Dr. Mayur Narayan is a trauma intensivist who has a special interest in the development of trauma systems, especially in underdeveloped countries. Â In this talk Dr. Narayan discusses the challenges to developing an efficient trauma system, the basics to trauma care, and some of the recent advancements in taking care of the critically injured patient.
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Pearls
- Does it matter if non-trauma surgeons manage Trauma ICU patients? Â NO! Â There have been no proven difference in survival to discharge or better outcomes.
- ATLS still teaches ABCs as an initial approach to the trauma patient, but for the patient in hemorrhagic shock – START with circulation!
- When to transfer a sick trauma patient? Â ASAP. Â A common pitfall is waiting until after diagnostic tests (specifically CT scans) Â to transfer a sick patient.
- You can only prevent secondary neurologic injury by avoiding hypotension and hypoxia. Â In the patient with hemorrhagic shock, address the cause of hypotension FIRST. Â Remember the 5 compartments:
Suggested Reading
- ATLS Subcommittee; American College of Surgeons’ Committee on Trauma; International ATLS working group. Advanced trauma life support (ATLS®): the ninth edition. J Trauma Acute Care Surg. 2013 May;74(5):1363-6.
- Shere-Wolfe RF, Galvagno SM Jr, Grissom TE. Critical care considerations in the management of the trauma patient following initial resuscitation. Scand J Trauma Resusc Emerg Med. 2012 Sep 18;20:68.
- Ahmed JM, Tallon JM, Petrie DA. Trauma management outcomes associated with nonsurgeon versus surgeon trauma team leaders. Ann Emerg Med. 2007 Jul; 50(1):7-12, 12.e1. Epub 2006 Nov 15.
