IN HOSPITAL CARE-

TRAUMA RECEPTION AND

RESUSCITATION

Dr. V RAJESH
Casualty Medical Officer
Hospital Coordinator TAEI
RGGGH
1864
 State Trauma Surveillance Centre
Level 1 Trauma Care Centres
RGGGH-Highly Specialised Hospital/Super Specialties
and All Trauma Care services 24 X 7
Level 2 Trauma Care Centres
MC Hospitals/ 300 500 beds/ED,ICU, blood bank etc.
Level 3 Trauma Care Centres
District and Taluk Hospitals/100 200 beds/limited facilities
Emergency Stabilization Centres at CHC/ SDHs on
Highways 2 ICU beds and 1- IP bed

Level 4 Pre Hospital Care in 108 Ambulances

 Premier Tertiary care referral centre with 3500 beds.

8 ICUs with 90 beds in medical and 110 beds in surgical related ICUs

ED : Casualty, Trauma Ward, Orthopedic and Medical Emergencies.

90 Beds in the respective Emergency Departments combined.

Round the clock availability of specialists and super-specialists.

24 hours Laboratory services, X-Ray, CT and MRI imaging.

Well equipped Emergency Theatre Complex with 6 tables and facilities to

carry out any major life saving procedure.

 Average Daily Census in Casualty

S. No No. Of Cases

Trauma
Trauma 70

Non Trauma

Non Trauma 180

Total 250
 Trauma Related Cases

S. No No. Of Cases

RTA 30

Fall 25

Assault 12
RTA

TTA 1 Assault

TTA

Death 2 Fall
 Chennai - RTA Hospital Admission - Month Average
600

500 487
No of Admissions

427
400

300 Total Admissions

255
230 IFT Admissions
197
200

100 67
32 36
22 12
0
CHN001 CENTRAL CHN003 STANLEY CHN002 KILPAUK CHN004 CHINNA STANLEY
CHN001CHENNAI
GH MCH MCH ROYAPETTAH GH GH
RGGGH
Hospital Name
RTA Death - Age wise distribution

Avg per year Per 100 Fatalities

666 84 5 1
5% 0%
18 - 27 5% 1%
1904 18 - 27
14% 3591 28 - 37 14 26
26%
28 - 37
14% 26%
38 - 47 38 - 47
3306 24 48 - 57
48 - 57
24%
4215 24% 31 58 - 67
31% 58 - 67 30%
68 - 70
68 - 70
 TAEI ER Model
Standard Emergency room, streamlined workflow
mechanism in the trauma care facility with :

A System of Triage

Color coding in ER (RED, YELLOW, GREEN)

Advanced Trauma Life Support (ATLS) Protocols

Proper coordination with Multi Disciplinary Teams at

Hospital levels

Appropriate linkage with 108 Ambulance Services

 Three Tier Triage System:

Priority 1: Immediate care needed

Airway, breathing and circulation compromised.

Colour code RED

Priority 2: Urgent or intermediate care needed

Potentially unstable patients.

Colour code YELLOW

Priority 3: Delayed care

Needs treatment, but can be safely delayed.

Colour code GREEN

 Stage Description

1 Reception in Casualty Triage/Quick History

2 Primary Survey Check ABCDE

3 Resuscitation Manage ABCDE (ATLS protocol)

4 Registry AR Entry/MLC

5 Secondary survey Detailed History & examination

6 Investigations Imaging & blood investigations

7 Specialist opinion Opinion and management

8 Monitoring & re-evaluation Continuous post resuscitation monitoring and

evaluation
ATLS Protocol

Primary Survey
1. Airway Maintenance with Inline Cervical Spine
Stabilization
2. Breathing and Ventilation
3. Circulation with Hemorrhage Control
4. Disability/Neurological Assessment
5. Exposure and Environmental Control

Secondary Survey
1. Detailed History
2. Head to Toe Evaluation/Complete Physical Examination
3. Reassessment of Vitals
RGGGH Casualty
Trauma Ward
Supporting
Institutes
 IMAGING SERVICES

24 X 7 digital x-ray unit

24 X 7 CT unit

MRI Scanning

FAST/Bedside Ultrasound
CT Console

X Ray Console
DAMAGE CONTROL
Traumas Lethal Triad
Blood Transfusion/Massive Transfusion
Protocols

Damage Control Surgery/Resuscitation

 Massive Blood Transfusion
More than 10 units of Packed Red Blood Cells
in 24 hours
More than 50% of blood volume within 3
hours
Patients entire blood volume over 24 hour
period
More than 4 units of RBCs in 4 hours
Single transfusion more than 2500 to 5000 ml
over a period of 24 hours
 When to Initiate
Blood Pressure <90 mm/Hg
Heart rate >120 bpm
Hemoglobin <11 gm/dl
INR >1.5
pH <7.25/Base deficit >6
Temperature below 34 degree celcius
 COMPONENTS
FFP/Cryoprecipitate, Packed Cells and Platelets
in the ratio of 1:1:1 or 2:1:1

Recombinant VIIA

Tranexamic acid
 Limitations
No Standardized Protocols

When to initiate

Ratio of Blood products to be used

Wastage of blood products

RGGGH Blood Bank
 DAMAGE CONTROL
SURGERY/RESUSCITATION
Aim is to maintain Homeostasis following
severe hemorrhage

Prioritize Physiological Recovery over

Anatomical Reconstruction

Multi-disciplinary team approach

 DC 0 : Pre-hospital and Early Resuscitation

DC 1 : Initial Laprotomy
Hemorrhage control
Contamination control
Temporary Packing
Temporary Closure

DC 2 :Critical care/ICU resuscitation

Core rewarming
Reversal of Coagulopathy
Reversal of Acidosis
Ventilatory Suport

DC 3 : Definitive Reconstruction
 EMERGENCY OT

5 major cases are

operated on an
average

Six tables with the

facility and
equipment to carry
out any major life
saving procedure
including
Amputations,
Splenectomy, Bowel
resection/
anastomosis,
Neurosurgeries etc.
 Five Point Agenda

1. Trauma Registry Development and Maintenance

2. Pre Hospital Notification

3. Trauma Reception and Resuscitation (TR&R) System

4. Trauma Care Quality Improvement

5. Rehabilitation After Discharge

Thank You