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Course Image Multiple Trauma Part IV: Trauma care in the ICU and beyond

Multiple Trauma Part IV: Trauma care in the ICU and beyond

ACE
Trauma and Emergency Medicine

Summary

In severely injured trauma patients, several cells (endothelial and macrophages mainly) are damaged and activated by massive tissue disruption and microcirculatory hypoperfusion. This leads to the release of “alarm” molecules named “alarmins” or DAMPs (Damage or Danger Associated Molecular Patterns). Like PAMPs (Pathogen Associated Molecular Patterns), molecules are released after pathogen attacks. Several of these molecules are passively released from dying cells; others are actively secreted. Similar proteins will be released after a cellular injury during bacterial infection or traumatic injury because the genetic background of the bacteria and the cells’ mitochondria involved in the injury response is very similar. An insult triggers the release of PAMPs and/or DAMPs. 



General Information

Enrolled trainees 484

Open 25.04.2023

Available for ESICM members

Student effort 2

Last Updated April 25, 2023

Intended Learning Outcomes

After studying this module on Multiple Trauma Part IV: Trauma care in the ICU and beyond you should be able to:

  • To describe and manage specific challenges and complications in trauma patients in the ICU in the immediate post-resuscitation and chronic ICU phase
  • To optimize supportive and preventive therapies
  • To identify challenges and issues regarding patient comfort, prevention of PTSD, psychological care for the patient and relatives


Relevant competencies in CoBaTrICE

  • 1.1 Adopts a structured and timely approach to the recognition, assessment, and stabilisation of the acutely ill patient with disordered physiology
  • 1.2 Manages cardiopulmonary resuscitation
  • 1.3 Manages the patient post-resuscitation
  • 1.4 Triages and prioritises patients appropriately, including timely admission to ICU
  • 1.5 Assesses and provides initial management of the trauma patient
  • 2.1 Obtains a history and performs an accurate clinical examination
  • 2.2 Undertakes timely and appropriate investigations
  • 2.3 Performs and interprets transthoracic cardiac ultrasound for the recognition and assessment of left ventricular and right systolic failure, contraction pattern and dilation and pericardial tamponade
  • 2.3b Performs and interprets ultrasonographic assessment of the lungs and pleura for the recognition and assessment of consolidation, pleural effusion and pneumothorax.
  • 2.3c Performs and interprets ultrasonographic assessment of the abdomen to assess intraperitoneal free fluid, hydronephrosis and bladder volume.
  • 2.6 Obtains and interprets the results from blood gas samples
  • 2.7 Interprets chest x-rays
  • 2.8 Liaises with radiologists to organise and interpret clinical imaging
  • 2.9 Monitors and responds to trends in physiological variables
  • 2.10 Integrates clinical findings with laboratory investigations to form a differential diagnosis
  • 3.3 Recognises and manages the patient with circulatory failure
  • 3.4 Recognises and manages the patient with, or at risk of, acute renal failure
  • 3.5 Recognises and manages the patient with, or at risk of, acute liver failure
  • 3.6 Recognises and manages the patient with neurological impairment
  • 3.8 Recognises and manages the patient with acute respiratory failure and acute respiratory distress syndrome (ARDS)
  • 3.9 Recognises and manages the septic patient
  • 4.1 Prescribes drugs and therapies safely
  • 4.2 Manages antimicrobial drug therapy
  • 4.3 Administers blood and blood products safely
  • 4.4 Uses fluids and vasoactive / inotropic drugs to support the circulation
  • 4.6 Initiates, manages, and weans patients from invasive and non-invasive ventilatory support
  • 4.7 Initiates, manages, and weans patients from renal replacement therapy
  • 4.8 Recognises and manages electrolyte, glucose, and acid-base disturbances
  • 4.9 Provides nutritional assessment and support
  • 6.5 Manages the pre- and post-operative care of the trauma patient
  • 7.1 Identifies and attempts to minimise the physical and psychosocial consequences of critical illness for patients and families
  • 7.2 Manages the assessment, prevention, and treatment of pain, delirium, and other distress *7.3 Manages sedation and neuromuscular blockade
  • 7.4 Communicates the continuing care requirements of patients at ICU discharge to health care professionals, patients, and relatives
  • 7.5 Manages the safe and timely discharge of patients from the ICU
  • 8.1 Manages end of life care and the process of withdrawing and withholding treatment with the multidisciplinary team
  • 8.2 Discusses end of life care with patients and their families / surrogates
  • 8.3 Manages palliative care of the critically ill patient

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