October 2011
19 posts
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Trauma In Wine Country?
Nope. Sorry. The two don’t mix. I just finished attending the American College of Surgeons meeting in San Francisco, and now I’m moving up to the Napa Valley for a few days. However, enjoying the sights, food and wine here is not conducive to writing coherently.
So I’m taking a few days off to concentrate on other things. I’ll return on Tuesday with several days of...
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Emergency Care Of Bleeding From Dabigatran
Finally, a consensus report has been finalized by the Institute for Clinical Systems Improvement (ICSI) regarding bleeding in patients taking dabigatran (Pradaxa). I’ve written about the special problems posed by patients who are injured while taking this drug and related ones. I’ve also provided some management algorithms for consideration while complete ones were crafted. Well, here...
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ED Thoracotomy: Practice Management Guideline
I still encounter a quite a bit of confusion about ED thoracotomy: when to do it, when to stop. A nice set of guidelines was developed by the Subcommittee on Outcomes of the American College of Surgeons Committee on Trauma about 10 years ago. And really, things haven’t changed very much since then.
In general, the literature on this topic has been all over the place. Most studies are...
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Trauma Care And HIPAA Demystified
There is a lot of confusion and misinformation out there regarding HIPAA (Health Insurance Portability and Accountability Act). This law was enacted in 1996 with the intent of protecting the health insurance benefits of workers who lose or change their jobs, providing standards for electronic health care transactions, and protecting a patient’s sensitive health information. This last part...
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Distracted Driving In Police Officers
A lot has been written about the hazards of distracted driving. Now, there is new information about the impact of distraction on police officers! A public safety administration class at St. Mary’s University here in Minnesota analyzed 378 crashes involving police cars from 2006 to 2010. The results are intriguing!
Key findings included:
Most crashes occurred during non-emergency responses
...
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CT Cystography For Bladder Trauma
Bladder injury after blunt trauma is relatively uncommon, but needs to be identified promptly. Nearly every patient (97%+) with a bladder injury will have hematuria that is visible to the naked eye. This should prompt the trauma professional to obtain a CT of the abdomen/pelvis and a CT cystogram.
The CT of the abdomen and pelvis will identify any renal or ureteral (extremely rare!) source for...
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More on Distracting Injury and Spine Clearance
There is a lot of angst out there among trauma professionals when it comes to clearing the cervical spine and possible distracting injuries. I’ve written about this before, and the most important technique I use is to try to see if the patient is aware of pain in areas distant from the suspected distraction.
A recent prospective study looked at injury patterns and c-spine clearance in over...
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Using The Slide Board In The ED
I’ve written several times on the importance of getting patients off the backboard promptly in the ED. Many hospitals use slide boards to facilitate patient movement on and off the ED cart when undergoing imaging studies. How should we manage the use of this device?
There is no difference between a backboard and a slide board to the patient. It’s hard and uncomfortable to lie on for...
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Practical Tips On Diaphragm Injury
Diaphragm injuries are notoriously hard to detect, and there is a significant rate of delayed or missed diagnosis. Today I’ll offer a few practical tips on finding and managing this rare injury.
Mechanism is important. Penetrating injury is more common, and it can be really tough to diagnose this injury in stabs to the lower chest. Anything below the nipples is suspect. Blunt injury...
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Removing The Backboard II
Ten months ago I wrote about getting patients off backboards as soon as possible. The question has arisen again, so I did a little digging to find some good science behind this. And I found it.
This problem has been looked at three ways. From best to worst they are: studies on OR patients who developed pressure ulcers postop, studies on animals, and studies on tissues. I’ll focus on the...
