September 2010
15 posts
3 tags
NEW: Indexed Archive for the Trauma Professional's...
Over the past several months, I’ve wanted to refer to older blog entries while teaching our surgical and emergency medicine residents. However, I’m not completely satisfied with the search system available here on Tumblr, my blog host. And although the Archive View feature is fun (you can see a snapshot of entries by month), it’s still tough to drill down to a specific post.
...
3 tags
Probiotics in Trauma Care
Probiotics are live micro-organisms that can be taken orally that can restore balance to the intestinal microflora. These bacteria or yeasts can also produce nutrients and anti-oxidants that fight bacterial endotoxin and activate the lymphoid tissue found in the intestine.
Probiotics come in a variety of forms and can cost very little or quite a lot. The simplest and cheapest forms are live...
“The older you grow, the less you touch with your fingers”
– MDM
4 tags
PulseCheck: Hot Topics In EMS Handout
PulseCheck: Hot Topics in EMS is going on today at the Holiday Inn Select in Bloomington! The program includes TV anchor Don Shelby speaking on the evolution of Primary Service Areas in Minnesota.
I will be giving a presentation on pediatric trauma. This talk was added to the program on short notice, so no handout was available to participants.
To download a copy of the slides I presented,...
4 tags
How To: Flexion / Extension Views of the Cervical...
Clearance of the cervical spine can often be done using clinical criteria alone (see this video at http://youtu.be/NhjF9kDOcjE). If this is not possible, a combination of radiologic and clinical evaluation is usually carried out.
In some cases, radiographic studies (usually CT) are normal, but there is pain on clinical exam. Our next step is to send the patient to xray for flexion and extension...
5 tags
Can Fish-Oil Supplements Speed Recovery From TBI?
Overall, omega-3 fatty acids (O3FA) are thought to be an important and beneficial part of our diet. Recently, the Journal of Neurosurgery published an online paper that looked at the potential benefits of fish oil supplementation on recovery from brain injury.
Originally, axonal damage from TBI was thought to occur at the time of impact. Recent research has shown that the injury is really a...
3 tags
Performance Improvement for FAST
FAST is an integral component of major trauma evaluation. Unfortunately, although lots of people do them, quality control is not very consistent.
Researchers at the University of Pennsylvania studied how the use of a standard checklist and it’s impact on exam quality. Detection of fluid in any of the standard 4 FAST locations was recorded for every exam performed. No attempts were made to...
3 tags
Flying After Pneumothorax
Patients who have sustained a traumatic pneumothorax occasionally ask how soon they can fly in an airplane after they are discharged. What’s the right answer?
The basic problem has to do with Boyle’s Law (remember that from high school?). The volume of a gas varies inversely with the barometric pressure. So the lower the pressure, the larger a volume of gas becomes. Most of us hang...
4 tags
To Probe or Not To Probe: Penetrating Wounds
There is considerable variability in the way that penetrating wounds are approached. Some are located over areas of lesser importance (distal extremities) or are so superficial that they obviously don’t fully penetrate the skin.
Unfortunately, some involve high-value structures (much of the neck and torso), or are too small to tell if they penetrate (ice pick injury). How should these...
4 tags
Personal Decisions are the Leading Cause of Death
A relatively obscure research paper published in late 2008 by Ralph Keeney at Duke University makes this startling claim: over half of the people who died in this country in the year 2000 did so because of their own personal decisions! If you look at current mortality statistics, the top four causes of death from year to year are heart disease, cancer, stroke and injury. We naturally look at this...
3 tags
When To Remove a Chest Tube
Chest tubes are needed occasionally to help manage chest injuries. How do you decide when they are ready for removal?
Unfortunately, the literature is not very helpful in answering this question. To come up with a uniform way of pulling them, our group looked at any existing literature and then filled in the blanks, negotiating criteria that we could all live with. We came up with the following.
...
2 tags
Off-Label Use of the Foley Catheter
Foley catheters are a mainstay of medical care in patients who need control or measurement of urine output. Leave it to trauma surgeons to find warped, new ways to use them!
Use of these catheters to tamponade penetrating cardiac injuries has been recognized for decades (see picture, 2 holes!). Less well appreciated is their use to stop bleeding from other penetrating wounds.
Foley catheters...
3 tags
Syncope Workup in Trauma Patients
Syncope accounts for 1-2% of all ED visits, and is a factor in some patients with blunt trauma, especially the elderly. If syncope is suspected, a “syncope workup” is frequently ordered. Just what this consists of is poorly defined. Even less understood is how useful the syncope workup really is.
Researchers at Yale retrospectively looked at their experience doing syncope workups in...
2 tags
EMS: Which Field Airways Work The Best?
Oral endotracheal intubation is the gold standard when a field airway is needed. However, they are not always possible due to protocol, training, patient anatomy or specific injuries. To allow airway support in these situations, a number of techniques and devices have been developed. The problem is, do we really know which one(s) are best?
To try to answer this question, a huge meta-analysis of...
3 tags
Trauma Factoid: What Cars Were Doing When Involved...
What were cars doing when they got involved in a fatal crash?
69% - going straight ahead
15% - negotiating a curve
6% - turning left
4% - not known
2% - passing
2% - merging or changing lanes
1.5% - stopping, slowing or starting in a traffic lane
0.8% - turning right
Bottom line - most fatal crashes occur when moving straight ahead, but look out when turning left!!
Reference: NHTSA
