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EMS SOLUTIONS INTERNATIONAL

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Nota Importante

Aunque pueda contener afirmaciones, datos o apuntes procedentes de instituciones o profesionales sanitarios, la información contenida en el blog EMS Solutions International está editada y elaborada por profesionales de la salud. Recomendamos al lector que cualquier duda relacionada con la salud sea consultada con un profesional del ámbito sanitario. by Dr. Ramon REYES, MD

martes, 19 de marzo de 2019

Manuales y Guias de TRAUMA y CIRUGIA. PDFs

 TRAUMA DESDE LA CALLE AL ALTA HOSPITALARIA

Web Series - Sunnybrook - Image #1
"Dispatch info: 40 yo male, multiple gunshot wounds, conscious, breathing. Staged event, police en route. Pt is located in the driver's seat of blue Honda Civic. Unknown if a shooter is still on scene."
This is the first image in my next web series. I'll be posting a new image every day as this call progresses. Follow my page and try to predict the injuries and outcome based on what you see and read. I encourage you to comment and interact with the other emergency workers who follow this series.
This is a staged series, and although it's based on a real event, these are not real-time photos.
Be safe everyone.
(place your company link here, message me for sponsorship opportunities)



Web Series - Sunnybrook - Image #2
The paramedics arrive at a secured scene to find a 38 yo male sitting on the road next to a Honda Civic. The car has several bullet holes in it with visible blood on the steering wheel and seat. The patient is alert and aware of their arrival and appears to be in obvious distress with SOB, active bleeding to right lateral neck, and right upper leg. He also has a GSW to the left axilla. The patient is pale, cool and clammy, he has sensation to all limbs but lacks motor to right leg.
The patient stated he was waiting in his car "minding my own business" when he was shot at by a passing vehicle. When asked why he was out of the vehicle he stated he was afraid there would be a second shooter and tried to run away but fell as soon as he stepped out of the car. The patient was unable to give a description of the car, how many people were in the car or the direction the car that shot at him was travelling.
The paramedics performed a rapid initial assessment, applied pressure to the neck and leg wounds and applied an occlusive dressing to the sucking chest wound. They loaded the patient in the ambulance and continued treatment en route to the hospital.
The patient is short of breath breathing at 32/min and has a weak and rapid radial pulse. SPO2 is 90% using a BVM at 15 l/min. He has no allergies or past medical conditions. He admits to recreational drug use earlier in the day. The paramedics have found 3 entry wounds - one to his right lateral neck, left axilla and right upper leg. They did not find any exit wounds on their initial assessment. Transport time to the hospital is 10 minutes.
What would you do? IV on scene or en route? Initial BP on scene or en route? What about C-spine precautions? If this was your patient what would you do next?
Follow my page to see how this call progresses. Image #3 & 4 will be posted tomorrow.
DanSun
www.dansungallery.com
(Place your company link here, message me for sponsorship opportunities)


 Web Series - Sunnybrook - Image #3 & #4
En Route - IV, TXA, pack leg wound, apply tourniquet. C-Collar applied (still able to visualize neck wound), ++ Swelling to neck. Ketamine is given for pain control. Upon arrival at hospital, Pt goes into pulseless V-Tach, defibrillate X1 to get pulse back.
Lung sounds present to left side but decreasing, P-119 and irregular, BP-78/60 after 500ml NS, R-30. Pt gains consciousness just before reaching the trauma bay.
Image #5 will be posted tomorrow.
Have a safe week everyone
DanSun

 Web Series - Sunnybrook - Image #3 & #4
En Route - IV, TXA, pack leg wound, apply tourniquet. C-Collar applied (still able to visualize neck wound), ++ Swelling to neck. Ketamine is given for pain control. Upon arrival at hospital, Pt goes into pulseless V-Tach, defibrillate X1 to get pulse back.
Lung sounds present to left side but decreasing, P-119 and irregular, BP-78/60 after 500ml NS, R-30. Pt gains consciousness just before reaching the trauma bay.
Image #5 will be posted tomorrow.
Have a safe week everyone
DanSun
 Web Series - Sunnybrook - Image #5
The medics patched to the hospital and the trauma team has assembled. If you're a member of a trauma team what would your priorities be based on the previous 4 images I posted?

 Web Series - Sunnybrook - Image #6
Hand off report: "This is Franklin, he's 38 years old. He was in a car when he was shot at by a passing vehicle. He has entry wounds to his left axilla, right femur and right neck. We didn't see any exit wounds. Decreased lung sounds to his left side and his neck wound is swelling. We have 2 lines with 500ml NS in, TXA, hemostatic agent and tourniquet applied to his femur. 16 mg of ketamine was given for pain. He went into pulseless V-Tach as we pulled up to the hospital and was defibrillated once. He's tachy and hypotensive, he started fighting us as we were rolling him in."
Follow my page to see how this scenario ends. Image #7 will be posted tomorrow.
 Web Series - Sunnybrook - Image #7
Now it's the trauma team's turn...
Follow my page to see how this series progresses, Image #8 will be posted tomorrow.
DanSun
 Web Series - Sunnybrook - Image #8
Patient ++ restless/agitated vital signs: BP 80/40, HR 120, RR 30, sat 91, T 34.6
Image #9 will be posted tomorrow...maybe...I'm travelling to Australia today and I'll try to get the next image finished and posted before my long flight to Melbourne.
DanSun
 Web Series - Sunnybrook - Image #9
Bilateral chest tubes inserted (1100 mL blood return on left, nil on right) – Blood infusing, BP hovers in 80’s. Intubation attempts begin, 2 unsuccessful attempts, Sats drop, HR brady’s down (sat in the 70’s, HR goes from 120 to 60 etc.)
Follow my page to see the outcome of this case. Image #10 will be posted tomorrow.
Have a safe weekend everyone.
DanSun
 Web Series - Sunnybrook - Image #10
Need for surgical airway determined.
Image #11 will be posted tomorrow.
DanSun
 Web Series - Sunnybrook - Image #11
ED Thoracotomy immediately after airway secured
Image 12 will be posted tomorrow.
DanSun
 Web Series - Sunnybrook - Image #12
Prepped for transfer to OR. Image 13 will be posted tomorrow.
DanSun
 Web Series - Sunnybrook - Image #13
The patient is in surgery.
Image #14 will be posted tomorrow.

Web Series - Sunnybrook - Image #14, Final image
After several weeks of post surgical recovery the patient is finally released. He will live the rest of his life paralyzed from the chest down as a result of the shooting.
Have a safe weekend everyone, I hope you enjoyed this series. Thanks again to Dr. Avery and his team at Sunnybrook - Toronto for helping me with this series.
DanSun

NO EXISTE RELIGION EN MEDICINA, LO MAS IMPORANTE ES EL PACIENTE.

There is not religion in Medicine, only patients are the most important...

Les esperamos en el #Grupo de #TELEGRAM sobre #Salud#Medicina y #Emergencias de toda #Iberoamerica 


1. SOPORTE VITAL BASICO AL TRAUMA GRAVE by Mario Jesus Perez Diaz y Antonio Correa Ruiz. EPES 061 año 2017
emssolutionsint.blogspot.com/2017/12/soporte-vital-basico-al-trauma-grave-by.html

2. Protocolo de Triage Prehospitalario de Trauma

emssolutionsint.blogspot.com/2013/03/protocolo-de-triage-prehospitalario-de.html

3. Descompresión de Neumotórax a Tensión

emssolutionsint.blogspot.com/2016/07/descompresion-de-neumotorax-tension.html

4. FORMULA DE PARKLAND. QUEMADOS: REGLA DE LOS NUEVES PARA ADULTOS, NIÑOS Y BEBÉS. Guía de Práctica Clínica para el cuidado de personas que sufren Quemaduras. Lund y Browder Quemaduras en niños

emssolutionsint.blogspot.com/2011/05/formula-de-parkland-quemados.html

5. Guía de Práctica Clínica para el cuidado de personas que sufren Quemaduras  emssolutionsint.blogspot.com/2012/11/guia-de-practica-clinica-para-el.html


6. UPDATE PHTLS 2018. NEW Certification NAEMT and PHTLS, starting Jan 2017, PHTLS Prehospital Trauma Life Support. / Nueva Certificacion NAEMT y PHTLS, iniciando desde enero 2017.  

emssolutionsint.blogspot.com/2016/12/phtls-prehospital-trauma-life-support.html

7. Mitos en Trauma Prehospitalario by Revista EMSWORLD en Español   emssolutionsint.blogspot.com/2017/07/mitos-en-trauma-prehospitalario-by.html  


8. PREHOSPITAL TRAUMA CARE. Free PDF Book  emssolutionsint.blogspot.com/2013/06/prehospital-trauma-care-book.html   


9. Procesos Trauma Grave de la Empresa Pública de Emergencias Sanitarias. 2012 España  emssolutionsint.blogspot.com/2017/04/procesos-trauma-grave-de-la-empresa.html  


10. Cinematica de Trauma ATROPELLO, Explosion, Peatones   emssolutionsint.blogspot.com/2016/07/cinematica-de-trauma-en-peatones.html  


11. European Trauma Course – The Team Approach to Trauma ETC  emssolutionsint.blogspot.com/2017/03/european-trauma-course-team-approach-to.html 


12. GUIA DE ACTUACION ANTE EL PACIENTE QUEMADO Unidad de Enfermeria de Quemados. Hospital R.U. Carlos Haya. Malaga. España PDF Gratis 
http://emssolutionsint.blogspot.com/2018/06/guia-de-actuacion-ante-el-paciente.html


13. MANUAL DE ENFERMERÍA EXTRA HOSPITALARIO Vol, I, Vol II y Vol. III by Consejo de Enfermeria de la Comunidad de Valencia. España. PDF Gratis http://emssolutionsint.blogspot.com/2018/06/manual-de-enfermeria-extra-hospitalario.html 


14. COMPORTAMIENTO Y PRIMEROS AUXILIOS EN CASO DE ACCIDENTE DE TRAFICO. Direccion General de Trafico DGT. España 2013 1-19  emssolutionsint.blogspot.com/2015/06/comportamiento-y-primeros-auxilios-en.html


15. Procedimiento actuación en los accidentes de tráfico en Andalucía  emssolutionsint.blogspot.com/2017/03/procedimiento-actuacion-en-los.html


16. GUIA DE RESCATE SANITARIO EN ACCIDENTES DE TRAFICO 2012  emssolutionsint.blogspot.com/2013/01/guia-de-rescate-sanitario-en-accidentes.html


17. Manual sueco de rescate en Accidentes de Tráfico "Sweden road car extrication" PDF  emssolutionsint.blogspot.com/2016/04/manual-sueco-de-rescate-en-accidentes.html 


18. MANUAL para la IMPLEMENTACIÓN de un SISTEMA de TRIAJE para los CUARTOS de URGENCIAS by Organizacion Mundial de la Salud 
http://emssolutionsint.blogspot.com/2017/11/manual-para-la-implementacion-de-un.html


19. Trauma abordaje inicial en los servicios de urgencias Laureano quintero. Laureano Quintero. Fundacion Salamandra 2013. Colombia
http://emssolutionsint.blogspot.com.es/2017/11/trauma-abordaje-inicial-en-los.html 


20. Manual del Alumno Curso de Soporte Vital Avanzado en Trauma 2011. Xunta de Galcia PDF
http://emssolutionsint.blogspot.com.es/2017/12/manual-del-alumno-curso-de-soporte.html 


21. 75th Ranger Regiment Trauma Management Team (Tactical) Ranger Medic Handbook FREE pdf
http://emssolutionsint.blogspot.com.es/2018/02/75th-ranger-regiment-trauma-management.html 


22.Trauma/Burn Clinical Guidelines. A Quick Guide for the Management of Trauma/Burn Disasters for Emergency Department Personnel Rev. August 2013 

http://emssolutionsint.blogspot.com/2013/10/traumaburn-clinical-guidelines-quick.html 

23. ABORDAJE INCIAL DEL PACIENTE QUEMADO (ABLS) Centro Medico NAcional de Occidente Unidad de Quemados    

emssolutionsint.blogspot.com/2018/07/abordaje-incial-del-paciente-quemado.html


24. Balística de las heridas: introducción para los profesionales de la salud, del derecho, de las ciencias forenses, de las fuerzas armadas y de las fuerzas encargadas de hacer cumplir la ley http://emssolutionsint.blogspot.com/2017/04/balistica-de-las-heridas-introduccion.html

25. Guía para el manejo médico-quirúrgico de heridos en situación de conflicto armado by CICR http://emssolutionsint.blogspot.com/2017/09/guia-para-el-manejo-medico-quirurgico.html

26. CIRUGÍA DE GUERRA TRABAJAR CON RECURSOS LIMITADOS EN CONFLICTOS ARMADOS Y OTRAS SITUACIONES DE VIOLENCIA VOLUMEN 1 C. Giannou M. Baldan CICR
27. Protocolo de cirugía menor en Atención Primaria. PDF Gratis by Gobierno Canario de Salud. España
http://emssolutionsint.blogspot.com/2018/06/protocolo-de-cirugia-menor-en-atencion.html

28. Manual Suturas, Ligaduras, Nudos y Drenajes. Hospital Donostia, Pais Vasco. España http://emssolutionsint.blogspot.com/2017/09/manual-suturas-ligaduras-nudos-y.html

30. Manual de suturas. Menarini
http://emssolutionsint.blogspot.com/2017/09/manual-de-suturas-menarini.html
31. Técnicas de Suturas para Enfermería ASEPEYO y 7 tipos de suturas que tienen que conocer estudiantes de medicina
http://emssolutionsint.blogspot.com/2015/01/tecnicas-de-suturas-para-enfermeria.html
32. Cuaderno Enfermero.Cirugia Menor Heridas Suturas
http://emssolutionsint.blogspot.com/2016/07/cuaderno-enfermerocirugia-menor-heridas.html
33. Manual Práctico de Cirugía Menor. Grupo de Cirugia Menor y Dermatologia. Societat Valenciana de Medicina Familiar i Comunitaria
http://emssolutionsint.blogspot.com/2013/09/manual-practico-de-cirugia-menor.html
34. Protocolo de Atencion para Cirugia. Ministerio de Salud Publica Rep. Dominicana. Marzo 2016 http://emssolutionsint.blogspot.com/2016/09/protocolo-de-atencion-para-cirugia.html
35. Manual de esterilización para centros de salud. Organización Panamericana de la Salud
http://emssolutionsint.blogspot.com/2016/07/manual-de-esterilizacion-para-centros.html
37. Inmovilizacion Espinal en el Paciente de Trauma, Inmovilizacion Selectiva, El NEXUS, El Canadian C-Spine Rule, Consenso Británico 
http://emssolutionsint.blogspot.com/2016/09/es-necesario-inmovilizar-todos-los.html

38. Traumatismo Vertebral y Medular PDF by SeMicyuc. PDF Gratis  

39. CRITICAL BLEEDING MASSIVE TRANSFUSION Free PDF emssolutionsint.blogspot.com/2017/12/critical-bleeding-massive-transfusion.html

40. Guía de Práctica Clínica Para el diagnóstico y tratamiento de pacientes adultos con trauma craneoencefálico severo Sistema General de Seguridad Social en Salud – Colombia Guía completa 2014- Guía No. GPC-2014-30   

emssolutionsint.blogspot.com/2018/06/guia-de-practica-clinica-para-el.html

41. “Guía de práctica clínica sobre el manejo del traumatismo craneoencefálico en el ámbito extra e intrahospitalario de la CAPV”. Osakidetza   

emssolutionsint.blogspot.com/2016/05/guia-de-practica-clinica-sobre-el.html

42. ATENCIÓN DE PACIENTES ADULTOS CON TCE LEVE EN EL SERVICIO DE URGENCIAS CRITERIOS DE INGRESO EN LA UCE pdf Gratis  http://emssolutionsint.blogspot.com/2018/07/atencion-de-pacientes-adultos-con-tce.html 


43. CURA DE HERIDAS SERVICIO DE URGENCIAS HOSPITAL SAN PEDRO - LOGROÑO pdf Gratis  

emssolutionsint.blogspot.com/2018/07/cura-de-heridas-servicio-de-urgencias.html

44. 10 things you need to know to save lives (eBook) By EMS1 BrandFocus Staff FREE pdf  emssolutionsint.blogspot.com/2018/07/10-things-you-need-to-know-to-save.html

45. Trauma: 10 cosas que debes saber para salvar vidas. PDF Gratis  emssolutionsint.blogspot.com/2018/07/trauma-10-cosas-que-debes-saber-para.html


46. Manta Térmica en Emergencias Prehospitalarias (Hipotermia) Triada Letal en Trauma, M.A.R.C.H.  

emssolutionsint.blogspot.com/2016/05/manta-termica-en-emergencias.html 

47. Proceso Asistencial Integrado de Atención al Paciente Quirúrgico. pdf Gratis  emssolutionsint.blogspot.com/2018/08/proceso-asistencial-integrado-de.html


48. GUIA DE AYUDA A AFECTADOS POR ACCIDENTES DE TRÁFICO. España. PDF Gratis http://emssolutionsint.blogspot.com/2013/08/guia-de-ayuda-afectados-por-accidentes.html


49. WHO guidelines for safe surgery: safe surgery saves lives Authors: World Health Organization FREE pdf

http://emssolutionsint.blogspot.com/2018/08/who-guidelines-for-safe-surgery-safe.html

50. Manual de aplicacion de la lista OMS de verificacion de la seguridad de la cirugia 2009 LA CIRUGIA SEGURA SALVA VIDAS pdf Gratis
Enlace para DESCARGAR gratis 

51. LA CIRUGIA SEGURA SALVA VIDAS. OMS pdf Gratis
Enlace para DESCARGAR pdf Gratis 

52. LISTA OMS DE VERIFICACIONES DE SEGURIDAD DE LA CIRUGIA MANUAL DE APLICACION pff Gratis 
Enlace para DESCARGA pdf Gratis 

53. PROGRAMA DE CIRUGÍA SEGURA DEL SISTEMA NACIONAL DE SALUD PROTOCOLO pdf Gratis Enlace para DESCARGAR pdf Gratis emssolutionsint.blogspot.com/2018/08/programa-de-cirugia-segura-del-sistema.html

54. CIRUGÍA DEL PACIENTE POLITRAUMATIZADO. 2017

by Guías Clínicas de la Asociación Española de Cirujanos PDF Gratis https://emssolutionsint.blogspot.com/2018/12/cirugia-del-paciente-politraumatizado.html

55. Cuando las maquinas "RobotS"​ hacen daño"​- A CHINESE factory worker has survived being skewered with TEN metal spikes when a robot malfunctioned.

https://www.linkedin.com/pulse/cuando-las-maquinas-robots-hacen-da%C3%B1o-chinese-worker-dr-ramon/

56. Evaluación y manejo inicial del niño “Gran Quemado” PDF Gratis MEXICO Enlace para DESCARGAR pdf Gratis

https://emssolutionsint.blogspot.com/2018/12/evaluacion-y-manejo-inicial-del-nino.html

57. Diagnóstico y tratamiento de las lesiones traumáticas de la columna vertebral en el adulto en el tercer nivel. pdf Gratis MEXICO https://emssolutionsint.blogspot.com/2018/12/diagnostico-y-tratamiento-de-las_26.html


58. Diagnóstico y tratamiento del TRAUMATISMO DE TÓRAX en adultos. 2017 PDF Gratis MEXICO 

https://emssolutionsint.blogspot.com/2018/12/diagnostico-y-tratamiento-del.html

59. Guias para Programas de Mejora de la calidad en el Trauma BY WORLD HEALTH ORGANIZATION pdf Gratis 

https://emssolutionsint.blogspot.com/2018/12/guias-para-programas-de-mejora-de-la.html

Mas libros gratis de Trauma y Cirugia en el ENLACE http://emssolutionsint.blogspot.com/2018/07/trauma.html

MAS LIBROS MEDICINA Y SALUD https://www.facebook.com/pg/DrRamonReyesMD/photos/?tab=album&album_id=620883388254594 Dr. Ramon Reyes, MD http://emssolutionsint.blogspot.com.es/2016/12/dr-ramon-reyes-diaz-md-emt-t-dmo.html