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Pediatric Trauma III 2014

Aired on 2.20.2014
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Pediatric Trauma III 2014
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01-Trauma III-Introduction-Principles of Performance-David Tuggle MD

This video is about 01-Introduction-Principles of Performance-David Tuggle MD

Description

Pediatric Trauma III 2014, Worldwide Web Symposium, is directed by Martin R. Eichelberger, M.D., Wayne Meredith, M.D., and Todd Ponsky, M.D. The topics will cover the management of multiple casualty incidents (Disaster Management), Burn Care, Extremity Injury, Anesthesia-Pain Management, Exploratory Laparotomy, approach to the Retorperitoneum and Nursing Care of the injured child.  The faculty will present “How I Do It” followed by a panel discussion to illustrate controversy, respond to viewer questions and discuss a relevant case. The format encourages lively discussion and debate by opinion leaders in the field of Trauma. The worldwide audience will be able to participate, pose questions and offer opinions. In 2013, Pediatric Trauma II attracted over 1200 participants from 33 countries.  The presentations are concise and the discussions of interest. We look forward to your participation to save the lives of children and to improve the care of the severely injured child.

#pedstrauma2014

Portuguese Translation Available

Directors & Faculty

Directors

Martin Eichelberger, M.D.

Professor of Surgery and of Pediatrics, George Washington University, Children's National Medical Center. Safe Kids Worldwide, Founder. Washington, D.C.

Wayne Meredith, M.D.

Executive Director of the Childress Institute for Pediatric Trauma, and Chair of General Surgery and Director of the Division of Surgical Sciences at Wake Forest Baptist Medical Center in Winston-Salem, NC.

Todd Ponsky, M.D.

Associate Professor of Surgery at Northeast Ohio Medical University (NEOMED), Pediatric Surgeon at Akron Children’s Hospital. Dr. Ponsky is founder of GlobalCastMD which was created as a result of his desire to create global education by doctors, for doctors. Akron Children's Hospital, Akron, Ohio.


Additional Faculty

Robert Bass, M.D.

Executive Director, Maryland Institute For Emergency Medical Services System, Baltimore, Maryland.

Jeremy Cannon, M.D.

Associate Professor of Surgery, Uniformed Services University for the Health Sciences; Chief, Trauma & Critical Care, San Antonio Military Medical Center San Antonio, TX

Eric Elster, M.D.

Chair, Department of Surgery, Uniformed Services University of the Health Sciences, and U.S. Navy Staff Transplant Surgeon, Walter Reed National Military Medical Center. Bethseda, Maryland.

John Fildes, M.D.

Professor of Surgery, Vice Chair, Department of Surgery, Program Director, General Surgery Residency Chief, Divison of Trauma & Critical Care at the University of Nevada School of Medicine. Las Vegas, Nevada.

Joel Fish, M.D.

Associate Professor, Department of Surgery at the University of Toronto, Medical Director of the Burn Program at The Hospital For Sick Children. Toronto, Canada.

Jennifer Fritzeen, MSN, RN

Trauma Program Manager at Children's National Medical Center. Washington, D.C.

Lenworth Jacobs , M.D.

Professor and Chairman of the Department of Traumatology and Emergency Medicine, and Professor of Surgery at the University of Connecticut School of Medicine, Vice President of Academic Affairs, Chief Academic Officer at Hartford Hospital, Hartford, Connecticut.

Margaret Knudson, M.D.

Professor of Surgery at UCSF and Interim Chief of Surgery, San Francisco General Hospital and Trauma Center. San Francisco, California.

Ken Mattox, MD

Distinguished Service Professor at Baylor College of Medicine, Chief of Staff and Chief of Surgery at Ben Taub General Hospital. Houston, Texas

Mark McCollum, M.D.

Pediatric and Burn Surgeon, Director of Trauma, Akron Children's Hospital. Akron, Ohio

Johannes Mayr, M.D.

Professor, Department of Pediatric Surgery, University of Basel, Basel, Switzerland.

David Mooney, M.D.

Associate Professor of Surgery, Director of Trauma Program, Boston Children's Hospital, Boston, Massachusetts.

Matt Oetgen, M.D.

Assistant Professor, Department of Orthopaedic Surgery, George Washington University. Interim Chief, Division of Orthopaedic Surgery and Sports Medicine, Director of Orthopaedic Research Children's National Medical Center. Washington, D.C.

John Petty, M.D.

Director of Pediatric Trauma; Associate Professor of Surgery; Pediatrics Wake Forest School of Medicine, Winston-Salem, North Carolina.

Robert Sheridan, M.D.

Director, Acute Burn Service, Boston Shriners Hospital for Children; Associate Professor of Surgery at the Harvard Medical School. Boston, Massachusetts.

Steven Stylianos, M.D.

Rudolph N Schullinger Professor of Surgery, Columbia University College of Physicians & Surgeons, Surgeon-in-Chief, Morgan Stanley Children's Hospital. New York, NY.

Matthew Schmitz, M.D.

Chief of Pediatric Orthopedic Surgery, San Antonio Military Medical Center. Assistant Professor of Surgery, Uniformed Services University of Health Sciences, Major, US Air Force, Medical Corps. San Antonio, Texas.

Sophie Pestieau, M.D.

Pediatric Anesthesiology and Pain Medicine, Children's National Medical Center, Washington D.C.

David Tuggle, M.D.

Clinical Professor of Surgery, University of Texas Southwestern Medical School Associate Trauma Medical Director, Dell Children's Medical Center of Central Texas. Austin, TX.

Isaac Ashkenazi

Director of the Urban Terrorism Preparedness Project at the National Preparedness Leadership Initiative. Adjunct Professor in the Department of Epidemiology, the Rollins School of Public Health, Emory University. Adjunct Professor of Disaster Management at the UGA. Professor of Disaster Medicine at Ben-Gurion University in Israel; Consultant to Harvard University, the Centers for Disease Control and Prevention, the U.S. Department of Health and Human Services, the U.S. Department of Homeland Security. Israel.

Kevin Chung, M.D.

United States Army Institute of Surgical Research, Fort Sam Houston, Texas.

David Greenhalgh, M.D.

Professor and Chief, Burn Surgery, UC Davis Medical Center. Chief, Burns, Shriners Hospitals for Children. Associate Director of Research, Institute for Pediatric Regenerative Medicine. Sacramento, California.

Mark Bowyer

Professor of Surgery, Director of Surgical Simulation, Chief, Division of Trauma and Combat Surgery USUHS, The Norman M. Rich Department of Surgery. Bethesda, MD.

Agenda

9:00 am - 9:05 am
Introduction
9:05 am - 10:20 am
Multiple Casualty Incidents: Disaster Management
9:05 am - 9:20 am
Principles of Performance: "What must we anticipate?"
Epidemiology: World History, Incidence, Terrorism
Mechanism of Injury: Natural, Blast, GSW
Pattern of injury: Blast, Burn, Head, Abdomen, Extremity, Laceration
National, Regional, Local, Hospital: coordination
Family Separation
9:20 am - 9:35 am
Hospital Preparation: "What preparation is necessary to respond?"
Communications: EMS and Hospital, Equipment
Leadership: Team Organization
Triage: Simplify
Triage: Echelon of care
Expectations: radiology, internal communication, Public Relations
Performance Improvement: After Action Huddle and Report
9:35 am - 9:50 am
Actual Hospital Response: "What really happens?"
Asiana Flight 214 San Francisco Aviation Disaster
First notification! How team forms? Communications
Personnel: “actually, how do they respond?”
Injury Pattern: Systematic Evaluation
Continuity of patient care: Who is in charge of the patient and team?
Treatment process: Quality Improvement
Equipment
9:50 am - 10:00 am
Question and Answers: "Lessons Learned"



10:00 am - 10:20 am
Case Presentations
Bystander Role: Isaac Ashkenazi, M.D.
Boston Marathon: David Mooney, M.D.
Natural and Technologic Disasters and Terrorism: David Tuggle, M.D.


10:20 am - 10:30 am
Break
10:30 am - 12:00 pm
Burn Injury
10:30 am - 10:45 am
Overview and Initial Care
Scene and Transport: scoop and run? Appropriate care?
Initial Evaluation and Management: pre-hospital wound coverage
Fluid Resuscitation: type of fluid, volume, concentration
Resuscitation Endpoints: PO2, Urine output, SAO2, BP, HR
Decompression--Escharotomy and Fasciotomy
Early Respiratory Challenges: ? ECMO
Common Traps and Complications: hypoxia, acidosis, hypothermia
10:45 am - 11:00 am
Early Surgery
Principles of Care: Strategy
Debridement techniques: partial or full thickness
Topical Dressing: Xeroform, gauze saline, Mepelex, adaptic gauze
Alternative: Immediate Debridement + skin (Autograft)
Debridement + staged coverage (Allograft + Skin)
Immobilization: technique (simple, reliable)
Aftercare: short and long term
Complications
11:00 am - 11:15 am
Critical Care
“Beware!” Anticipate complications and avoid edema
Monitor devices: intravascular management
Invasive and noninvasive hemodynamic monitoring
Fluid management: post-op
Ventilation: guidelines (short & long term strategy); tracheostomy
Nutrition: practical guideline (austere environment), specific
Antibiotic Strategy
11:15 am - 11:30 am
Reconstruction
Principles of selection for surgery
Fundamental Surgical Procedures
Anatomic regions: Upper and lower extremity, hand, face, neck
Supplemental post-op treatment: pressure garment, steroid, silicone
Outcome expectation: long term
11:30 am - 11:45 am
Questions and Answers: Burn Injury




11:45 am - 12:00 pm
Case Presenatation
Blast with 40% TBSA Burn, Head, Thorax, Abdomen, Lower Ext. Amputation
12:00 pm - 12:15 pm
Break
12:15 pm - 1:45 pm
Extremity Injury
12:15 pm - 12:30 pm
Fracture Dislocation
Principles of care: Strategy, Urgency, Timing, Open vs. Closed
Pattern of Injury: mechanism- blunt, penetrating, blast
Upper vs. Lower Extremity
Physical exam: signs, pulse, Doppler ratio
Radiology: Plain Film, Sonography, Computed Tomography, MRI, Angiography
Strategy: Reduction, Alignment, Damage Control, Infection mitigation (Phased)
Three Essential Maneuvers: Pain Relief (conscious sedation/Anesthesia)
In-line traction: temporary immobilization
External vs Internal Fixation: Timing
VAC Application: Vacuum Assisted Closure
Internal Fixation: Exposure
Pitfall: Orthopedic Fracture Repair versus Vascular Repair
Post-Op Care
12:30 pm - 12:45 pm
Vascular Injury
Principles of Care: Upper and Lower Extremity, Timing
Pattern of Injury: Brachial, Femoral
History and Physical
Evaluation: Doppler, Angiogram, CTA
Technique and Tactics: Exposure, Bleeding Control (Proximal-Distal)
Emergency re-perfusion: Shunt Procedure- anticoagulation
Damage Control = Shunt +External Fixation + Delayed Primary Repair
Complications
Aftercare and Rehabilitation
12:45 pm - 1:00 pm
Compartment Syndrome
Pathophysiology
Injury Pattern: Upper and Lower Extremity, Timeline, Anatomy, Complication
Signs and Physical Examination: Pulse, Pressure Measurement
Clinical Indications for surgical decompression
Surgical Procedure: Compartment Decompression (Video)
Upper Extremity: forearm, Hand
VAC: “Does it increase Compartment Pressure?”
Reconstruction: timing and technique
Lessons Learned

1:00 pm - 1:15 pm
Amputation
Principle of Care: Pediatric Consideration, Strategy
Indications: Complete or Phased Debridement (muscle-nerve viability)
Unique Anatomy: Bone Growth, Limited Muscle
Procedure: Upper and Lower Extremity, Aftercare, Complications
Prosthetic Device: Long term revision, Activity of Daily Living,
1:15 pm - 1:30 pm
Questions and Answers: "Extremity Injury"






1:30 pm - 1:45 pm
Case Presentations
Wound Hemostasis: Topical Dressing: Eric Elster, M.D. Internal Nail Femur Fixation: Johannes Mayr, M.D. Right Upper Extremity Amputation: John Petty, M.D.


1:45 pm - 2:00 pm
Break
2:00 pm - 3:30 pm
Special Topics: "When many patients need surgery?"
2:00 pm - 2:15 pm
Anesthesia and Pain Management
Principles of Care: Team Approach vs Individual
Optimal Airway management
Rapid Sequence Intubation: technique and complications
Drug utilization: short and long acting
Intra-operative management: surveillance, monitor
Anticipate: hypovolemia, hypothermia, acidosis, coagulopathy
Principles of Transfer: PACU + ICU
Post-op pain management
Follow-up sequence: multiple injuries, austere environment
2:15 pm - 2:30 pm
Abdominal Exploration
Principle of management: “Damage Control Laparotomy”
Physiology: Avoid: hypothermia, acidosis, coagulopathy
Avoid: non-compressible hemorrhage Preparation: monitor, anticipate, “when to make the incision?”
Rapid Exploration Technique: evacuate, suction, pack, and stabilize
Management of solid organs and bowel: temporary or definitive
VAC Technique: application, complications (how to avoid?)
Re-exploration: timing, phased approach, diversion
2:30 pm - 2:45 pm
Retroperitoneal Hemorrhage
Principles of Care
Pattern of injury: “which patient most likely to have injury?”
Exploratory Laparotomy: anatomic manifestation
Surgical Exposure: Technique
Proximal-distal control
Vascular vs Bowel perforation (Small bowel, colon)
Surgical Hemostasis: definitive vs temporary repair
Bowel repair: Duodenum, Colon, SMA small bowel ischemia.
Damage Control Laparotomy: cautions?
Re-exploraton: “Second Look” timing, progression of care
Key points to minimize complications and increase survival.
2:45 pm - 3:00 pm
Trauma Nursing
Principles of Care: Global Approach to Bedside Trauma Care
Patient Management: accountability, teamwork, communication
Essential Components: surveillance, treatment, equipment
Anticipate, Evaluate, Intervene, Communicate, QI
Special Consideration: Head, Thorax, Abdomen, Extremity
Quality Improvement: Team Approach
3:00 pm - 3:15 pm
Question and Answers: "Special Topics"





3:15 pm - 3:30 pm
Case Presentations
Damage Control Resuscitation + Abdomen: Johannes Mayr, M.D.
Abdominal Surgery: Pancrease: Steven Stylianos, M.D.
Abdominal Compartment Syndrome: David Mooney, M.D.
3:30 pm - 3:35 pm
Closing Remarks


: - :

Topics Covered

  • Management of Multiple Casualty Incidents (Disaster Management)
  • Burn Care 
  • Extremity Injury 
  • Anesthesia-Pain Management
  • Exploratory Laparotomy
  • Approach to the Retorperitoneum 
  • Nursing Care of the Injured Child

Objectives

  • Recognize new concepts of care for the injured child
  • Explain the controversies of treatment methods
  • Describe the multiple casualty incidents of performance, hospital preparation and response
  • Identify burn injury initial and critical care management as well as early surgery strategies and reconstruction techniques
  • Review principles of care in fractures dislocation, vascular injury, compartment syndrome and amputation
  • Discuss surgical approach to abdominal exploration and retroperitoneal hemorrhage after a trauma
Co-Sponsors

Supporter

Endorsers

Accreditation Statement

This activity has been planned and implemented in accordance with the Essential Areas, Elements & Policies of the Ohio State Medical Association through the joint sponsorship of Children’s Hospital Medical Center of Akron and GlobalCastMD. Children's Hospital Medical Center of Akron is accredited by the OSMA to provide continuing medical education for physicians.


The Children’s Hospital Medical Center of Akron designates this live activity for a maximum of 5.75 AMA PRA Category 1 Credits TM.  Physicians should claim only the credit commensurate with the extent of their participation in this activity.

This activity provides self assessment credits toward Part 2 of the ABS MOC Program.

 

This event is produced by Akron Children's Hospital.

Rosen Nelson
Pediatric General Surgery- Pediatric Trauma Program
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