The Golden Hour What should we be doing? Rapid assessmentĪTLS Resuscitation and stabilization Definitive management/TransferĪTLS Overview The ATLS Concept Primary Survey Adjuncts Secondary Survey Definitive Care/TransferĪTLS Overview The ATLS Concept treat life threatening injuries as they are identified assessment/diagnosis and resuscitation are simultaneousĪirway Breathing Circulation (neurologic) Disability Exposure / EnvironmentĪTLS Overview Adjuncts Urinary catheter NG tube XraysĪTLS Overview Secondary Survey Thorough “head to toe” assessmentĪirway obstruction tension PTX open PTX flail chest massive hemothorax cardiac tamponade
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Restores circulating volume improves oxygen delivery prevents cellular ischemia and tissue necrosis prevents onset of secondary cellular injury prevents onset of MODS The Golden Hour Rapid Resuscitation The Golden Hour Shock Pathophysiology prolonged hypoperfusion creates a vicious cycle of ischemia and shock 2 most important steps in managing shock: The Golden Hour Shock Pathophysiology inadequate organ perfusion and tissue oxygenation 3 factors determine: 1. Hemorrhagic shock is usually caused by bleeding into or from: A) abdomen B) pelvis C) chest D) head E) all of the above F) A,B,C
The bloody vicious cycle of trauma refers to: A) bleeding, hypothermia, and acidosisī) bleeding, hyperthermia, acidosis C) transfusion, hypothermia, acidosis D) transfusion, hypothermia, alkalosisĥ. The most commonly injured solid intraabdominal organ in blunt trauma is: A) liverĤ. The most easily reversible cause of shock in the trauma patient is: A) hemorrhagicī) neurogenic C) tension pneumothorax D) cardiac tamponadeģ. What is the most common cause of shock in the trauma patient? A) septicī) cardiogenic C) hemorrhagic D) neurogenicĢ. The Golden Hour Time and Trauma Outcomes no convincing studies that time to treatment consistently leads to better outcome outcome related to many factors including reduced time between injury and definitive care Ann Surg. You might not die right then it may be three days or two weeks later - but something has happened in your body that is irreparable." - R Adams Cowley If you are critically injured you have less than 60 minutes to survive. The Golden Hour "There is a golden hour between life and death. The Golden Hour recently, the validity of the “golden hour” as a rigidly defined timeframe scrutinized core principle of rapid intervention in trauma cases remains universally accepted
The Golden Hour originated by R Adams Cowley first sixty minutes after the occurrence of multi-system trauma victim's chances of survival are greatest if they receive definitive care in the OR within the first hour after a severe injury
Objectives concept of a golden hour pathophysiology of shock in the trauma patient resuscitation according to ATLS principles overview specifics
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Trauma: The Golden Hour Dennis Kim MD FRCS(C) General Surgery Trauma & Critical Care POS Core Lecture Series February 17 2009
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