September 2011
21 posts
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Anticoagulation Reversal In Trauma
I’ve previously written about reversing specific agents that may interfere with clotting in trauma patients. Today I’m going to provide a reference sheet to help you reverse any of the common agents that your trauma patients may be taking.
This reference is a work in progress and will change as new drugs are introduced. I’ll update it as revisions are made. And as always,...
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Urinary Tract Infection in the Elderly Trauma...
Yesterday I talked about using a medical orthopaedic trauma service to provide better care to elderly patients with fractures. Many of these patients have multiple pre-existing diseases and are quite fragile. A recent paper from the Rhode Island Hospital shows just how fragile these patients may be.
Urinary tract infection (UTI) is one of the most common nosocomial infections, accounting for...
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The Medical Orthopaedic Trauma Service
Our population is aging, and falls continue to be a leading cause of injury and morbidity in the elderly. Unfortunately, many elders have significant medical conditions that make them more likely to suffer unfortunate complications from their injuries and the procedures that repair them.
A few hospitals around the world are applying a more multidisciplinary approach than the traditional model....
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What The Heck? Final Answer
This one was a bit tricky. I chose it because it looks like there is an extra tube in the neck. You can see two stripes traveling from the mouth down the neck. The one closest to the cervical spine is in the esophagus, an orogastric tube. The other one passes anterior to it, in the trachea, so it is the orotracheal tube. But what about the tube shaped density that is located in the posterior...
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What The Heck? Hint
What The Heck?
Okay, the little spring is not from a pen. It is the valve mechanism for the cuff on an orotracheal tube, which is one of the stripes in this picture.
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When To Image The Aorta In Blunt Trauma
Blunt injury to the thoracic aorta is one of those potentially devastating ones that you (and your patient) can’t afford to miss. Quite a bit has been written about the findings and mechanisms. But how do you put it all together and decide when to order a screening CT?
There are a number of high risk findings associated with blunt aortic injury. Recognize that they are associated with the...
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AAST 2011: Predicting Post-Traumatic Stress...
Today is the last day of the annual AAST meeting, so I’ll wind up with one last abstract presented at this meeting.
PTSD can cause significant morbidity after trauma. Most centers manage this problem reactively, when the patient exhibits obvious symptoms in the hospital or after discharge. Wouldn’t it make more sense to screen for it routinely? Is there a way to figure out which...
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AAST 2011: Placement of ICP Monitors By...
Traumatic brain injury (TBI) is a common injury world-wide, but neurosurgeons are scarce. Traditionally, neurosurgeons are the ones to place invasive monitors to watch intracranial pressure (ICP). But what about injured people who are taken to a hospital where there is no available neurosurgeon?
A group at Wichita, Kansas looked at their 10 year experience with ICP monitor placement, where it can...
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Pediatric CT Scans Before Transfer to a Pediatric...
CT scan is essential in diagnosing injury, although concerns for unnecessary radiation exposure are growing. These concerns are even greater in children, who may be more likely to have long-term effects from it. This makes avoiding duplication of CT scanning extremely important.
Unfortunately, there are only about 50 pediatric trauma centers in the US, so the majority of seriously injured...
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AAST 2011: Benefit of Transport to a Trauma Center
Most trauma systems set certain prehospital criteria that, when met, direct that patient to a trauma center. It is now well-established that care of these patients results in improved survival if they are managed at those centers. Unfortunately, undertriage is still a problem, meaning that those patients may not always be taken to a hospital most appropriate to care for their injuries. What is the...
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Bystander CPR For People Not In Cardiac Arrest
CPR has increased the survival rate of patients suffering cardiac arrest, and early bystander CPR has been shown to double or triple survival. The sad truth is that CPR is not frequently performed by the general public. The American Heart Association has attempted to simplify CPR to the point that even untrained bystanders can administer chest compressions without a pulse check and without rescue...
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The 8 Hour Rule For Open Fractures: We're So Over...
For decades, the standard of care for irrigation and debridement (I&D) of open fractures has been within 8 hours of injury. There is a growing body of orthopedic literature that says this isn’t necessarily so.
A paper being presented at the AAST meeting in Chicago next week retrospectively looked at their experience with early (<8hrs) vs late I&D in a series of 248 patients. They...
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AAST 2011: Video-Assisted Intubation Edges Out...
Intubation is the one procedure that provokes the most anxiety for trauma professionals. What about those facial fractures? What if you can’t get it? Video-assisted intubation is now readily available and at a reasonable cost. And it seems like a great idea, but does it make intubation easier?
A paper to be presented at the AAST next week looked at intubation success among relatively...
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AAST 2011: The Initial Hematocrit Matters
Traditional teaching is that we bleed whole blood, and it takes time to pull volume out of the interstitial space to replace it. Therefore, the initial hematocrit should be normal when a fresh, bleeding trauma patient rolls through the doors.
An observation I have made over the years is that this is not necessarily so. A few patients have low initial hemoglobin or hematocrit readings, and they...
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Another Anticoagulant To Watch Out For
In May, I wrote about a new direct thrombin inhibitor named dabigatran (Pradaxa). This drug appears beneficial for patients who need ongoing anticoagulation without the hassle of blood testing to check drug levels. The danger for trauma patients is that there is no antidote or rapid reversal possible. This means that significant traumatic bleeding, particularly in and around the brain, cannot be...
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