December 2010
14 posts
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Clinical Tip: The Flat Vena Cava in Blunt Trauma
Trauma patients who are hypotensive in the Emergency Department can only be transported to one of two places: the operating room or the morgue. With rare exception, they should never be taken outside the department (e.g. CT scan) because of the fear that they may arrest in an area that is not conducive to efficient resuscitation.
Sometimes patients are initially stable but decompensate later....
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What Is The Cost of the "Personal Freedom" Not To...
The Highway Safety Act of 1966 led to a mandate that all states adopt universal helmet laws for all motorcycle riders or risk the loss of federal highway funds. By 1975, all but 3 states had enacted these laws. However, Congress then did an about-face and eliminated the helmet law requirement for receiving the funds. Many states then revisited their laws, and some repealed them. As of now, 20...
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EAST Practice Guideline - Geriatric Trauma (2010...
The EAST Practice Management Guideline on management of geriatric trauma was updated early this year. This post gives the details of the proposed changes. Click here to open a copy of the existing PMG for comparison.
Prehospital Triage
Level II - Injured patients with advanced age (>=65) and pre-existing medical conditions (PECs) should lower the threshold for field triage directly to a...
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Observation of Occult Pneumothorax
An occult pneumothorax is one that is seen only on CT scan, but not on conventional chest x-ray. They are noted in somewhere between 2% and 10% of major blunt trauma patients. Although management is usually conservative, this has not been well studied.
A paper was presented at the AAST earlier this year based on a prospective, multicenter trial. The authors attempted to determine what factors...
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A Shortage of On-call Surgical Specialists to EDs?
The results of a survey published this month details problems caused by the lack of surgical specialists on call to emergency departments. It was conducted by the Robert Wood Johnson Clinical Scholars program and Yale University. They sent the survey to ED directors at 715 randomly selected hospitals around the country. The response rate was very good, with 62% returning their surveys.
An...
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Orthopedic Hardware And TSA Metal Detectors
Many trauma patients require implantable hardware for treatment of their orthopedic injuries. One of the concerns they frequently raise is whether this will cause a problem at TSA airport screening checkpoints (Transportation Safety Administration).
The answer is probably “yes.” About half of implants will trigger the metal detectors, and these days that usually means a pat down search. And...
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Removing The Backboard
Backboard usage by EMS is an important part of patient safety. It keeps the patient from injuring themselves or others within the confines of the ambulance or helicopter. But too much of anything is bad, and this is true of backboards as well. As little as 2 hours on a board can lead to skin breakdown. The most common reason that patients are not taken off boards sooner is concern for spine...
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Posterior Hip Dislocation
Although posterior hip dislocation is an uncommon injury, the consequences of delayed recognition or treatment can be dire. The majority are caused by head-on car crashes, and 90% of these are posterior dislocations. The femoral head is forced across the back wall of the acetabulum, either by the knee striking the dash, or by forces moving up the leg when the knee is locked. This occurs most...
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Drug Use and Automobile Crashes
All trauma professionals are keenly aware of how often alcohol is involved in automobile crashes. Something you may not know is that one third of drug tests for other substances are positive in drivers involved in car crashes!
There has been a 5 percent increase in the number of positive drug screens in drivers over the past 4 years. The drugs range from hallucinogens to prescription pain...
