New Technique for Fasciotomy Closure
Fasciotomies are much more easily opened than closed! Once the edematous muscle is released, it’s not easy to get the skin to close over it again. On occasion, an immediate closure can be carried out. But in most cases, the process is performed with one or more additional operations. Continuous tension across the skin edges is important. This keeps the wound from getting wider while the...
Can Texting Bans Be Bad?
By now, everyone probably knows that texting while driving is bad. So legally banning texting is good, right? It seems that way, since everyone is doing it. Thirty states plus the District of Columbia currently ban texting while driving, and a third of those laws were passed just this year. Talk about the law of unintended consequences. The Highway Loss Data Institute compared collision insurance...
Bleeding and Pelvic Fractures
Arterial bleeding from a pelvic fracture is more common than previously thought. The doctor books used to say that 10% of bleeding was arterial and 90% was venous, so angiographic techniques were seldom used unless there was clinical evidence of blood loss. It looks like arterial bleeding occurs more frequently than we think. Here are tips that help you identify patients at risk: What type of...
Scoop and Run or Stay and Play for Trauma Care?
Scoop and run vs stay and play are traditionally EMS concepts. Do I stay at the scene to perform invasive procedures, or do I perform the minimum I can and get to the nearest hospital? For trauma patients time is the enemy and there is a different flavor of scoop and run vs stay and play. Do I take the patient to a nearby hospital that is not a high level trauma center to stay and play, or do I...
Which Lacerations Can I Close?
There is always debate about which lacerations can be closed, but not a lot of literature to back it up. Here are some good rules to follow: In general, close all face and scalp lacerations. They almost never get infected. Complicated ones may need extra care, debridement, or involvement of a plastic surgeon. Closing lacerations that are more than 24 hours old is risky (except for the face)....
Yet Another Paper on Treating Pneumothorax With...
Back in February, I thought I closed the door on using high inspired oxygen to try to speed up the resolution of pneumothorax (see related post below). I’ve just run across another attempt which is equally as bad! This article was published in the Journal of Pediatric Surgery in 2000. The authors randomly divided 27 rabbits into three groups: room air, 40% O2, and 60% O2. Each was given a...
Radiation Exposure in Pediatric Trauma
The use of radiographic imaging in trauma patients has exploded over the past decade. A growing amount of research is looking at adult patients, but what about children? Johns Hopkins did a one year retrospective review of radiographic imaging in kids age 14 and below. The studies performed and the estimated radiation dose was calculated for each child. A total of 719 children were studied and...
How Big Was The Knife?
As part of a thorough history and physical on any trauma patient, we typically ask “How big was the knife you were stabbed with?” and “How deep did it go?” Unfortunately, the answers you typically will get are “This big!” while they hold their hands at least 3 feet apart, and “All the way, doc!” These answers are not very helpful, so it is not...
Making Aeromedical Flights Safer
There are about 840 EMS helicopters operating nationwide. The fatal accident rate has doubled from the mid-90’s to the growth spurt seen in the earlier part of this decade. Since late 2007, 57 crew members and patients have died in these helicopter crashes. According to the FAA, the most frequent causes of these crashes were controlled flight into terrain, inadvertent flight into instrument...
Diagnosing Facial Fractures With CT
Facial fractures are common after major blunt trauma. There are a number of diagnostic tests available for their diagnosis, including head CT, conventional facial imaging and facial CT. Our preference has been to add a facial CT to the list of diagnostics in any patient with external evidence of facial trauma. Subjectively, it appeared that there were not many injuries being identified, and the...
Prone Positioning After Laparotomy
Patients with serious abdominal injury may require a laparotomy, and a subset of these may need a temporary closure for damage control surgery. Concomitant spine injury may have your spine surgeons asking “is it safe to prone the patient who is postop with a midline incision or an open abdomen.” What to tell them? There’s not much guidance out there in the literature. One paper...