Day 1 :
Keck medical school USC(University of Southern California), USA
Keynote: Trauma Team Dynamics
Time : 10:00-10:40 AM
Dimitrios Karakitsos is an Associate Professor in Medicine at University of South Carolina, School of Medicine and an Adjunct Associate Professor in Critical Care at Keck Medical School, University of Southern California. He is an international, well-published expert and Researcher in “Critical care ultrasound and crisis resource management in trauma”. Currently, he is also affiliated to the Trauma Center of King Saud Medical City (KSMC) in the Kingdom of Saudi Arabia.
Background: In trauma care, teams of experts are using modern technology and techniques to secure life and limb, conserve organs in acute peril and manage chronic complications. Trauma care also requires the coordination of individuals with different biases, priorities, personalities, skill sets and timelines. Although the American College of Surgeons’ Advanced Trauma Life Support (ATLS) course has been the backbone of trauma care, it focuses on the sole practitioner, rather than how we function in larger teams and complex situations.
Methods: In 1977, a large aviation disaster has led NASA to the development of crew resource management training. These ideas have been adapted to medicine and resulted in crisis resource management (CRM) training. Human errors in medicine are estimated to contribute to approximately 100,000 annual deaths in the United States alone. Simulation trauma team training typically encompasses five keys areas: communication, leadership and followership, resource utilization, problem solving and situational awareness. While even routine civilian trauma can be challenging, add to this the potential for natural disasters, terrorist attacks, and other such fluid environments and CRM training becomes imperative. Finally, CRM logistics have led to the development of temporary constructs such as Emerging Multi-Organizational Networks (EMON) which consist of task-oriented and mission specific collaborations of individuals and resources.
Conclusions: The addition of CRM skills to modern trauma care is of growing interest. Whether the former may improve team performance, team empathy and patient outcomes is an area of on-going research.
Laval University in Quebec City, Canada
Time : 11:00-11:40 AM
Lynne Moore is an Associate Professor of Epidemiology and Biostatistics in Department of Social and Preventative Medicine at Laval University in Québec City. She is recipient of a Research Career award and has published 140 peer-reviewed papers over her research career. Her research interests include “Improving the quality of acute injury care”. She has led the development, validation, implementation and evaluation of a comprehensive quality tool assessment for acute injury care which has been implemented across Canada. She is Co-leader of International Injury Care Improvement Initiative.
Statement of the Problem: In response to evidence of variation in patient outcomes across providers and growing financial pressures, healthcare authorities in high-income countries have emphasized the urgent need to develop tools to monitor quality of care.
Aim: Aim of this study is to develop Canadian benchmarks to monitor mortality and hospital length of stay (LOS) for injury admissions.
Method: Benchmarks were derived from data from the Canadian National Trauma Registry on patients with major trauma admitted to any level I or II trauma center in Canada and the following patient subgroups: isolated traumatic brain injury (TBI), isolated thoracoabdominal injury, multisystem blunt injury, aged ≥65 years. Predictive validity was assessed using measures of discrimination and calibration. Extensive sensitivity analyses were performed to assess the impact of replacing analytically complex methods (multiple imputation, shrinkage estimates and flexible modelling) with simple models that can be implemented locally.
Results: The mortality risk adjustment model had excellent discrimination and calibration (area under the receiver operating characteristic curve=0.883; Hosmer-Lemeshow=122). The LOS risk-adjustment model predicted 31% of the variation in LOS. Overall, observed-to-expected ratios of mortality and mean LOS generated by an analytically simple model were highly correlated to those generated by analytically complex models (r>0.95; kappa on outliers>0.90).
Conclusion & Significance: We propose Canadian benchmarks that can be used to monitor quality of care in Canadian trauma centers using a simple Excel program (provided) that can be implemented using local trauma registries. We observed significant variation in mortality and LOS across Canadian trauma centers indicating room for improvement in the quality of acute care for Canadian injury admissions.
University of Medicine and Pharmacy at HCM city, Vietnam
Keynote: Direct Traumatic Carotid Cavernous Fistula: Angiographic Classification and Treatment Strategies. Study of 172 Cases
Time : 11:40-12:20
Cuong Tran Chi is a Medical Director of Stroke International Services System, Vietnam. He is the President of Interventional Neuroradiology Society of HCM city, Vietnam and Senior Consultant of Interventional Neuroradiology of Vietnam. He has been a member of World Federation of Interventional and Therapeutic Neuroradiology (WFITN) since 2007. He has performed more than 2000 Neuro-interventional procedures including: Carotid cavernous fistula, intracranial and spinal dural fistula, and treatment aneurysm by coiling, treatment AVM, carotid stenting and intracranial stenting, flow-diverter stenting, percutaneous vertebroplasty.
Objectives: We report our experience in treatment of traumatic direct carotid cavernous fistula (CCF) via endovascular intervention. We hereof recommend an additional classification system for type A CCF and suggest respective treatment strategies.
Methodology: Only type A CCF patients (Barrow’s classification) would be recruited for the study. Based on the angiographic characteristics of the CCF, we classified type A CCF into three subtypes including small size, medium size and large size fistula depending on whether there was presence of the anterior carotid artery (ACA) and/or middle carotid artery (MCA). Angiograms with opacification of both ACA and MCA were categorized as small size fistula. Angiograms with opacification of either ACA or MCA were categorized as medium size fistula and those without opacification of neither ACA nor MCA were classified as large size fistula. After the confirm angiogram, endovascular embolization would be performed impromptu using detachable balloon, coils or both. All cases were followed up for complication and effect after the embolization.
Results: A total of 172 direct traumatic CCF patients were enrolled. The small size fistula was accountant for 12.8% (22 cases), medium size 35.5% (61 cases) and large size fistula accountant for 51.7% (89 cases). The successful rate of fistula occlusion under endovascular embolization was 94% with preservation of the carotid artery in 70%. For the treatment of each subtype, a total of 21/22 cases of the small size fistulas were successfully treated using coils alone. The other single case of small fistula was defaulted. Most of the medium and large size fistulas were cured using detachable balloons. When the fistula sealing could not be obtained using detachable balloon, coils were added to affirm the embolization of the cavernous sinus via venous access. There were about 2.9% of patient experienced direct carotid artery puncture and 0.6% puncture after carotid artery cut-down exposure. About 30% of cases experienced sacrifice of the parent vessels and it was associated with sizes of the fistula. Total severe complication was about 2.4% which included one death (0.6%) due to vagal shock; one transient hemiparesis post-sacrifice occlusion of the carotid artery but the patient had recovered after three months; one acute thrombus embolism and the patient was completely saved with recombinant tissue plasminogen activator (rTPA); one balloon dislodgement then got stuck at the anterior communicating artery but the patient was asymptomatic.
Conclusion: Endovascular intervention as the treatment of direct traumatic CCF had high cure rate and low complication with its ability to preserve the carotid artery. It also can supply flexible accesses to the fistulous site with various alternative embolic materials. The new classification of type A CCF based on angiographic features was helpful for planning for the embolization. Coil should be considered as the first embolic material for small size fistula meanwhile detachable balloons was suggested as the first-choice embolic agent for the medium and large size fistula.
Hamad Medical Corporation, Qatar
Keynote: Sequential trauma education programs (STEPS):The experience of advanced trauma care education in low and middle income countries
Time : 12:20-13:00
Mohamed E Abbasy is currently working as an Emergency Medicine Clinical Fellow at Hamad Medical Corporation, Qatar. He successfully completed his Injury Prevention Research and Training Program at University of Maryland, School of Medicine, Maryland, USA. He has attended R Adams Shock Trauma Center, University of Maryland, School of Medicine, Maryland in 2008. He completed his training in Emergency Medicine and successfully awarded the fellowship of Egyptian Board of Emergency Medicine in 2009. He has a good experience of working in Gulf region and worked as an Assistant Program Director of Saudi Board of Emergency Medicine in Eastern region, KSA in 2013. He successfully passed his membership examination of Royal College of Emergency Medicine UK in 2014 and European Board of Emergency Medicine in 2016. His research interest includes Critical Care, Trauma and Emergency Ultrasound.
- Trauma Care
Trauma in Nursing & Midwifery
Critical Care in Trauma
Teleflex Medical UK Ltd, UK
Tim Collins has 20 years of experience in Critical Care. He holds the position of Consultant Nurse, Lead Nurse, Charge Nurse, ICU Educator and Senior Lecturer. He is currently a British Association of Critical Care Nurses (BACCN) elected national board member and Editorial Board Member of Nursing in Critical Care Journal (Wiley). He has given a number of presentations at European & international conferences and has published a number of papers in peer reviewed journals and book chapters. He completed his Doctorate Degree and MSc in Critical Care. He is an Instructor in both Adult and Pediatric Advanced Life Support. His interests include Sepsis, Clinical Shock, Vascular Access, Resuscitation, Organ Donation and Hemodynamic monitoring.
Target Participants: This will be applicable to all emergency and critical care providers.
Contents of Workshop:
Anatomy and physiology relating to nasal absorption.Evaluation of the literature relating to nasal atomization.How nasal absorption of medications works; appraisal on the benefits and limitations of the nasal medication route.Bioavailability of medications and the significance of first pass metabolism.Practical demonstration for achieving best practice techniques for nasal atomization; application of theory to a practical demonstration using nasal atomization and an interactive quiz to facilitate discussion, reflection and learning relating to nasal atomization.
Participant Involvement: This workshop will provide attendees with the theory and practical application relating to intra-nasal atomization. Demonstration and application of best practice nasal atomization techniques will be simulated. Attendees will be able to practice nasal atomization techniques and apply theory to clinical practice. The workshop will provide opportunity for attendees to reflect upon nasal atomization and provide facilitated discussion within a supportive environment. An interactive nasal atomization case study relating to the use of atomization will be simulated and an attendee quiz will facilitate discussion and reflection among participants.
Flow of Workshop: Visual power point slides evaluating the theory of nasal absorption. Visual power point slides relating to anatomy and physiology and evidence based atomisation.A video demonstrating nasal atomisation theory.Critique of the benefits and limitations of nasal atomisation.Demonstration of best practice techniques for achieving effective nasal atomisation.Participants having the opportunity to demonstrate nasal atomisation techniques. Application of nasal atomisation for a patient requiring topical anaesthesia following an acute cerebral event.Interactive quiz with facilitated group discussion and reflection.
Intended learning outcome:
This practical workshop aims to provide an overview of the theory relating to nasal atomisation and provide emergency providers with the opportunity to demonstrate best practice nasal atomisation techniques that can be applied to clinical practice.
Institute of Medical Sciences, BHU, India
Time : 14:40-15:10
Background: - Multiple factors have been implicated by various workers around the world to predict the outcome in the patients of polytrauma. A numbers of trauma scoring systems also prevail. We conducted a study in a tertiary level trauma centre so as to find out various factors and formulate a clinical scoring system which can be used as a tool for exact prediction of outcome of trauma patients in terms of mortality and morbidity.
Material and methods:-A prospective study was done at Trauma Centre, Institute of Medical Sciences, BHU. Five hundred trauma patients were enrolled in the study depending upon inclusion and excluding criteria. The patients were assessed clinically and management started as per protocol. HR, RR, SBP, MBP, GCS, AIS, delay in arrival, mode of trauma was recorded. A clinical scoring system based on organ systems injured and severity of injury was used for scoring. Further the management done, course during hospital stay, complications and final outcome were also recorded. Final correlation and analysis was done.
Result and discussion: - It was found that patients those who met with high velocity trauma and associated with head injury have high mortality rate. Mortality has also been more when head injury was associated with chest trauma. Spine trauma was found to be associated with high morbidity in form of para or quadriparesis. Patient having associated extremity fracture along and degloving injuries have prolonged hospital stay.
Conclusion:- In polytrauma patients various physiological, anatomical, biochemical parameters are important to predict the outcome of trauma patients. The scoring system used was also validated and found rational and useful.
King Saud University Medical City, Kingdom of Saudi Arabia
Title: Helical and retrograde aortic flow in the early phase of septic shock educed by multiphase non-Newtonian hemodynamic simulations
Time : 15:10-15:40
Aim: We studied whether any aortic flow changes could be observed in the early stage of septic (warm) shock.
Patients and Methods: Computed tomography data and image reconstruction software packages to analyze patient-specific aortic flow patterns based on computational fluid dynamics models (non-Newtonian Navier-Stokes equations) were used. Boundary conditions were extracted from hemodynamic monitoring of trauma patients. Ten stable trauma patients [35 ± 9.9 years of age, 6 males, injury severity score (ISS) 26 ± 3.9] served as controls. Ten trauma septic patients [37 ± 8.7 years of age, 5 males, ISS 27 ± 4.2] were studied. Hemodynamic monitoring was performed using a pulmonary artery catheter.
Results: In warm shock, the model depicted: 1. increased asymmetry of the three-dimensional aortic vortex (Dean number increased 77%), 2. reduction of secondary flow in the peripheral blood vessels (Reynolds number increased 78%), 3. Increased aortic wall shear stress; while no pathology in aortic flow geometry was documented (Womersley number unchanged).
Conclusion: In warm shock, a severely distorted aortic vortex may be responsible for reduction of secondary flow to peripheral arteries and increased aortic wall shear stress.
St Mary’s Hospital, UK
Time : 16:00-16:30
Urologists are not typically considered part of the emergency trauma team. These old connotations continue to fade; with increasing importance on the input of reconstructive urology in individuals with abdominal and pelvic trauma.
Novel therapies in the management of renal trauma are considered; with focus on the acute control of hemorrhage with view to preservation surgery as opposed to emergency total nephrectomy. We review modern imaging techniques which are increasingly used as diagnostic adjuncts and important therapeutic devices, with an increasingly important role for urologists alongside interventional radiology.
Bladder trauma remains poorly understood; we explore the varied opinion of experts when considering conservative and invasive management of traumatic bladder perforation.
Urethral and ureteric trauma can propagate to complex sequelae in patients beyond the immediate management stage. We review the importance of isolating areas of tubular damage and instigating appropriate management to restore urinary flow and act as a prophylactic agent against future complications.
Urology remains at the forefront of technological advancement; and as such, has a pivotal role in the maintenance of the current best standard of trauma management.
Alexandria University, Egypt