Surviving the Crash: The Fourth E€¦ · Surviving the Crash: The Fourth E Well, not so much this...

Surviving the Crash: The Fourth E

Well, not so much this one, but the next.

Leading Causes of Death in Minnesota

Heart Disease 29%

Cancer 33%

Injury 9%

Stroke 9%

Chronic Lower Repiratory Disease

7%

Alzheimer's 4%

Diabetes 4%

Influenza & Pneumonia

3%

Kidney Disease 2%

Source: MDH Injury and Violence Prevention Unit

Designation Levels

1 adult & ped.

Definitive care for all trauma patients

2 adult & ped.

Definitive care for most patients

3 Definitive care for some;

most major trauma stabilized and transferred

4 Major trauma stabilized

and transferred

Crash Mortality

Source: Nathens, et al; JAMA 2000.

Tri-modal Death Distribution

Massive brain injury High spinal cord injury Major vessel disruption

Remedy: Injury prevention

1st Peak

Tri-modal Death Distribution 2nd Peak

Brain injury Major chest injury Massive blood loss Ruptured spleen/liver Fractured pelvis

Remedy: Rapid recognition,

Immediate care

Tri-modal Death Distribution 3rd Peak

Infection Organ failure

Remedy: Effective system of care

Performance Improvement

Case Identification Chart audit, PI committee, rounds, staff report ,

patient complaint, observation

Filters fall out? Process concern?

Care concern?

Tertiary Review Provider case review

Secondary Review TPM + TMD + others?

Trauma Program Team

Tertiary Review Multidisciplinary

Process concern? Care concern?

Primary Review TPM

Develop an action plan. Define loop closure.

Performance Standards

05,000,000

10,000,00015,000,00020,000,00025,000,00030,000,00035,000,00040,000,00045,000,000

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Hours Flown

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Accident Rate

Source: Aircraft Owners and Pilots Association

• T-bone crash • 2 vehicles

• Vehicle #1: 3 injured • Vehicle #2: Fatal

• 22 year old female • Belted driver

• Estimated 40 mph

Observations & Assessment

• Alert, anxious • Short of breath,

painful respirations • R side chest pain

• R lung sounds diminished

• Belly soft, diffusely tender

BLOOD PRESSURE (mm/Hg) SpO2%

142/88 96

HEART RATE RESPIRATIONS

126 20

Treatments

• IVs, O2

• Collar, spine board • Code 3 to local level 4 trauma center

At the local trauma center…

• Anxious • Pale, sweaty • Short of breath

• Trauma Team Activation • Warm • Blood draw • X-rays

BLOOD PRESSURE (mm/Hg) SpO2%

142/88 96

HEART RATE RESPIRATIONS

126 20

BLOOD PRESSURE (mm/Hg) SpO2%

112/78 98

HEART RATE RESPIRATIONS

136 24

BLOOD PRESSURE (mm/Hg) SpO2%

142/88 96

HEART RATE RESPIRATIONS

126 20

BLOOD PRESSURE (mm/Hg) SpO2%

96/68 89

HEART RATE RESPIRATIONS

142 28

BLOOD PRESSURE (mm/Hg) SpO2%

112/78 98

HEART RATE RESPIRATIONS

136 24

Remedy: Rapid recognition, Immediate care

You are Here

BLOOD PRESSURE (mm/Hg) SpO2%

142/88 96

HEART RATE RESPIRATIONS

126 20

BLOOD PRESSURE (mm/Hg) SpO2%

96/68 89

HEART RATE RESPIRATIONS

142 28

BLOOD PRESSURE (mm/Hg) SpO2%

112/78 98

HEART RATE RESPIRATIONS

136 24 BLOOD PRESSURE (mm/Hg) SpO2%

108/78 94

HEART RATE RESPIRATIONS

110 20

• Air-lifted to level 1 trauma center

• Discharged home after 5 days

Performance Improvement

Review the care

Review the crash

Source: National Highway Traffic Safety Administration