Elderly patients

  Due to a decline in birth rates and increased life expectancy, New Zealand’s population is aging. In 2018, 15% of New Zealanders were aged 65 years or older and by 2051, this is projected to steadily increase.   From https://www.health.govt.nz/nz-health-statistics/health-statistics-and-data-sets/older-peoples-health-data-and-stats   This is significant as the elderly have increased Read more…

Bariatric patients

In 2016, worldwide 13% of adults, (650 million) were obese1, however  New Zealand had  the 4rd highest prevalence of obesity in the world at 32.3%  (behind USA and Mexico and Chile)2. Traditionally obesity has been defined as a BMI of >30 kg/m2, but recently redefined as “a chronic, relapsing, multifactorial, neurobehavioural Read more…

Pregnancy

General principles Excellent maternal resuscitation is the best treatment for the fetus While fetal radiation exposure is an important consideration – this needs to be balanced with investigations which are in the best interests of the mother Even seemingly minor mechanisms (eg: fall from standing, low speed RTC) can cause Read more…

Pericardiocentesis

Patients with cardiac tamponade following trauma require an urgent thoracotomy. If this is not immediately available, pericardiocentesis might be considered as a temporising measure, however it will not address the cause of bleeding and the patient will rapidly destabilise again.   Indications Traumatic cardiac tamponade and thoracotomy not an immediate Read more…

eFAST

Extended Focused Assessment with Sonography in Trauma The aim of eFAST is to rapidly identify life-threats in unstable trauma patients as part of the primary survey. Ultrasound is increasingly being performed on stable patients – this can confirm clinical impressions and can be useful as a baseline if the patient Read more…

Intubation

  Indications   Indications for intubation in patients with trauma include: Loss of airway patency Airway burns Facial/neck trauma Foreign material in airway (teeth, vomit, blood) Loss of airway protection Decreased GCS Respiratory/cardiac arrest Poor oxygenation or ventilation Hypoventilation with hypoxia Head injury High spinal trauma Severe chest trauma eg: Read more…

Resuscitative thoracotomy

** This topic is available as a learning module on Ko Awatea ** Click HERE to access this course     Introduction  A resuscitative thoracotomy performed in the ED is a procedure of last resort to save a potentially salvageable patient who has suffered a traumatic cardiac arrest. A meta-analysis performed Read more…

Traumatic cardiac arrest

The mortality from traumatic cardiac arrest (TCA) is high with survival rates ranging between 5.1% – 7.5% (with good neurological outcomes ranging between 2-6%-6.6%).1 Patient with TCA are a heterogeneous group however. Those suffering a TCA as a result of penetrating trauma have been shown to have better survival to Read more…