Diagnostic Imanging in Shock Room of Emergency Department in Primary Survey of Politraumatized Patients: Importance of E-Fast in Decision Making in Hemodinamically Unstable Patients

Editorial

Austin J Radiol. 2015;2(1): 1008.

Diagnostic Imanging in Shock Room of Emergency Department in Primary Survey of Politraumatized Patients: Importance of E-Fast in Decision Making in Hemodinamically Unstable Patients

Giovanni Bellanova*

Surgery 2nd Division HBP Surgery, S.Chiara Hospital, Italy

*Corresponding author: Giovanni Bellanova, Surgery 2nd Division HBP Surgery, S.Chiara Hospital, L.go Medaglie d’Oro, 9 Trento - 38122 – Italy

Received: January 10, 2015; Accepted: January 12, 2015; Published: January 30, 2015;

Keywords

Primary Survey; Politrauma; Damage Control Resuscitation; E-FAST

Abbreviations

ATLS: Advanced Trauma Life Support; DCR: Damage Control Resuscitation; DCS: Damage Control Surgery; CT: Computer Tomography; E-FAST: Extended – Focused Assessment with Sonography for Trauma; ACOI: Associazione Chirurghi Ospedalieri Italiani

Editorial

In recent years, studies of clinical evidence and ATLS have always emphasized how the “golden hour” of severe polytrauma represents the time that will be influenced the prognosis.

More simply, the “golden hour” is the time available we have to try to save the patient’s life and/or improve his prognosis and outcome.

Out of hospital, at the scene of accident, according to experiences of war surgery, we passed from the “stay and play” concept to “scoop and run” strategy. Differently from the past the politraumatised patient was no transported to the nearerest rural hospital, but in the more appropriate Trauma Center, according to the principle of centralization (trans port to referenced trauma center) with the coordination of operations emergency rescue center at the time of call until the arrival in hospital.

In trimodal curve of survival of the trauma patients described by ATLS, resuscitation care obtains the major successes just in second peak of the “golden hour” which, over the years, according to studies of clinical evidence has clearly shortened its duration.

Actually we can sintetized all these with a single phrase: “Make Less, Make Better and Fastest as Soon as Possible!”

The Damage Control Surgery therefore falls within to be part of the resuscitation of severe polytrauma patients, enabling control of the bleeding and the continuation of the intensive care until hemodynamic stabilization.

To achieve this goal the first level diagnostics is an indispensable element in the decision of the subsequent therapeutic approach, reaffirming that in case of hemodynamic stability the gold standard in the diagnosis of lesions of polytrauma patients is the CT scan.

The dr. Tugnoli, director of Surgery of Trauma Unit in Bologna in his lessons in the ACOI School of Surgery of politraumatizated patient, does not speak of “golden hour” but of “five hundredth of a second of Diamond”, identifying the time needed to surgeon to decide the diagnostic approach in therapeutic severe polytrauma patients.

Deciding whether to do a CT scan or going directly in the operating room depends on this fraction of time, based on the information of the clinical and radiological diagnosis of first level performed in shock room.

Recently, in a scheme exposed in reports on the activityof the Emergency Department in my hospital (S.Chiara Hospital Trento), the chain of survival was reviewed and described as in Figure 1.