Emergency theatre and surgery

North of Scotland major trauma guidelines
NHS Grampian

Scope

DCR should be employed in all patients with active haemorrhage who have ANY of the following:

  • Acidaemia
  • Hypothermia
  • Coagulopathy.

Two surgeons operating

The Theatre coordinator is included in a code red trauma team alert. They are tasked with identifying an available theatre and team to accommodate an expected patient until stood down by anaesthetist or ODP.

All unstable code red patients will ideally, but not always go to theatre. This may include Orthopaedic & Cardiothoracic patients.

  • Patients should be taken directly to the operating theatre rather than the anaesthetic room.
  • Surgery for haemorrhage control should not be delayed for arterial line insertion and other non-therapeutic monitoring/interventions.
  • Team(s) should be prepared to start surgery immediately following RSI.
  • Patients who require haemorrhage control should not wait in the Emergency Department for Consultants and other staff to come in. They should be immediately transported to the nominated theatre.
  • Ensure that blood bank is aware of patient movement, and that any blood products go with the patient.
  • A surgical pause must still be performed once in theatre.

Damage Control Resuscitation (DCR)

There are five principles of DCR

  • Damage Control Surgery
  • Correct coagulopathy
  • Avoid hypothermia
  • Limit volume (using only blood/blood products)
  • Time-limited permissive hypotension.

Access to Specialists

Consultants from all specialties should be immediately available to attend to a Major Trauma patient. Examples are given below:

  • Anaesthesia – All emergency major trauma cases.
  • General Surgery – All emergency laparotomies.
  • Orthopaedics–Pelvic Packing, compromised limb.
  • Vascular – compromised limb.
  • Cardiothoracics – All emergency cardiothoracic surgery.
  • IR – Haemodynamically unstable pelvic fractures.
  • Neurosurgery – All emergency craniotomies.
  • Urology – Haemodynamically unstable high grade renal injuries.
  • Plastics – open fractures/compromised limb & burns.
  • ENT – Penetrating Neck injuries.
  • Maxillofacial – torrential maxillofacial haemorrhage.
  • Paediatrics – Patients <16 years old.
Major Trauma Care should be Consultant led

Fixation of pelvic ring injuries

Pelvic ring fractures should be fixed within 24 hours of injury in physiologically stable patients.