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Trauma: development of a sub-algorithm

¹ Director, Trauma Service, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
² Director of Research and Development, Sydney Medical Simulation Centre, Royal North Shore Hospital, St Leonards, New South Wales, Australia
³ Professor and Head, Department of Anaesthesia and Intensive Care, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
⁴ Senior Staff Specialist, Department of Anaesthesia and Intensive Care, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
⁵ Consultant Anaesthetist, Princess Royal University Hospital, Orpington, Kent, UK

Correspondence to:
Professor W B Runciman
President, Australian Patient Safety Foundation, GPO Box 400, Adelaide, South Australia, 5001, Australia; research{at}apsf.net.au Background: Anaesthetists are regularly involved in the management of patients who have suffered trauma. Acute physiological derangements can occur at any time after the original injury, with life threatening sequelae. These problems may be complex in nature and evolve rapidly, often with an obscure aetiology, so a systematic approach to them is essential.

Objectives: To examine the role of a previously described core algorithm "COVER ABCD–A SWIFT CHECK" supplemented by a specific sub-algorithm for trauma, in the management of anaesthesia involving trauma cases.

Methods: The potential performance of a structured approach for each of the trauma incidents among the first 4000 incidents reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual performance as reported by the anaesthetists involved.

Results: There were 38 relevant reports relating to trauma in the first 4000 reports to AIMS. In 39% of these there was "emergency corner cutting", although in the majority the urgency was thought to have been more perceived than real. The previously described "core" crisis management algorithm for crises during general anaesthesia was an effective means of discovering (82%), diagnosing (68%), and correcting (66%) the majority of trauma incidents. However a sub-algorithm specific for the traumatised patient was required for unusual, obscure, or complex presentations.

Conclusion: Although the small numbers preclude validation of the sub-algorithm, it would have successfully managed all the trauma cases reported to AIMS.

Keywords: incident monitoring; trauma; ventilation; hypotension; hypovolaemia; desaturation; patient transfer; crisis management

Relevant Article

Crises in clinical care: an approach to management

W B Runciman and A F Merry
Qual. Saf. Health Care 2005 14: 156-163. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

				W B Runciman, M T Kluger, R W Morris, A D Paix, L M Watterson, and R K Webb Crisis management during anaesthesia: the development of an anaesthetic crisis management manual Qual. Saf. Health Care, June 1, 2005; 14(3): e1 - e1. [Abstract] [Full Text] [PDF]