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Title: A reflection of pre-hospital imaging on traumatic intra-abdominal haemorrhage
Author: Chaudery, Muzzafer
ISNI:       0000 0004 6347 1790
Awarding Body: Imperial College London
Current Institution: Imperial College London
Date of Award: 2016
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Torso haemorrhage remains one of the leading causes of preventable morbidity and mortality from trauma particularly in the prehospital setting. Early identification of the haemorrhage source is essential in order to improve outcomes and an effective imaging modality may help to establish the diagnosis. This thesis examines how to improve abdominal haemorrhage identification in the prehospital setting in order to achieve rapid haemorrhage control. The current literature is appraised and a national questionnaire distributed to frontline trauma care physicians. For haemorrhage identification research into ultrasound is recommended and for haemorrhage control novel procedures such as Resuscitative endovascular balloon occlusion of the Aorta (REBOA) are valued. FAST (Focused abdominal sonography for trauma) is considered the most appropriate modality for haemorrhage identification in the prehospital setting but it is associated with a steep learning curve. In order to improve training, a face, content and construct validation of a FAST simulator model is undertaken. Furthermore to better understand an ideal performance, an ergonomic analysis of experts’ workspace and force during a FAST scan is conducted. From this, an expert set of metrics is derived of the ideal ultrasound probe position and force for each FAST region. A learning curve study is implemented to assess two randomised groups of novices one trained with the expert metrics and the other trained using a standardised curriculum. The expert metrics group are faster and more accurate at performing a FAST scan than the control. This is also the case in a prospective validity study. REBOA is being investigated as a novel technique for prehospital haemorrhage control. Accurate inflation of the balloon catheter within the correct zone is critical to gain control of bleeding and prevent adverse effects, particularly in the prehospital setting. A feasibility study identifies that ultrasound guidance and balloon insufflation with contrast agent enhances catheter placement within Zone III. Subsequently, two groups of physicians are randomised to perform REBOA with and without ultrasound guidance. The former are faster and more precise than the latter group hence supporting the robustness of the ultrasound imaging technique. Overall this thesis enhances prehospital abdominal haemorrhage identification by improving FAST training and augments haemorrhage control through accurate REBOA placement with the use of ultrasound and contrast agent.
Supervisor: Darzi, Ara ; Clark, James Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral