August 2011
25 posts
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AAST 2011: Patients Evaluated But Not Transported...
Injured patients transported to the ED are just the tip of the iceberg. There are some patients who are evaluated by EMS, either at the scene or in their home, but never transported. These patients do not appear in any trauma registry and little information is known about how they do after their evaluation.
Stanford University reviewed county data and found 5,865 patients out of 69,000 who were...
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AAST 2011: CT Evaluation of Penetrating Neck...
In the old days, stab injuries to Zone 2 in the neck meant a trip to the operating room. Then it became acceptable to evaluate stable patients with this injury via endoscopy, angiography and a swallow study. Most chief residents didn’t have the patience for this and opted for OR anyway. CT now promises to simplify the evaluation process, rolling these studies into one fast and simple one.
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AAST 2011: Autopsy Reports and Performance...
Autopsy reports have traditionally been used as part of the trauma performance improvement (PI) process. They are typically a tool to help determine preventability of death in cases where the etiology is not clear. Deaths that occur immediately prior to arrival or in the ED are typically those in which most questions arise.
The American College of Surgeons Trauma Verification Program includes a...
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AAST 2011: Acute Kidney Injury From IV Contrast
Yesterday, I wrote about using acute kidney injury (AKI) as a predictor for multiple organ failure. But what about kidney failure that we may inadvertently create through the use of IV contrast during CT scan evaluation? Contrast is generally safe for use in the general trauma population, but is known to cause renal problems in high risk groups like the elderly and critically ill.
Investigators...
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AAST 2011: Acute Kidney Injury And Multiple Organ...
Organ failure after major trauma is relatively common. Acute renal failure can occur for a variety of reasons, and tends to occur early. This abstract from Denver Health looked at acute kidney injury as a predictor for the development of multiple organ failure.
The authors retrospectively reviewed 12 years of their registry data for patients at high risk for developing organ failure. They found...
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AAST 2011: Preview Of The Annual Meeting
The 70th annual meeting of the American Association for the Surgery of Trauma begins on September 14 in Chicago. Starting tomorrow, I’m going to highlight some of the most interesting abstracts that are scheduled for presentation. Please recognize that I can only review the abstract itself, so my analyses will be limited. The complete manuscripts will not be available in published form for...
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Brain Injury and DVT Prophylaxis Part II
I previously wrote about a new review that looked at using chemical prophylaxis for deep venous thrombosis (DVT) in patients with traumatic brain injury (TBI). The authors showed that it was safe to give subcutaneous heparin products within 24 to 48 hours after a stable 24 hour followup CT.
A just-published article now helps to refine the selection of the heparin product. A retrospective review...
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What To Do About Upper Extremity DVT
Deep vein thrombosis (DVT) is a potential problem for all trauma patients, primarily due to the small but real possibility of a resultant pulmonary embolism (PE). Many trauma programs have protocolized their evaluation and management of DVT, but this usually only involves clot in the lower extremities and pelvis. Unfortunately, up to 10% of DVT occurs in the upper extremities, and they are not...
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Timed PI Audit Filters: When Does The Clock Start?
Several of the performance improvement (PI) audit filters typically used at trauma centers include a time parameter. These include:
Craniotomy > 4 hrs
Laparotomy > 4 hrs
OR for open fracture > 8 hrs
Compartment syndrome > 2 hrs
The question that needs to be asked is: 2 or 4 or 8 hours after what?
There are several possible points at which to start the clock:
Arrival in the ED
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Followup Cystogram After Bladder Injury
I’ve previously written about management of extraperitoneal bladder injuries. One of the tenets is that every injury needs to have a routine followup cystogram to ensure healing and allow removal of any bladder catheter. I routinely like to question dogma, so I asked myself, is this really necessary? A retrospective registry review from the Ryder trauma center in Miami helped to answer this...
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CIWA Protocol Precautions
The post entitled “CIWA Demystified” is one of the most popular on this blog. This type of symptom triggered therapy for alcohol withdrawal applies some degree of objectivity to a somewhat subjective problem. However, it is possible to take it too far.
A retrospective review of registry patients who received CIWA guided therapy was performed. A total of 124 records were reviewed for...
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WatchProcedural Sedation and Analgesia
The Regions Hospital Multidisciplinary Trauma Conference on August 4 dealt with the use of procedural sedation in the emergency department. The presentation was delivered by Ben Watters MD.
This presentation is 56 minutes long.
Important disclosure information: off-label use of ketamine is discussed.
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Tranexamic Acid and Trauma
I recently received a request to write about tranexamic acid (TXA) and trauma patients. There is a lot of interest in this agent, especially in the military, and there are some good, recent papers to review.
Tranexamic acid works differently than the quick clotting agents out there. It is an antifibrinolytic, so it actually prevents clot breakdown. It has been approved by the FDA for use in...
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Guidelines for Consultants to the Trauma Service
Trauma surgeons often rely on consultants to assist in the care of their patients. Orthopedic surgeons and neurosurgeons are some of the more frequent consultants, but a variety of other surgical and medical specialists may be needed. I have found that providing a set of guidelines to consultants helps to ensure quality care and provide good communication between caregivers and patients /...
