Trauma Assessment - Teaching Scenario
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- เผยแพร่เมื่อ 8 ก.ย. 2024
- This video - produced by students at Oxford University Medical School in conjunction with the faculty - demonstrates how to perform the initial assessment of a patient with suspected traumatic injury. This scenario is of an uninjured patient.
All videos on this channel are linked to Oxford Medical Education (www.oxfordmedicaleducation.com)
This video was produced in collaboration with Oxford Medical Illustration - a department of Oxford University Hospitals NHS Trust. For more information, please visit www.oxfordmi.nhs.uk
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Student: "I'm now checking breathing."
Dungeon Master: (rolls D12) "Breathing is normal."
Janeyanna was
im dead that is too funny
LOL
This is a training video. Clearly in practice the speed and order may differ but the structure of this ATLS-based system ensures nothing is missed.
Excellent
Thank you very much for this presentation. I would like to congratulate to the entire team for making such an excellent and complete video based on ATLS principles. I completely disagree with the comment on its outdated practice, as I am an ATLS trained professional and did not find any contradicting move in it. I would recommend this to every one including practicing EM physicians and the one who are preparing for the UK based EM boards.
This video is for a very specific purpose and that seems fairly obvious to me that it is not intended to cover all eventualities from warfare to the tertiary emergency dept. There are clearly circumstances where the ATLS principles need adaptation depending on locality and availability of resources. I am interested in the hostility and chest thumping nature of many of the postings related to this video and would like to commend the professionalism of those replying to the comments made.
Thanks for this, much appreciated and glad you find the videos useful.
Thanks for you comment. At the time of production all videos were scripted in accordance with ATLS guidelines. However, guidelines do adapt slightly over time so these videos may contain minor differences from the current ATLS algorithm.
Thanks for the video. I served 3 tours as a team medic, and have seen my share of field trauma.Unless one has taken the ATLS course, passed both the "hands on portion" of ATLS, the written ATLS test , and have some years experience in a ED trauma setting your expertise as a critic is fundamentally flawed. Again, thank you for the video.
So thankful for this video, i give no criticism. I understand fully. humble.
Thanks very much for this video presentation, especially with the scenario training that Medical students do go through, and should continue to go through, as to always prepare for the real thing when it happens. Excellent training procedure and awareness, job well done. Sincerely Matthew
If you're going to cover something up, such as with a c-collar, check the area FIRST. No matter what ATLS says. Do a quick scan for major bleeding, regardless of what ATLS says. Etc.
Good job ,neck veins very important to describe as it gives alot of informations.
I m also wondering why to order amylase for the trauma patient early
Great video but for some reason it stops playing after 9:30. ??
Medicine is not just a science, it's an art.
If your patient is answering questions he is probably breathing. Look Listen and Feel is not needed for airway.
Thank you very much for doing the video.
The pragmatic ATLS approach is shown.
Thank you again!
Thanks for this video
Karbala medical college ...
great job
Great effort and video series , thx
I like how he is constantly getting permission from the patient to do any work.
you must be from an Asian country
Excellent
brilliant
Excellent educational video.
Circulation.. did you miss listening to the heart sounds in circulation and for exposure no need for abd exam?
every stage i was hoping, ok now he will find what the patient is suffering from! now there will be a twist and he will discover a major life threat...
i wish every patient i wheel into the ER would get this sort of care and treatment.
Spo2 99% why is the patient on 15 litres of 02? Thorough exam but we have forgotten the basics
Spent about 2 minutes putting caller on ...in mean time patient is bleeding out.
thanks
I worked level one trauma as a nurse at leading facilities such as Denver General and Oregon Health Sciences many years. I was going to be a flight nurse. ER medicine around trauma is based on mechanism, and DG coined the "golden hour" of trauma where I trained. I later went on to have the procedure numerous times called ECT or electroshock after a bad reaction to an SSRI anti-depressant. I lost memories of my job training and college education. As a result of repeated traumatic brain injuries secondary to electrical mechanism of trauma I ended up of permanent disability. I know based on my years of experience just as most providers know, that this results in TBI at best. My peers that have had this procedure are evolving in symptoms of CTE and ALS years out from initial injury. I cannot understand the silence of providers knowing of this harm taking place most likely at your facility. My peers I worked with for years and highly respected cover for their peers and facilities vs. recalling their oaths taken to warn, protect, and not cause harm. You in your silence passively condone this, while patients are being harmed. I ask you to have conversations to address this. Law suits are taking place currently on a national level around devices used in this procedure, but the harm continues. Advocate for patients please as this is purely electrical trauma, being passed off as useful to vulnerable and hurting patients. Increase in suicide following this procedure because many cannot find help to address damages. th-cam.com/video/7BaWGCwnxLg/w-d-xo.html
I wonder why he didn't choose a pair of gloves that fit him properly?
It’s sometimes one size fits all
Why do you need to "look listen feal" if he is talking to you?
Because there could still be abnormal breath sounds even if they r talking
Putting on a c-spin colar before B?
Thank you for them!
Nice
Your out of date guys. Also if you stabilise the neck and do the checking of airway at the same time the head and neck...........??
1) airway+ collar
2) oxygent
Do we check for A and B when patient can talk? or we go straight to C?
Hi Hati. 'A' is patent if the patient is talking normally so no need to check further. Always check 'B' though - measuring saturations and auscultating lung fields - as these can still be abnormal if the patient is talking.
why do the student in this video asks the patient to open his mouth even when patient was alert and talking ? Also i d like to know; do we check breathing ( look and feel the chest rise) even if he is talking? is not talking ( say with no concerning sign such as stridor) means A is just fine and we could put the o2 on and move on to B with no further evaluation for A? thanks.
Percussions in A.T.L.S. ?
need some O2 in that bag on the NRB!
hi
dont we put the collar on first and then check the breath sounds?
No, cervical spine injury is secondary to airway patenciy. airway obstruction does kill first rather than spine injury
Just for you guys to know, these procedures are outdated. It's not according to the 2010 AHA/ACC and the last ATLS. So be careful..
Never Secure the head to anything before the body is strapped on !!!!!!!!!!!
No G.C.S. score?
seriously got go through all that to get to the BP and HR?
Too much slow, but this is a demo. Very interesting.
Why oxygenate at the beginning?
Ella Fearless we assume all patients of major trauma to be hypoxic
why run fluids when obs. are normal? O2 continued after Sats. of 99% logical for an Osci perhaps but not good for the patient.
Exactly. Runs a whole bag through each IV!! Just to maintain patency! Must want to do unnecessary procedures and sell unnecessary supplies. He just said the patient is hemodynamically stable, yet runs 2 bags of fluid in!
I think that Mr " Isis Rodriguez" is the most rude and obnoxious person on You Tube. Very sad that we allow people like that to put such comments. He is a shame. I hope this" person" is not a doctor! If so I would scrap it from the medical council instantly.
why does the nurse look angry?
breathing 4:55
It should be fast.. Not slow as shown. We should resuscitate imediately
U clearly have no fucking clue what’s going on
expouser 9:11
circulation 7:14
8:13 disapility
okay grammar Natzi - actually both "practise" and "practice" have the same meaning - look it up. secondly, he does have help and she is just standing there without direction. thirdly, not ungrateful, just frustrated at the lack of skill in this video. 25 years in EMS between SAR, Combat medic and Fire and/or medic capacity, I am pretty sure I know what I am doing. I stand by my assessment and anyone with the same training as me would agree also
Coming from a military back ground I personally think this demo was not up to standard. 1. In the military we go by the pneumonic C-ABC or MARCH in other words check for massive haemorrhage first especially in a patient that has sustained trauma. Absolutely no good what so ever checking C spine, airway etc when the patient could be leaking life blood every where, blood on the floor and 4 more. Secondly why the need to give oxygen? Thirdly why the need to give IVI fluids? If the patient has a good palpable radial pulse, if you give IVI fluids then any clotting going on will be blown! I personally think this training video is out of touch and needs addressed.
Hi Paul, thanks for your comments. As you probably note this video is essentially an ATLS scenario. Though it has its limitations it is still the major algorithm for hospital medical staff. In the military the focus is quite rightly on major haemorrhage as this is common and will kill first (hence C-ABC and the MARCH mnemonic). In civilian medicine immediate life-threatening haemorrhage is less common, hence the ABC approach in ATLS. However, I agree that if a patient was absolutely hosing blood one would assume it would be addressed first. The following paper might be of interest: Ramirez, M. Resident Involvement in Civilian Tactical Emergency Medicine. J Emerg Med. 2010;39(1):49-56.
As to the fluids and oxygen point, here is my previous reply to a similar comment: You're absolutely right, 15L of O2 in a conscious patient with normal saturations is not realistic [nor is the blanket delivery of fluids]. In this scenario it is included purely to make sure students don't forget about it: a surprisingly common omission. Practical oxygen delivery is often a contentious topic but in reality most would only advocate oxygen if there were signs or respiratory distress or saturations under 95%.
Hope this clarifies a few things, thanks for your interest.
Maintenance fluids at least would also keep large bore cannulae patent as rightly highlighted; the patient may also benefit if fasting for imminent surgery if there are further surgical findings in exposure/examination or FAST.
Y can't he call the nurse by her damn damn!
Or NAME.
It's a teaching video. It's just to demonstrate the correct procedure, so that it's clear that he's talking to the nurse
hmmm, doing look, listen and feel on a conscious pt talking to him. 15L o2 without checking pulse ox, maybe ask the pt what happened, where he is and what day of the week is, wastint time immobilizing head without checking for any obvious life threatening injuries, hmmm, now the pulse ox at 3 minutes, probably could get a better look at the back before he immobilized the head, 5:12, rechecking the pt still without asking what happened and not finishing primary assessment. and b/p
ungrateful much? Firstly, in a real ED there wouldn't be just one guy doing everything so things could be done simultaneously, with just one guy this is correct. Secondly, it's practise, "practice" is a noun, what you said doesn't make any sense. that's like me saying I'll chair down on the sofa. Thanks for posting these videos.
Paramedics would have usually already exposed the patient and conducted a full head-to-toe.
I unfortunately couldn't help laughing at the way he said trachea. He made it sound like a car dealership. Like TRA-KIA, idk IKEA, maybe I'm just immature.
Or from the states?
There's a difference?
That's how they say it in the UK
alot of times there is no reason to expose a patients privates,if the patient is talking an knows whats hurting an not.. hospitals get carried away when they expose patients . respect the patients privacy...
Not very good.
6:30 finally asking about external bleeding and checking pelvis and legs, good thing he didn't have a femoral bleed. grips and pushes would have been nice by now, oh, at 8:00 finally doing pupils. 8:38 finally exposing pt, cutting off clothes - I would have been fired if It took me that long to strip and flip. I guess that is why doctors "practice" medicine
thanks