Simulation #1 Trauma Massive Hemorrhage Protocol
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- Опубликовано: 31 июл 2024
- Sponsored by the Ontario Regional Blood Coordinating Network, MHP Education Working Group and MHP Steering Committee Members: Andrew Petrosoniak, Katerina Pavenski and Jeannie Callum.
Learning Objectives:
1. Demonstrate safe and proficient management of an adult patient with injury and significant bleeding.
2. Recognize need for massive hemorrhage protocol (MHP) and demonstrate ability to activate an institutional protocol.
3. Achieve high performance in situational awareness, teamwork and communication in a simulated setting.
4. Identify areas of improvement and develop a plan.
Link to MHP supporting materials: transfusionontario.org/en/cat...
Link to process improvement / feedback evaluation:
urldefense.com/v3/__https:/or...
Checkout our latest whiteboard style video on Blood Transfusion => ruclips.net/video/mZfzdNUA3kw/видео.html
As a phlebotomist for a blood center, it’s crazy to see just how quickly those units can be used up. Really makes every collection we do feel even more important now
As an EMT student it's great to understand what happens after patient is handed over. Thanks so much for sharing this :)
When I did my EMT-B schooling last year, the ER was honestly my favorite experience. I got to hang out in trauma as well as just the general ER. Those ER trauma doctors are some amazing and intellectual people and its fantastic to hear them control the patient and the room just through verbalization.
Just remember as an emt bleeding control and airway management is your bread and butter
As a ten tear EMT in multiple environments remember your ABC-CAB, in high stress situations don’t over complicate what we’re ultimately trying to do, “air goes in and out, blood goes round and round”. The best advice I could give any new tech is “slow is smooth, smooth is fast”. Good luck and I wish you a long and happy career.
does that ever make you wish you were an em doc?
As a non-medical professional who just likes medical stuff this was SUPER cool to watch. Everyone worked so well together.
It’s a little more chaotic in a real trauma 😅
This was great to watch even as someone who works at an urban level 1 trauma center in the US. Briefing/establishing priorities before the trauma arrives is something we could add, we typically wait for EMS arrival to give report and then formulate a plan as we’re establishing IV access if not present and obtaining vitals. Finger thoracotomy before chest tube placement is also different. We usually move straight to chest tube placement. This was done flawlessly. The only thing I would add is maybe have some O negative present before the patient arrives. Whenever we know we have a massive hemorrhage arriving, we call the blood bank and send someone to get that asap. 7 mins before blood products arrived seems a bit delayed. Overall, excellent job! Learned a lot!
People who do this for a living are amazing, real life hero’s 💕 . I would personally have a panic attack and pass out, even with a dummy lol. Great job guys!! 👏
I can’t wait to be a doctor. Currently a undergrad studying Medical Biology and watching this makes me excited to go to med school and become a doctor.
I’m currently training to work in the lab at a hospital. It’s cool to see how labs and the work that blood bank does is so important to saving lives even in a trama situation.
As an experienced (3 decades) trauma blood banker, we have those units in the room before the patient even arrives. They are uncrossed emergency release at that time. We notify the trauma team when we have the type and screen completed.
As a RUclipsr watcher, this was great to watch!
Thank you for watching! Checkout our other MHP simulation videos!
Simulation #2 GI Bleed Massive Hemorrhage Protocol => ruclips.net/video/ya6YG6ZrE28/видео.html
Simulation #3 Pediatric Massive Hemorrhage Protocol: activation in a community hospital setting => ruclips.net/video/2PlDW0weySE/видео.html
This was great! I need more of these videos
i was a trauma stepdown RN at a level 1 trauma center in flatbush, brooklyn. it was nuts and a lot and i LOVED IT but my goal is to be in critical care trauma! this code was amazing. just wish all trauma codes were like this lmao
As an airline pilot, I see the medical establishment is running the show pretty close from our cockpit management. If you could add some onscreen Artificial Intelligence paired the use of electronic checklists, then the patient gets all the benefit of maximum care.
Very impressive to watch. Keep up the good work..
As an RN, It nearly brought tears to my eyes, the role that the nurse has after Florence Nightingale. We are literally there to make sure everything is compatible... such as blood type, vitals, etc... What an amazing lifesaving operation.
This is wonderful. I was wondering if we could periodically see a VS on the screen. I would also love to see a voiced over version of this to add to why certain things are being done. Just a thought.
Amazing how calm they all are! Job well done. 👍🏽🙏🏽❤️
That's a mannequin.
Its amazing how advance our education has become
Great video. Thanks for sharing!
I would never wish it on anybody, but I love working a MHP. My favourite job is to run the rapid infuser.
Oh my, there are a couple of things that give me a headache:
Why would you open a pelvic sling for clinical examination? If the pelvis is fractured and the patient is in hemorrhagic shock (what appears to be the situation) the least thing you want to do is open up the pelvis to aggravate bleeding. And for what, clinical examination? You got X-Ray and CT, use it.
That brings me to my second point: Why wasting time with X-Ray? The patient suffered from multiple injuries. He's got a cervical collar on so I recon cervical spine injury is suspected. There's a hematopneumothorax. There's free intraperitoneal fluid as eFAST revealed. There's a suspected pelvic fracture. And, even though it wasn't specifically mentioned, trauma mechanism requires ruling out traumatic brain injury, especially since he's anticoagulated.
All in all you want native CT head to pelvis plus multiphase CT-angiography at least of the abdomen and pelvis; I'd prefer CTA head to pelvis as well.
Something that also bothers me in the hospital I work in: Even though other stretchers are available to put things on, prepare stuff etc., that's not how it should work. There may be times all stretchers are in use and you still need to have enough work space to prepare your stuff.
There are some more things (patient handover from EMS/emergency physician to ER team was unstructured and missed elemental information, primary survey did not follow ABCDE-scheme etc.) but I will leave it at that.
I agree plus surgical team to accompany pt to CT for a) immediate assessment of CT and injuries requiring OT and b) log roll when moving them onto scanner
I remember when they first opened the health sciences building of our college they did a demo like this. Never again. Through my 3 semesters we never did any kind of demo. Hell, those expensive mannequins felt horribly underutilized. I will say my favorite though was the midterm practical on PPH. Walk into the "room" and the "PT" goes "Hey, I think I'm bleeding, LOOK!" And rips their covers off revealing a massive blood stain. One of my colleagues squeals and runs out, and the simulation was stopped immediately. She got it together and we did fine on the second go, and she ultimately passed, but that was the funniest series of events.
'Great to watch.
super cool ty for sharing
It is nice to see a simulation as an onlooker for once. Overall great strategy, calm atmosphere. I liked the stickers to indentify functions.
I'll just throw in my late night sleep-deprived thoughts in here without any claim of ultimate wisdom or truth. Feel encouraged to discuss if you think I am wrong at some point.
The legs, IIRC, were never uncovered, as should have happened during C or at the latest E.
General Surgery had no reason to open the pelvic sling. Stability testing of the pelvis is no longer recommended since it has low sensitivity and might worsen an open book fracture. With a positive FAST there also isn't much gain of information. Also, if he really needed to open it, he didn't put it back on tightly, it is absolutely ineffective now.
The time to put that IV in seemed quite long, though that may just feel longer as an observer than it feels as the one placing it. Also might be because they used the moment to draw blood at the same time. 18G seems a little small, but rather one 18G than zero 16G, so that's fine.
Resuscitate before you intubate, very well planned.
The way I learned and trained, induction meds would be decided upon by anaesthesia, not the team leader, but if that's how they are used to do it, why not. Sux is still weirdly popular in angloamerica, the go to relaxant here would be rocuronium, though again, if that's what you guys are used to, perfectly fine.
Nice intubation. Video laryngoscope was ready, manual in-line stabilisation was on point during intubation.
Good temperature management.
Why on earth would you want a chest and pelvic X-ray? Polytrauma patients should get a CT unless they are so unstable they need to go to the OR right away. I would accept the positive FAST as a reason to skip the CT and go right for a laparotomy, but chest and pelvic X-rays take ages and especially the chest X-ray yields no useful information at this point. If it had at least been performed after the chest tube was in, that would be somewhat understandable, since those things should be controlled through X-ray, but that too can wait until the OR.
This is a really nice evaluation.
A little late, but for our trauma activations the XR is already in the bay, CXR/PXR are taken prior to rolling to CT. Takes time to roll to CT, and it sucks to need to put a chest tube in CT - I find breath sounds unreliable in a trauma and I prefer not to miss a pneumo. PXR is a more reliable estimate of pelvic diastasis in pelvic fractures as the CT bed can close the pelvis. Have seen a binder taken off improperly because CT showed no diastasis and there was no PXR; that fellow had a rough time at M&M. Prefer sux as a relaxant as the half life is shorter than roc.
at first i thought it was gonna be real and I was confused how they don't care about sterility and time
Oh man sounds like a complete nightmare. Folks on blood thinners definitely need a med bracelet.
I’m realizing that now. I had a ruptured brain aneurysm a few years ago and I’m on blood thinners. I’ve been googling most of the stuff they’re calling out for and realize it’s all to counter the effects of blood thinners.
@@barbaravyse660 Yeah the decision to take blood thinners should be carefully considered. They're a cardiologists dream and a surgeons nightmare. Prevent blood clots but worsen any kind of trauma.
I just had blood clot in brain doctor told don't give pressure on yourself that is why hemmorage happens
5:09 do NOT palpate the pelvis please!
Amazing.
ORBcon!?!?!?!?! LOVE
i’m a high schooler but this is so interesting to me-
Good scenario, hopefully manikin is cared for by someone knowledgeable.. often they are beaten to hell by people who cant maintain them good and not well versed in technology.
Is it a big deal that the nurse didn't flush the IV after giving the TXA or vitamin K? (I've never worked in trauma and am only a student so genuinely just asking)
Is it OK to use suxamethonium when Pt is suffering from fallen from height and, possible multiple muscles injury may causing raise in K+ levels..? also there may be a risk of possible K+ amount with massive blood transfusions too. then why not something else..?
Anti hiperkalemic treatment if K seric levels is 6 or more than 8 meq,
Calcium gluconate, salbutamol, glucose 50% with 7 - 8 units rapid action insulin, furosemide. But for prevention of hipercalemic signs like arrithmic manifestasion on the monitor calcium gluconate and also hidrocorthisone is well after 4 units of globular masive transfusion or sanguineal derivates. And monitoring K levels.
Thats what I do in my Emergency Departament, Im Chief MD Emergency departamet, 35 years expetise, and this protocole works and safe lifes. Thank You. The most important is correct the hipovolemic shock and monitoring.
I was wondering, are the blood products real or they are specifically made for simulations ?
Looked like saline dyed red to me. Or something of that sort, it seemed to be too thin to be actual blood products.
Blood products are not wasted for sim labs. It’s a sort of substitute
They actually make simulated blood products for training purposes (though I don't know if that's what is used here).
Thanks for sharing. I'm curious as to your alternatives to blood if you had a patient come in who refused blood due to personal/ religious beliefs.
Hospitals should have policies in place for those patients that refuse or unable to receive blood and blood products. Please see the link for more information specifically related to Jehovah Witness patients however these alternatives could be considered for other patients that refuse or unable to receive blood and blood products. Thanks for your question!
👉transfusionontario.org/english/flipbooks/bloody-easy-4/#p=145
@@ORBCoN1 Neat reference. Great work!
@@ORBCoN1 chris evans how do can go out in time for the first day of my life back on this would be back in people would love cool thanks you and the next time you can make me happy now that new one will call me back in time
I doubt this would be relevant in an MTP for a variety of reasons - simply an interesting fact. Recently my hospital began administering bovine-derived blood products to patients with an objection to human blood administration. It should go without saying that patients/families are fully advised on the nature of the products and fully-consented.
Are you guys like Héma-Québec?
is this medical school
What happens if you can’t ever find a vain for blood work. Since I’ve been 8 I have only been able to do blood work with a ultrasound. What happens if there’s an emergency?
A lot of the time there are ultrasounds available in the trauma bays or close too. At my hospital our trauma has its own ultrasound.
@@finleyrolls401 unfortunately, not mine. They always say they have just one to serve the whole department.
ER Trauma docs are trained in advanced venous access. They can and will access the femoral artery to obtain blood for testing if other sites have been tried unsuccessfully. Also generally a trauma patient in the ER is the most critical patient in the hospital. They will have priority use of equipment ie ultrasound, X-ray.
Intraosseous line is exactly what is to be used in that situation
IO straight to the bone if it’s that bad. Medics might have also already established IV access en route
Maybe this is a stupid question, but when you try to intubate the patient ,won't it make things worse if the patient has a cervical injury? Did we do a CT to check if the cervical region is ok?
Thank you.
There are ways to stabilize the neck when a patient is in need of intubation and has a cervical injury
In line stabilisation with blocks or manual, on top of this airway takes priority and a patient that critical is not a good choice for CT
Airway compromise will kill a patient faster than a cervical injury. Always prioritize ABC's.
The jaw-thrust maneuver could be used instead of the traditional head tilt/chin lift in cases of suspected cervical injury!
Good point. Indeed, intubations in patients with cervical spine injury are difficult. Usually we will tilt the head back to make the glottis more visible. This cannot be done under suspected C-spine injury.
As you can see in the video, staff took off the collar and general surgery proceeded to manually hold the head in place, so no C-spine injury must be feared.. To make intubation easier despite not hyperextending the head, the anaesthesiologist used a video laryngoscope. Rather than a classical laryngoscope, that just pushes everything out of the way and opens the view onto the glottis, this thing has a small camera on its tip. The anaesthesist can look at the screen to his right and maneuver the tube into the trachea from that image.
😮
Real life greys anatomy