December 2011
19 posts
Taking A Few Days Off?
Yes, I’m traveling today through the end of next week. Of course, I’ll be keeping my eyes open for interesting trauma stuff. If I don’t find anything really interesting, I’ll be running some “best of” columns that highlight good stuff from the past.
I’ll be attending EAST after that, and I’ll be tweeting from the meeting like a madman.
I will be...
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Hypothermia and Massive Transfusion
Tuesday, I talked about a new notion of using profound hypothermia to save critically injured trauma patients. Since this concept is not yet ready for prime time, we still have to treat hypothermia as our enemy. Most trauma centers have established massive transfusion protocols that detail the use and ratios of specific blood components to avoid fatal anemia and coagulopathy. But do we pay enough...
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Induced Hypothermic Arrest In Patients Bleeding To...
Here’s an interesting note out of the University of Pittsburgh. They are preparing to engage in a study to look at the role of hypothermic arrest as a way to salvage trauma patients who are bleeding to death. Sometimes we encounter catastrophic injuries that are exceeding difficult to stop the bleeding. Some vascular injuries within the abdomen come to mind, particularly retrohepatic vena...
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Percutaneous Tracheostomy Without The Bronchoscope
It’s always nice to find an article that supports your biases. I’ve been doing percutaneous tracheostomy since the 1990’s, and have used a variety of kits and equipment. Some of these turned out to be rather barbaric, but the technique is now quite refined.
A routine part of the procedure involved passing a bronchoscope during the procedure to ensure that the initial needle was...
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Pneumocephalus And Air Transport
Everybody remembers Boyle’s law, right?
Volume of a gas = k / Pressure (where K is a constant)
Which means that, as pressure goes down, the volume of a gas increases. This is important for patients who have a pneumothorax and get on an airplane. As the plane ascends the pneumothorax gets bigger and they may have serious problems. Click here to see guidelines on flying after...
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Q&A: Prothrombin Complex Concentrate
An anonymous user recently asked about decision-making with regard to anticoagulation reversal. Specifically, they were interested in using prothrombin complex concentrate (PCC) vs activated Factor VII (FVIIa). I’ve done a little homework on this question, and am going to include some information on the use of fresh frozen plasma (FFP), too.
Unfortunately, there’s not a lot of good...
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Bucket Handle Injury - Part 2
Yesterday, I wrote about the basics of bucket handle injuries of the intestine. Today, I’ll deal with diagnosing them.
An understanding of the mechanism of injury and a good physical exam are paramount. If the patient took a significant blow to the abdomen, especially in a motor vehicle crash (lap belt), be very suspicious. Any abdominal pain is of concern, particularly in the right lower...
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Yes, Smoking is Bad!
Everybody knows that smoking is bad. But how often have you stopped by to see one of your trauma patients and have been told “they’re out smoking?” Well, it turns out it’s bad for their injuries as well.
A German group looked at the effects of smoking on healing of a “simple” tibial fracture. They looked at 103 patients who underwent treatment for an isolated...
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