined the Trauma Department as Director in February and look forward
to providing a comprehensive service for patients and providors of trauma
care in the South West. The concept of an Area-wide focus on trauma care
will continue and to help in its achievement your ideas and suggstions would
be very welcome.
Michael Sugrue
Click here to find out who's who in the Trauma department.
TRAUMA EDUCATION
Over the next 12 months we will expand our trauma education program. At
present we have the following events planned:
-- Trauma Audit 07:30 Every Thursday (sharp)
Conference Room, Level One, SWAPS Building
-- Trauma Education Sessions February 20 and 27th
12:30-12:45 Emergency Conference Room.
These meetings are open to all trauma care providors in South West Sydney.
We would welcome your potential input in choosing cases for the trauma audit
meeting. In addition an Area-wide trauma education programme will continue
with visits to urban and rural hospitals in the area. We start 1996's programme
with a visit to Bowral on April 12th.
Maria Seger is currently canvassing for nursing topics, which will be dealt
with in the next six months.
Ambulance Education evenings will continue and the next will take place
in August this year.
MEETINGS
SWAN IV
SWAN IV will take place on November 8 th and this year will feature
three overseas speakers:
Dr. Ken Boffard Director of Trauma, Johannesburg Trauma Service,
South Africa.
Carol Shagoury Trauma Co-ordinator, San Franscisco General Hospital,
USA.
Dr. Tim Hodgetts Emergency Consultant, British Army Aldershot UK.
The program will be as exhausting and exciting as ever, with the emphasis
this year on penetrating trauma and pelvic fractures. Keep an eye out for
the registration form and full program.
DEFINITIVE SURGICAL TRAUMA CARE COURSE (DSTC)
This course on the definitive care and surgery of complex traum, will run
for the first time in Australia in May. The course will be run by Professor
Stephen Deane (of Liverpool Hospital) with a local and overseas faculty.
Guest overseas faculty include Don Trunkey, Howard Champion (leading
US traumatologist) and Abe Fingehut. This is one of the most exciting
courses to be piloted since the introduction of EMST in 1987.
Further information about the meeting, which will be run with the support
of the RACS, can be obtained from Professor Stephen Deane or myself.
The Department of Trauma at Liverpool has over the last few years run a
2 day rural trauma course in Alice Springs (Northern Territory) and this
year we plan to pilot a major restructured course with input from Dr. Tim
Hodgetts and Sabrina Knight (remote Nurses Council) on November
10th and 11th.
ROYAL AUSTRALASIAN COLLEGE OF SURGEONS ANNUAL SCIENTIFIC CONGRESS -
MAY 1996 - MELBOURNE
This year Professor Stephen Deane of Liverpool Hospital has been
honoured as the foundation speaker in Trauma at the College Meeting, recognising
his tremendous contribution to trauma care over the last 15 years.
If you feel that a trauma patient may need an intensive care bed at Liverpool,
ring the trauma hotline number:
(02) 828 3666
and the ICU registrar will organise an interhospital trauma transfer should
one be required. This is preferable to ringing the Emergency or Surgical
Registrar.
Los Angeles
Ortega and colleagues in a study of penetrating abdominal trauma have found
that the diagnostic laparoscopy may be useful in reducing the negative laparotomy
rate fo abdominal stab wounds.
Laparoscopy was used in abominal stabbing to determine if peritoneal penetration
had occured in patients who were haemodynamically stable. They found that
21% of these stab patients had no penetration and so did not require a laparotomy.
Laparoscopy also had the advantage of clearly visualising the diaphragm.
Ortega emphasised that care must be taken to avoid a pneumothorax during
laparoscopy and a pre-laparoscopy chest drain insertion may be required
if the stab wound could have transversed the diaghragm.
Surg Endosc 1996 10; 19 - 22
TRAUMA X-RAY LIBRARY
We are delighted to welcome Dr. Ulvi Budak as Trauma Associate to the Trauma
Department. Ulvi is developing a comprehensive trauma fracture library with
the help of Glen Burt and Dr. Richard Bell (Radiology).
CASE OF THE MONTH
At 09:34 on the 12 February, a car hit a pole, trapping a 23 year old driver.
The patient was trapped for 50 minutes.
At The Scene
The ambulance officers and paramedics applied a hard collar, administered
Oxygen at 14L/min, placed a 16 G IV line and gave 300mls of Hartmans solution.
10mg of Morphine was also given IV for analgesia.
A Intact.
B Tachypnoea (RR 20/min), 96% saturated, decreased air entry left base.
C Pale, Tachycardic (P 120), Normotensive (SBP 120), Good Capillary Return.
Emergency Room
10:46
Primary Survey
A Intact
B Tacypnoea (RR 22/min), 99% saturated, Trachea central, decreased air entry
left chest.
C Tachycardic (P 115), Normotensive (SBP 120).
What would you do? Chest drain or CXR first? CXR or CspineXR first?
11:00
Progress
2 IV's in place, bloods obtained, 1200mls of haemaccel administered
Xrays taken and the secondary survey (with the exception of the log roll)
was complete:
CspineXray was normal
CXR revealed a left sided pneumothorax, # Right Clavicle, and # Left 2nd
Rib.
11:06
Left chest drain inserted
11:25
Repeat Primary survey
A Intact
B Improved air entry both sides
C Tachycardic (P120), Normotensive (SBP 115), cold peripheries, poor capillary
filling
after 2500mls of haemaccel and 300mls of pre-hopital fluid.
Is this patient haemodynamically stable?
Repeat Secondary Survey revealed markedupper abdominal tenderness. A urinary
catheter is in place.
How would you progress from here?
The outcome of the case and a discussion will take place in next month's
Trauma Grapevine.
During the year we will present to you some real scenarios which have occurred
in South Western Sydney and provide a critique of care for your benefit.
I hope you enjoyed the first edition and if you wish to write (or fax) to
the trauma Department with your comments, observations, or letters please
do so. Copyright 1996 Trauma Department, Liverpool Hospital, Elizabeth
Street, Liverpool 2170 .
Fax (02) 828 5305
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