Level 1 Trauma Care at CHOP: The First Minutes (2 of 7)

EMERGENCY TRAUMA THREE.>>IT TRIGGERS A SEQUENCE
OF EVENTS THAT’S SORT OF PRE-ARRANGED
AND CHOREOGRAPHED AND INVOLVES THE ALERTING
OF PERSONNEL THROUGHOUT THE ED AND THE HOSPITAL.>>WE’RE ACTIVATING A
WHOLE TEAM OF PEOPLE. WE HAVE A TEAM OF
SURGEONS THAT COME IN. THE EMERGENCY DEPARTMENT HAS
A CORE GROUP OF PHYSICIANS AND NURSES THAT RESPOND
TO THE RESUSCITATION.>>ALL RIGHT, WE’RE GOING
TO ROLL YOU, OKAY, BUDDY? YOU DON’T NEED TO
DO ANYTHING, OKAY?>>AT THE HEAD OF THE BED
IS GOING TO BE THE CRITICAL CARE PHYSICIAN OR ED
PHYSICIAN HELPING MANAGE AND ASSESS THE AIRWAY. AND AT THE SIDE OF THE BED
IS GOING TO BE SOMEBODY WHO’S CALLED A
PRIMARY ASSESSOR, AND THEY’RE GOING TO DO
THE INITIAL EVALUATION OF THE PATIENT, AND
THEY’RE GOING TO RELAY THAT INFORMATION TO THE TEAM.>>LET’S RECAP. WE HAVE A 15-YEAR-OLD MALE WHO
HAS STAB WOUNDS TO HIS LEFT–>>RADIOLOGY IS ON CALL TO
READ X-RAYS IMMEDIATELY.>>TRAUMA DOESN’T
ALWAYS FOLLOW A PATTERN. THERE CAN BE A WIDE VARIETY
OF ASSOCIATED INJURIES THAT YOU HAVE TO SORT
OUT PIECE BY PIECE.>>A CHILD MAY BE CROSSING
A STREET AND GET HIT BY A CAR, AND THEY CAN HAVE INJURIES
TO BASICALLY ANY PART OF THEIR BODY.>>IT’S OFTEN NOT
JUST A SIMPLE FRACTURE. THEIR HEAD CAN BE INJURED. THEIR CHEST CAN BE INJURED. THEY CAN HAVE
INTERNAL ABDOMINAL INJURIES.>>YOU DEAL WITH THE MOST
IMMINENTLY LIFE-THREATENING PROBLEM FIRST, AND
THAT LITERALLY HAPPENS, YOU KNOW, SECOND TO SECOND
WHEN THE CHILD ARRIVES. THAT CRITICAL TIME
PERIOD HAS A LOT TO DO WITH SURVIVAL AND OUTCOMES, AND
THERE’S ALWAYS AN ONGOING DIALOGUE AND COLLECTIVE
DECISION MAKING TO FIGURE OUT WHAT HAS TO
HAPPEN FIRST.>>WE HAVE SOMETHING CALLED
FAMILY PRESENCE IN OUR RESUSCITATION ROOM, SO EVEN
THE MOST INJURED CHILDREN CAN HAVE THEIR
FAMILIES CLOSE BY. SOCIAL WORKERS AND CHILD
LIFE TALK TO THE FAMILIES AND MAKE SURE THAT THE
FAMILIES UNDERSTAND WHAT IS GOING ON.>>I HAVE TO BE ABLE TO
MEET THE FAMILY WHERE THEY ARE AND BE SUPPORTIVE
TO TALK ABOUT THE INJURY, MENTALLY AND PHYSICALLY. THEY NEED TO KNOW
EVERYTHING THAT IS GOING ON, AND WE NEED THEM
TO TALK TO US. SO THEY PLAY AN
INTEGRAL PART.>>AND IN MANY CASES,
THEY CAN ACTUALLY PROVIDE US INFORMATION THAT
HELPS WITH THEIR CARE, OR THEY CAN
COMFORT THE CHILD.

Written by Valentin Lakin

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