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Emergency, Acute Care Medicine and Trauma

Overview

Continental Institute of Emergency, Trauma & Critical Care

Emergency, Trauma and Critical Care medicine is related to the care of unscheduled patients who require immediate medical treatment. It involves spontaneous decision making and carrying out of actions that are pivotal to prevent further degeneration of the patient's condition. An emergency physician is responsible for providing immediate acknowledgement, evaluating and stabilizing adult and paediatric patients. The EP is supported by a team of clinicians, surgeons and nurses well trained to work under high stress and time sensitive situations.

The Continental Institute of Emergency, Trauma Services & Critical Care Management is a Level 1 Tertiary comprehensive centre equipped to deal with every type of urgent life-threatening condition. We are of the select few private hospitals in Hyderabad and South India to have a bedded A&E equipped with state-of-the-art equipment for a wide spectrum of patients with acute emergencies for initial evaluation, resuscitation, treatment, investigation, stabilization, monitoring and disposition. Working round the clock, our physicians have access to highly advanced and accurate laboratory and radiology tests. Our Continental Life Care on Wheels Ambulance Service has an efficient and high tech line of ambulances that are available 24*7 to transport critically ill or injured patients.

When unforeseen circumstances appear before a person that calls for immediate action, it’s called emergency. A medical emergency could be accidents, cardiac arrests, strokes, heart attacks, etc. An outbreak of diseases such as cholera, swine flu, dengue can also lead to medical emergencies.  These emergencies are life-threatening and require immediate care by medical professionals.

In medical terms, trauma means a serious or life-threatening accident or injury to an individual resulting in broken bones, wounds or damage to the internal organs of a person/s. It also means a distressing or disturbing psychological experience that occurs to an individual.

Traumatic injuries are caused by injuries on the body from an external force, which can be blunt or penetrating. Blunt trauma includes falls, road traffic crash injuries, assaults like kicking and burns. Penetrating trauma includes shooting, stabbing, impalement, and severe internal injuries to a person. Major trauma causes prolonged disability or death.

Critical care or intensive care is specialized care provided to patients suffering from severe, life-threatening conditions and requires comprehensive care and constant monitoring by health professionals.

In India, one of the major causes of mortality and morbidity is a road accident on national highways. In such a scenario, the Government of India has encouraged setting up trauma facilities by hospitals, especially near the national highways. In this regard, Trauma centers at various levels have been set up based on their capabilities and the facilities available.

The different levels (Levels I, II, III, IV, V) refer to the kind of staff and facilities available at the center as well as the number of patients admitted yearly.

Level I Trauma Center is capable of providing total comprehensive care to patients from every aspect, like

  • 24 hours in-house care by general surgeons and prompt availability of care in all the specialties such as orthopedic surgery, anesthesiology, neurosurgery, emergency medicine, radiology, internal medicine, plastic surgery, oral and maxillofacial, pediatric and critical care
  • Provides continuing education of the trauma team members
  • Incorporates a comprehensive quality assessment program
  • Operates an organized teaching and research effort to help direct innovations in trauma care
  • Meets minimum requirement for annual volume of severely injured patients
  • Provides leadership in the prevention, public education to surrounding communities

Level II trauma center can initiate definite care for all injured patients including

  • 24 hours immediate coverage by general surgeons and by specialties like orthopedic surgery, anesthesiology, neurosurgery, emergency medicine, radiology, and critical care
  • Tertiary care needs such as cardiac surgery, hemodialysis, and microvascular surgery referred to a Level I trauma center

 

Level III trauma center has demonstrated an ability to provide prompt assessment, resuscitation, surgery, intensive care and stabilization of injured patients and emergency operations including

  • 24-hr immediate coverage by emergency medicine physicians and the prompt availability of general surgeons and anesthesiologists
  • Has developed transfer agreements for patients requiring more comprehensive care at a Level I or Level II trauma centers.

 

Level IV trauma center has demonstrated an ability to provide advanced trauma life support (ATLS) before the transfer of patients to a higher-level trauma center. It provides evaluation, stabilization, and diagnostic capabilities for injured patients which includes

  • Basic emergency department facilities and 24-hour laboratory coverage
  • Available trauma nurse(s) and physicians available upon patient arrival.
  • May provide surgery and critical-care services if available.
  • Has developed transfer agreements for patients requiring more comprehensive care at a Level I or Level II Trauma Center.

 

Level V trauma center provides initial evaluation, stabilization and diagnostic capabilities and prepares patients for transfer to higher levels of care which includes

  • Basic emergency department facilities
  • Available trauma nurse(s) and physicians available upon patient arrival
  • May provide surgery and critical-care services if available.
  • Has developed transfer agreements for patients requiring more comprehensive care at Level I through III Trauma Centers.

Continental Hospitals is one of the best hospitals for emergency and critical care in Hyderabad as its dedicated Continental Institute of Emergency, Trauma Services & Critical Care Management is a Level I Tertiary comprehensive center that is equipped to deal with every type of urgent life-threatening condition.

Why Choose Continental Hospitals for Emergency, Acute Care Medicine & Trauma?

When patients face life-threatening injuries or diseases that require immediate attention and where vital organs of the body are affected, emergency and trauma services are essential for such patients. Hospitals that mange trauma from minor injuries to major injuries in infants, women, children, and the elderly by providing quality care is one of the cornerstones of an emergency and trauma department in such hospitals.

The doctors in Continental Hospitals have received extensive training in A&E services and ACLS protocols. The ability to think on the feet and take spontaneous decisions is ingrained in each doctor, surgeon and nursing staff of Continental Hospitals. Our esteemed doctors examine, diagnose and treat life-threatening injuries as soon as they are diagnosed. Time is of the utmost importance in the treatment of a patient who is brought in the emergency area, so having a multidisciplinary team of specialists round-the-clock helps the patient get good quality care and safety.

Continental hospitals is a Level I trauma center and are one of the few hospitals in South India, who have this distinction to serve emergency and trauma patients in the golden hour period with prompt medical and surgical treatment preventing death.  Continental Hospitals is the best hospital for emergency and Trauma services in Hyderabad as our multidisciplinary team of doctors, surgeons and nurses follow ACLS protocols and provide immediate medical services to critically ill or injured patients.  Our Continental Life Care on Wheels Ambulance Service has an efficient and high-tech line of ambulances that are available 24*7 to transport critically ill or injured patients. At Continental Hospitals, the emergency and trauma team provide individual patient care from emergency resuscitation, surgery, intensive care, and rehabilitation, deeming it the best hospital for critical and trauma care in Telangana.

The emergency department in a hospital is the first place where critically ill or injured patients are admitted for treatment. The healthcare provider in the emergency department has brought about various advances in diagnostic procedures. Diagnostic tests are carried out by the doctors in the emergency department to rule out any conditions such as intracranial hemorrhage, pulmonary embolus, aortic aneurysm or dissection, and more.

In trauma centers, teamwork is essential to evaluate critically injured patients and diagnostic procedures are performed simultaneously to save time for the treatment provided to the patients.

Triage (the process of sorting people based on their need for immediate medical treatment as compared to their chance of benefiting from such care) is done based on the ABCDE principles as mentioned in WHO’s Emergency and Essential Surgical care (EESC) program.

ABCDE principles are:

  • A=airway obstruction to be cleared
  • B=breathing and ventilation -any chest decompression
  • C=circulation with hemorrhagic control
  • D=Disability or neurological damage
  • E=exposure/environmental control

The initial assessment or primary survey of the patient involves

  • Assessing the airway of the patient for any blockage or not. Diagnostic equipment for clearing the airway include
  • functioning laryngoscope with light
  • appropriate endotracheal tube
  • bag-valve-mask
  • oxygen source
  • suction

Defibrillators are devices that restore a normal heartbeat by sending an electric pulse or shock to the heart. They are used to prevent or correct an arrhythmia, a heartbeat that is uneven or that is too slow or too fast.

  • Breathing and ventilation of the patient to be checked for respiratory distress, indication for chest decompression, diagnoses include
  • open pneumothorax or open chest wound to be treated
  • tension pneumothorax-air leakage from a punctured lung
  • hemothorax-collection of blood in the space between the chest wall and the lung
  • Circulation assessment due to hemorrhagic shock
  • Large volumes of blood may be hidden in thoracic, abdominal and pelvic cavities, or from femoral shaft fractures.
  • Assessment is done on physical parameters like the level of consciousness, skin color, pulse, confusion, and blood loss in adults, children, elderly and athletes vary
  • Disability or neurological damage to be checked by
  • level of consciousness using the Glasgow coma score (GCS)
  • pupils size and symmetry
  • any spinal cord injury
  • -radycardia, hypertension may indicate worsening condition
  • Exposure/ environmental control
  • examine the whole patient, child or adult, by removal of clothing but prevent hypothermia (exposure to extreme cold)

Some of the Diagnostic tests done are:

  1. X-rays of chest, pelvis, cervical spine
  2. Ultrasound-focused assessment with sonography for trauma

Additional assessment after the primary assessment of the patients includes head exam, neck exam, neurological exam, chest exam, abdominal exam, pelvis, and limbs.

Further monitoring is carried out by using the following types of equipments:

  1. ECG monitoring which can help in resuscitation by diagnosing dysrhythmias, ischemia, cardiac injury, pulseless electrical activity (PEA)
  2. Urinary/gastric catheters
  3. Pulse oximetry- a physiological monitoring device for heart rate, oxygenation, especially useful in anesthesia, ICU
  4. Physical examination by checking the person’s medical history, including allergies, medications currently used, past illness/pregnancy, last meals, events related to the trauma

For critical care patients, the diagnostic tests or procedures include

  • Blood gas test– it measures the amount of oxygen and carbon dioxide in the blood. It may also be used to determine the pH of the blood, or how acidic it is.
  • Coagulogram- is an analysis to find out about the main indicators of coagulation and anticoagulation systems of blood.
  • Capnography- monitoring of the concentration or partial pressure of carbon dioxide in the respiratory gases and helps to determine the oxygen supply at the tissue level 
  • Blood glucose monitoring– by using glucometers
  • Pulse oximetry- a method used to estimate the percentage of oxygen bound to hemoglobin in the blood.
  • Nerve conduction study– measures how fast an electrical impulse moves through your nerve. NCV can identify nerve damage.

Continental Hospitals is one of the best emergency hospitals in Hyderabad for providing emergency care and trauma care to the people who need immediate diagnosis and care.

As one of the largest Accident and Emergency Departments in the country, Continental Institute of Emergency, Trauma and Critical Care Medicine has the ability to handle all medical and surgical emergencies, including trauma and toxicological cases.

ADULTS:

  • Cardiac & Stroke Units are available 24x7 to respond to any emergency.
  • A dynamic Masters in Emergency Medicine Course with doctors qualified M.D in Emergency Medicine as teaching faculty offers residents the opportunity to practice amidst the brightest medical talent in the country.
  • International Triage System is followed with an Advanced Resuscitation Room that provides round-the-clock emergency care.
  • A well-equipped ambulance line led by EMRI certified teams.

CRITICAL CARE:

  • Ultra-modern Single room ICUs are fully equipped with the latest ventilators, monitoring devices and other life support devices to provide the best care.
  • Operation theatres with seamless modular systems, controlled air and 3D monitoring systems provide an optimum environment for our surgeons and staff in patient care.
  • Highly qualified critical care specialist doctors provide round the clock care to patients.
  • Visitor facilities for patient families are conveniently provided.

PEDIATRIC:

  • Provides initial evaluation, triaging, stabilization and treatment to acutely ill or injured infants and children.
  • Monitoring of pediatric poisonings and accidents by specialists trained in pediatric emergency medicine.

MEDICAL EMERGENCIES

When a medical emergency arises which may be life-threatening, treatment usually requires surgery. Some emergencies that require surgery are:

  • Invasive types of resuscitation and surgery for certain causes of acute respiratory failure. Cardiopulmonary resuscitation (CPR) consists of the use of chest compressions and artificial ventilation to maintain circulatory flow and oxygenation during cardiac arrest
  • Severe trauma to the head, chest, abdomen, or extremities. Surgery may be needed to repair injured organs which otherwise would be fatal and life-threatening
  • Severe burns - The depth of the burns is important to assess its severity and to plan care for the burn wounds-first degree burns causes pain and no blisters, second-degree burns characterized by red mottled skin and flash burns due to contact with hot liquids and third-degree burns where the skin becomes dark, leathery and dry caused by fire, electricity or lightning, and prolonged exposure to hot objects.
  • The surgery could be a plastic or reconstructive surgery to help the patients heal over time.
  • Cardiac events, such as heart attacks, cardiac shock, and cardiac arrhythmia, use of defibrillators that restore a normal heartbeat by sending an electric pulse or shock to the heart. They are used to prevent or correct an arrhythmia, a heartbeat that is uneven or that is too slow or too fast.
  • A ruptured aneurysm needs emergency surgery and without immediate repair, patients have a low chance of survival as it may cause long or short-term brain damage or fatal hemorrhage stroke.
  • Neurological conditions/brain conditions. Patients with a severe head injury will be admitted to an intensive care unit for close neurological monitoring for any signs of intracranial pressure by an ICP monitor placed in the brain to record pressure in the brain
  • Abdominal emergencies such as perforated ulcer, appendicitis, cholecystitis (gallbladder infection), or bowel blockage

Acute care is provided to individuals who require quality health care, time-sensitive, and continuous careful monitoring. At the core of the critical care system is the hospital’s Intensive Care Unit (ICU).

An intensive care unit (ICU) provides critical care and life support for acutely ill and injured patients comprises large sterile areas with a high concentration of specialized, technical and monitoring equipment providing care to critically ill patients.

Our hospital ICUs specialize in providing care for particular health conditions or injuries including:

  • Major trauma – Isolated or multiple injuries that may result in disability and death, which could be caused by road incidents, falls, sports injuries and acts of violence
  • Severe Burns – Treatment varies from individual to individual and the degree of burns that may also require plastic or reconstructive surgery to be done on a burnt patient to improve their quality of life.
  • Respiratory failure – Treatment depends on the severity and acuteness of respiratory failure. Oxygen therapy by tracheostomy is provided or a patient can be put on a ventilator machine when a person cannot breathe on his/her own and the machine breathes for the person by pushing in warm oxygenated air into the patient.
  • Organ transplants – It is the treatment for end state organ failures such as liver and heart failure. Some critical conditions like an acute liver failure from a drug overdose or poisoning or kidney failure can lead to emergency organ transplantation
  • Complex spinal surgery – Immobilization of the spine is the first step in a spine injury. The doctors will analyze the type and extent of the injury before deciding on surgery
  • Cardiothoracic surgery – Cardiothoracic emergencies are precipitated by one of the following conditions: (i) intractable myocardial ischemia, (ii) obstruction in cardiac output, (iii) hemorrhage, or (iv) obstruction to airflow.

Continental Hospitals is one of the best hospitals for emergency care in Hyderabad on account of round-the-clock 24*7 ambulance services, multidisciplinary 24-hr emergency care, doctors, surgeons, and nurses.

Equipment that may be used in an ICU includes

  • a ventilator – a machine that helps with breathing; a tube is placed in the mouth, nose or through a small cut in the throat (tracheostomy)
  • monitoring equipment – used to measure important bodily functions, such as heart rate, blood pressure and the level of oxygen in the blood
  • IV lines and pumps – tubes inserted into a vein (intravenously) to provide fluids, nutrition, and medication
  • feeding tubes – tubes placed in the nose, through a small cut made in the stomach or into a vein if a person is unable to eat normally
  • drains and catheters – drains are tubes used to remove any build-up of blood or fluid from the body; catheters are thin tubes inserted into the bladder to drain urine from the body
  • ICU teams are multi-disciplinary, made up of highly skilled intensive care nurses, doctors, and specialists trained in providing critical care for patients with a variety of medical, surgical and trauma conditions.

Our Doctors

The Continental Institute of Emergency, Trauma Services & Critical Care leverages well-trained emergency physicians who have immense experience in handling emergency and trauma patients. All nurses are well qualified and ACLS trained. The Emergency Radiology Center is fully functional with Qualified Intensivists, Emergency Personnel, and Emergency Medical Trauma Technicians. This is the only center that has emergency medical services with advanced cardiac and life support ambulances. The centre conducts regular mock drills for handling mass casualties on periodic basis. The center also trains emergency physicians and trauma technicians guiding them to educate the general public and ORR patrolling police on handling trauma patients.

The doctors at Continental Hospitals in the Continental Institute of Emergency, Trauma Services & Critical Care Management are reputed, knowledgeable and experienced in the area of emergency medicine. They have won many accolades for their quality medical care and presence of mind during emergencies. They are part of many societies and federations of Emergency medicine in India and overseas. Our doctors have also been involved in the continuous training of personnel in the innovative ways of handling trauma patients at Continental Hospitals.

Dr Sree Sowjanya Patibandla

MD ( Accident & Emergency Medicine) University Rank Holder,
MBA ( Health care and Hospital Management) BITS Pilani Post Graduate Diploma in Advanced Sonography and Echocardiography , Infectious Diseases and Cardiology Fellowship in International Society for Quality in Healthcare.

Senior Consultant and Head of the Department at Continental Institute of Trauma and Emergency Medicine

Dr John Doe
Dr Pradeep Malichetty

MBBS, MEM (GWU, USA)

Consultant

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