Using video audit to improve trauma resuscitation--time for a new approach.
Using video audit to improve trauma resuscitation--time for a new approach.
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使用视频审核来改善创伤复苏——是时候采取新方法了。
DOI：
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发表时间：
2006
期刊：
影响因子：
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通讯作者：
N. Farrow
中科院分区：
文献类型：
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作者：
M. Fitzgerald;Robert A Gocentas;L. Dziukas;P. Cameron;C. Mackenzie;N. Farrow
1‐6在医院护理阶段对重大创伤患者的协调接待和复苏是这些改善的关键。在这一阶段不仅要进行关键的复苏操作，而且临床决策也为进一步护理奠定了基础。重伤员的医院接待和复苏需要在短时间内做出许多管理决策。在这一护理阶段，在不可预测和不断变化的环境中，同时进行的过程以不同的速度进行。评估气道，确保足够的通气和纠正循环休克，同时诊断和治疗原发性和继发性问题。关键的决定和行动被创伤复苏的紧迫性和可变性所混淆。然而，即使在最好的中心，错误仍然会导致不良后果。不足为奇的是，在急诊科/创伤中心护理阶段出现的大多数错误都与复苏有关。创伤复苏中的错误可能没有什么即时效果，但最终可能危及最终结果。在这一护理阶段，未能干预和扭转危及生命的情况可能是由于缺乏经验、活动混乱、无法识别优先事项、固定错误和未能认识到问题的复杂性。多种活动的协调可能与做出正确的诊断或执行最适当的程序一样对患者的生存至关重要。在澳大利亚，维多利亚州咨询委员会2001/2003年关于道路交通死亡的数据发现，导致致命创伤病例中死亡的早期管理问题的平均数量至少比其他创伤护理领域高出50%。7在2002年至2003年期间，在急诊部门对致命创伤病例的管理中，平均每例死亡病例中发现6.09个错误，每例死亡病例中有3.47个错误被判定为导致死亡。大多数错误与复苏有关。即使在已建立的重大创伤服务机构中，也有23%的死亡被认为是可以预防或可能可以预防的。大多数可预防的错误的发生不是因为无知或缺乏资源，而是因为正确的治疗和诊断措施“没有在正确的时间、正确的数量或正确的顺序进行”。9
1‐6 The coordinated reception and resuscitation of patients with major trauma in the hospital phase of care is pivotal to these improvements. Not only do critical resuscitative manoeuvres occur during this phase, but the clinical decisions made establish the basis for further care. The hospital reception and resuscitation of seriously injured patients requires many management decisions in a short space of time. During this phase of care, simultaneous processes proceed at different rates in an unpredictable and changing setting. Evaluation of the airway, ensuring adequate ventilation and the correction of circulatory shock coincide with the diagnoses and treatment of primary and secondary problems. Critical decisions and actions are confounded by the urgency and the variability that characterizes trauma resuscitation. However, even in the best centres, errors continue to contribute to adverse outcomes. 7,8 Errors in trauma resuscitation Not surprisingly, most of the errors that arise during the emergency department/trauma centre phase of care relate to resuscitation. 7 Errors in trauma resuscitation may have little immediate effect but can eventually compromise the final outcome. Failure to intervene and reverse lifethreatening conditions during this phase of care may be the result of inexperience, disorganized activity, an inability to recognize priorities, fixation error and failure to realize the complexity of the problem(s). The coordination of multiple activities may be just as critical for patient survival as making the correct diagnoses or performing the most appropriate procedures. In Australia, the Victorian Consultative Committee 2001/2003 data on road traffic fatalities found that the average number of early management problems contributing to death in fatal trauma cases was at least 50% greater than in other areas of trauma care. 7 Between 2002 and 2003, a mean of 6.09 errors per fatal case were identified in the emergency department management of fatal trauma cases, with 3.47 errors per fatal case judged to have contributed to death. Most of the errors related to resuscitation. Even in established major trauma services, 23% of deaths were considered preventable or potentially preventable. Most preventable errors occurred not because of ignorance or lack of resources but because the correct therapeutic and diagnostic measures were “not done at the right time, in the right amount or in the right order.” 9