- Introduction
- What is Trauma?
- History
- How Trauma Management Evolves?
- How ATLS Developed?
- Dr Sejal's Principles of Trauma Management
- Dr Sejal's Classification of Trauma Management
- According to Time
- According to Age Group
- According to Severity of Injury
- According to Anatomical Parts
- Goals of Trauma Management
- Act and avoid fear Factor
- Criteria to Face Emergencies
- Pitfall in Trauma Management
- Recent Advances in Trauma Management
Introduction
What is Trauma?
Trauma is unavoidable incident or damage occurring suddenly to living part, that is beyond body's resilience.
In 2010, road trauma ranked 6th as cause of death in world table.
In 2020 it is estimated to be in 3rd place.
Today every one person dies in every six minutes on Indian roads.
By 2020, rate is expected to be more than one in every 3 minutes.
According to the Indian injury report 2010, injury is the 3rd cause of mortality in India.
Perhaps for this reason trauma is moving up the political agenda as one of only four themes in UK government's latest strategy of “Our Healthier Nation”.
High velocity trauma is number one cause of death in 18 to 44 years of age group world wide.
In US, loss of income due to death and disability resulting from high velocity trauma totals more than 75 billions dollar annually-huge economic loss to the government.
Goal of all governmental agencies is to minimize mortality and maximize return in this economically productive segment of population.
Despite of these major economic productive losses, less than 2% of total research budget is given in US.
So, for funding of research in injury prevention and trauma management, legislation must be passed, designed to minimize morbidity and mortality from vehicular accident.
History
History is a bowl of spaghetti, with all the strands being entangled together. Writing about history is like lifting up one strand and trying to find the end without having it to break (Fig. 1.1).
History gives us the opportunity to see the natural evolution of disease.
History of trauma dates back to ancient times in 3500 BC, where surgeons of ancient Egypt dressed wound, performing amputation and removing foreign body.
In the 5th century Hippocrates, the Greeks described fracture, dislocations and wounds.
Modern principles of acute trauma care begins in 20th century.
Today, we are treating disease early and have lost the day-to-day familiarity with its untreated course that physician formerly required.
Transformation to its current form has been achieved by prevention more than by treatment.
How Trauma Management Evolves?
About 500 years ago,
Trauma began in jungles, (Fig. 1.2) our foresfathers with bow and arrow, archery, protected themselves from wild animals, injuries were not much serious, and treated with local herbs and ayurveda techniques, splinting fractures with tree branches.
Later comes an era of wars (Fig. 1.3) with sword, bow and arrow, human being started fighting with each other for survival. During World War I and II come gunshot injuries, which still continue, injuries were crucial, but life saving. Knowledge of first aid, blood transfusion, wound dressing, along with medical and ayurveda came into existence.4
After 1960, (Fig. 1.4) an era of industrial revolution began all over world and machine injuries came into action, these were serious but life saving injuries. Concept of prevention of disability with reconstructive surgeries began and medical revolution of surgery and its tactics also began in this era.
Presently, we are living in era of 21st century where everything is instant, it's an era of automobile (Fig. 1.5), it is not life saving, it is life-threatening injuries. This is the most recent advances in field of medicine with concept of resuscitation, ABC of management.
Thereby ‘Golden Hour’ treatment comes into existence.
Today, car and pedestrian injuries provide most serious trauma in particularly developing countries.
Ironically, Nicholas-Joseph Cugnot (1725–1804), a French army captain, who invented (1770) the first automobile was injured by it.
How Advanced Trauma Life Support (ATLS) Developed?
Advanced trauma life support (ATLS) is trauma management guidelines published by American 6College of Surgeons and provide frame work for the management of injured person.
The ATLS has its origin in the US in 1976, when an orthopedic surgeon, piloting a light aircraft, crashed his plane into a field in Nebraska. His wife was killed instantly and three of his four children received critical injuries.
He was appalled enough at the haphazard treatment of his children, so he was to change the face of trauma cases throughout the world. Various medical, EMS and nursing groups within Nebraska region began a set of protocol for the management of trauma patient, these were then taken up and modified by the American College of Surgeons and published a ATLS in 1980.
Dr Sejal's Principles of Trauma Management
- Timely aggressive involvement of person during ‘golden hour’ of trauma management.
- Definitive protocols of detail management with productive working of trauma care system.
- Accurate assessment, action and management results in early and quick recovery.
- Proper understanding of anatomical and physiological changes in particular trauma results in good outcome.
Dr Sejal's Classification of Trauma Management
Management of trauma begins from event and site itself and it ends till body starts functioning physiologically and anatomically.
Management According to
Time
- Early at site
- Late at tertiary center
- Delayed after twenty-four hours.
Difference in different age group
- Pediatric
- Adult
- Geriatric
Severity of injury
- Life-threatening
- Life-saving
Anatomical parts
- Head, neck, chest, abdomen, limbs….
Goals of Trauma Management
- To save life with minimum disability
- It should be available to each and every injured person at any time and any place.
- Deficiency in resources and organization should be overcome.
- To bring out patient from site with spinal precaution and transport patient immediately to medical center.
- Early fast look over pulse—vitals, bleeding, consciousness, cause of trauma.
- Start treatment with whatever available like stick, pints, and clothes for bleeding, liquids/juices for diabetics.
- Early proper rehabilitation can change the outcome.“Normally there are three stages of illness (trauma)1st – ill2nd – pill3rd – bill and sometimes the 4th stage – willWe don't want this 4th stage in action.”
Act and Avoid Fear Factor
Do's and Don'ts in Trauma Management
Do's | Don'ts |
---|---|
• Be calm | • Do not be panic |
• Act fast | • do not waste time |
• Be strong | • Don't be afraid of medico- legal problems |
• Make fast decision | • Don't dither or wait till doctor or expert arrives |
• Ask for help | • Don't discuss/argue with anybody |
• Help yourself | • Don't wait for help |
• Act it | • Don't react it |
Any situation can worsen by getting panic
- As ones mind gets paralyzed.
- One can take wrong judgment.
- Even a small mistake can convert problem into tragedy.
- At the end, one will lose something (patient/ credit/both).
So,
In trauma to diagnose disease is easy as compared to other branches but to treat and manage patient is very, very difficult. So if you manage trauma properly, there is least chances of morbidity and impairment to many lives.9
90% of traumas are man made trauma, only 10% traumas are uncontrollable nature's gift.
“So trauma evolves from ourselves and treated by ourselves and ends with ourselves”.
So be kind, good, and courageous to your fellow beings and protect God's gift, never overcome it or you have to lose lives and ourselves.
Criteria to Face Emergencies
- You should be mentally, physically fit.
- You should be very sound in your basic knowledge of emergency.
- You should be good and remember your ethics.
- You should be well versed with the procedure and trained properly.
Legislation should be passed to make compulsory study for children in school, adults in colleges, offices, factories, all government institutions as a mandatory functional curriculum for basic trauma management.
Pitfall in Trauma Management
- Lack of knowledge/education of trainee/ person/society
- Lack of infrastructure
- Lack of government support
- Lack of training/educational centers, continuous medical education, and awareness programs.
- Lack of guidance for proper usage of machines, procedures.
- Lack of strict follow-up of laws.
Recent Advances in Trauma Management
- “Damage control” has become standard care to seriously injured patient rather than providing definitive treatment for all of the injured patient.
- One of the goal of resuscitation is identification and control of life-threatening hemorrhage.