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The Ryder Cognitive Aid Checklist for Trauma Anesthesia

6/4/2016

 
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Anesthesia & Analgesia May 2016;122(5):1484–1487.
Despite mixed results regarding the clinical utility of checklists, the anesthesia community is increasingly interested in advancing research around this important topic. Although several checklists have been developed to address routine perioperative care, few checklists in the anesthesia literature specifically target the management of trauma patients. We adapted a recently published “trauma and emergency checklist” for the initial phase of resuscitation and anesthesia of critically ill trauma patients into an applicable perioperative cognitive aid in the form of a pictogram that can be downloaded by the medical community. The Ryder Cognitive Aid Checklist for Trauma Anesthesia is a letter-sized, full-color document consisting of 2 pages and 5 sections. This cognitive aid describes the essential steps to be performed: before patient arrival to the hospital, on patient arrival to the hospital, during the initial assessment and management, during the resuscitation phase, and for postoperative care. A brief online survey is also presented to obtain feedback for improvement of this tool. The variability in utility of cognitive aids may be because of the specific clinical task being performed, the skill level of the individuals using the cognitive aid, overall quality of the cognitive aid, or organizational challenges. Once optimized, future research should be focused at ensuring successful implementation and customization of this tool.
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Development of a standard operating procedure and checklist for rapid sequence induction in the critically ill

2/9/2015

 
Scand J Trauma Resusc Emerg Med. 2014 Sep 11;22(1):41.

Introduction Rapid sequence induction (RSI) of critically ill patients outside of theatres is associated with a higher risk of hypoxia, cardiovascular collapse and death. In the prehospital and military environments, there is an increasing awareness of the benefits of standardised practice and checklists.

Methods We conducted a non-systematic review of literature pertaining to key components of RSI preparation and management. A standard operating procedure (SOP) for in-hospital RSI was developed based on this and experience from large teaching hospital anaesthesia and critical care departments.

Results The SOP consists of a RSI equipment set-up sheet, pre-RSI checklist and failed airway algorithm. The SOP should improve RSI preparation, crew resource management and first pass intubation success while minimising adverse events.

Conclusion Based on the presented literature, we believe the evidence is sufficient to recommend adoption of the core components in the suggested SOP. This standardised approach to RSI in the critically ill may reduce the current high incidence of adverse events and hopefully improve patient outcomes.

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Trauma Care at a Multinational United Kingdom-Led Role 3 Combat Hospital: Resuscitation Outcomes From a Multidisciplinary Approach

11/10/2014

 
Mil Med. 2014 Nov;179(11):1258-62.  


Abstract:
Recent conflicts have led significant advancements in casualty care. Facilities serving combat wounded operate in challenging environments. Our purpose is to describe the multidisciplinary resuscitation algorithm utilized at a United Kingdom-led, Role 3 multinational treatment facility in Afghanistan focusing on injury severity and in-hospital mortality. Methods: Data were extracted from our prospectively collected trauma registry on military members wounded in action. Results: From November 1, 2009 to September 30, 2011, there were 3483 military trauma admissions. Common mechanisms of injury were improvised explosive devices (48%), followed by gunshot wounds (29%). Most patients (83.1%) had an Injury Severity Score (ISS) <15. For patients with complete ISS data, 8.4% had massive transfusion and 6.1% had an initial base deficit >5. Patients admitted with signs of life had a died of wounds rate of 1.8% with an average 1.2 day hospital stay. The mortality rate for patients undergoing massive transfusion was 4.8%, and for patients with a base deficit >5, mortality was 12.3%. Severely injured patients (ISS > 24) had a mortality rate of 16.5%. Conclusion: A systematic, multidisciplinary approach to trauma is associated with low in-hospital mortality. The outcomes in this study serve as a measure for future care in Role 3 facilities.
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