July 2011
18 posts
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The Value of Protocols in Trauma
Earlier this week, I wrote about several protocols that can be used in patients with rib fractures. Most trauma centers have a massive trauma protocol. Many have pain management or alcohol withdrawal or a number of other protocols. The question arose: why do we need another protocol? Can we show some benefit to using a protocol?
I’ve looked at the literature, and unfortunately there’s...
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Financial Triage (Wallet Biopsy) and Transfer to...
A significant amount of volume coming in to Level I and Level II trauma centers is transferred from other hospitals. Occasionally, concerns are raised that some hospitals “cherry pick” the patients, retaining those who are insured and transferring those who are not. If this is true, it has the potential to undermine the entire trauma transfer system by delaying and impeding patient...
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Brain Injury and Chemical Prophylaxis for DVT
Deep venous thrombosis (DVT) and its complications are recognized and common problems in trauma patients, particularly those with traumatic brain injury (TBI). We know that giving chemical prophylaxis like heparin and low molecular weight heparin (LMWH) reduces the risk. Unfortunately, trauma professionals (and neurosurgeons in particular) are reluctant to give it after acute TBI for fear of...
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Fixation of Rib Fractures
Yesterday, I wrote about nonoperative management of rib fractures. Currently, the majority of rib fractures in this country are managed this way. During the past decade, a number of surgical rib fixation systems have been developed. The question is, when do you really need to consider this more invasive and potentially costly intervention? A review article from this hospital published earlier this...
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Rib Fracture Management
A reader sent a query yesterday regarding treatment of rib fractures, and specifically asking about epidural analgesia. Today, I’ll try to answer those questions.
Rib fractures, with or without other injuries, are a big killer in trauma patients. This is particularly true in the elderly. Overall mortality rates range from 3% to 13%, with the most import factor being pain. So what is the...
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Trauma 50 Years Ago! Gunshot Wound Debridement
I’ve generally written a post every month reviewing an article from the Journal of Trauma exactly 20 years earlier that illustrates the history of some of the things we do now. I’m reaching further back in the past today, looking 50 years ago to the July 1961 issue of the first volume of the Journal.
Most trauma hospitals do not see many gunshots. There are exceptions, of course, in...
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PAs and NPs In Level I Trauma Centers
Trauma service staffing is important to maintaining trauma center status. Teaching centers in the US have been grappling with resident work hour rules, and non-teaching centers have always had to deal with how to adequately staff their trauma service. What is the impact of staffing a trauma center with midlevel practitioners (MLPs) such as physician assistants and nurse practitioners?
A state...
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Managing Chest Tube Air Leaks
There are a lot of opinions and not so much literature on how to manage chest tube air leaks. Here is some practical advice on how to deal with this occasional problem.
Most air leaks are an alveolar-pleural fistula, representing a connection between a very small airspace and the pleura. This should not be confused with a bronchopleural fistula, which involves larger airways and is much more...
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New Developments On Distracted Driving
The Governors Highway Safety Association released a study that sifted through 350 scientific papers dealing with distracted driving. They summarized their analysis in a nice report that can be downloaded here.
There are 4 types of distraction:
Visual - looking at something other than the road
Auditory - listening to something not related to driving
Manual - manipulating something other than...
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More On The EMR / Trauma Flow Sheet Debate
I’ve posted several times regarding my opinions about using an electronic medical record (EMR) system for recording trauma activations. Yesterday, I received a well thought out response that I wanted to share and comment on:
“I defy any of them to come to a trauma resuscitation and rapidly and accurately transcribe all of the information presented, or try to review a PI case based on...
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Motorcycle Helmet Law Tragedy
I’ve written about motorcycle helmet laws in the past, and the research that supports their use. Unfortunately, not everyone buys into others telling them about the safety aspects. This article hit the news wires on Sunday:
ONONDAGA, N.Y. — Police say a motorcyclist participating in a protest ride against helmet laws in upstate New York died after he flipped over the bike’s...
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