January 2012
21 posts
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Giving Rhogam (Rh Immunoglobulin) To A Man?
Rhogam is for women, right? The ATLS course points out that pregnant women who are Rh- and sustain significant blunt torso trauma should empirically receive Rhogam in case the fetus turns out to be Rh+.
But there is one situation where men might receive it. Most trauma centers use O- blood as their universal donor units because it does not contain any major antigens. However, O- blood is...
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Trauma 20 Years Ago: Trauma & Critical Care
For those of you who read the Journal of Trauma, the first issue of 2012 just arrived in the mail. It sports both a new cover design and a title change. For many years, it was just The Journal of Trauma. Then, after 20 years under the editorship of John H. Davis, the name changed to The Journal of Trauma, Injury, Infection, and Critical Care in 1995. This occurred as Basil Pruitt became the new...
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Can Lead Poisoning Occur After A Gunshot?
This is a fairly common question from victims of gunshots and their families. As you know, bullets are routinely left in place unless they are superficial. It may cause more damage to try to extract one, especially if it has come to rest in a deep location. But is there danger in leaving the bullet alone?
One of the classic papers on this topic was published in 1982 by Erwin Thal at Parkland...
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The Societal Cost of ED Thoracotomy
ED thoracotomy can be a dramatic, life-saving procedure. From the patient’s perspective, there is only an upside to performing it; without it there is 100% mortality. But to trauma professionals, there is considerable downside risk, including accidental injury, disease transmission and wasted resources. What is the societal risk/cost if ED thoracotomy is performed for weak indications?
The...
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Pet Peeve: "High Index of Suspicion"
How often have you heard this phrase in a talk or seen it in a print article:
“Maintain a high index of suspicion”
What does this mean??? It’s been popping up in our work for at least the last 20 years. And to me, it’s meaningless.
An index is a number, usually mathematically derived in some way. Yet whenever I see or hear this phrase, it doesn’t really apply to...
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Blunt Aortic Injury And New Cars
Car crashes are a significant cause of trauma death worldwide. Aortic injury is the cause of death in somewhere between 16% and 35% of these crashes (in the US). Over the years, automobile safety through engineering improvements has been rising. A recent poster presented at EAST 2012 looked at the effect of these improvements on mortality from aortic injury.
The authors analyzed the National...
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Alert! CDC Identifies Major Binge Drinking Problem
The Centers for Disease Control (CDC) released a report on binge drinking in the US last week that is quite alarming. It provides a host of facts that should alarm any trauma professional. And I’m fairly certain that these statistics apply to just about any other country as well.
The study indicated that 1 in 6 adults in the USA is a binge drinker! My understanding of the term binge is that...
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Best Of: High Inspired O2 Is Not An Effective...
The use of high concentrations of inspired oxygen seems to be a time-honored technique for trying to avoid chest tube insertion for pneumothorax. But does it stand up to scrutiny, or is this just an urban legend?
This recommendation is based upon a single case report involving 8 patients in 1983! Six patients with a pneumothorax of less than 30% showed a decrease in size of 4.2% per day on...
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Best Of: VIP Syndrome In Healthcare (Very...
The VIP syndrome occurs in healthcare when a celebrity or other well-connected “important” person receives a level of care that the average person does not. This situation was first documented in a paper published in the 1960s which noted that VIP patients have worse outcomes.
VIPs have the expectation that they can get special access to care and that the care will be of higher...
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EAST Starts Today!
Today is the first day of the Eastern Association for the Surgery of Trauma’s Annual Scientific Assembly. I’ll be sitting in the front row taking it all in so I can share the good stuff with you.
I’ll be tweeting important info continuously using the hash tag #east2011, as well as #traumapro. I will also be blogging about the best papers over the next 10 days or so. I like to...
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How Likely Am I To Die From...
Some interesting facts on how likely you are to die from a given cause in the coming year:
choking on a non-food object - 1 in 96,300
drowning in a bathtub - 1 in 724,900
firearm discharge - 1 in 4,101,000
contact with a powered lawnmower - 1 in 4,606,000
strenuous movement - 1 in 23,030,000
handheld power tool accident - 1 in 24,950,000
contact with hot food - 1 in 74,850,000
escalator...
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Best Of How To: Stop Scalp Bleeding
Bleeding from scalp wounds may seem like a trivial problem, but I have personally seen someone die from unrecognized hemorrhage over time from one. All too often, these are covered up with a crude dressing when the patient arrives in the ED and is not looked at for some time.
Here are some tips to stop scalp bleeding:
Use direct pressure. This seems obvious but is frequently done incorrectly....
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Best Of: Pulmonary Embolism and DVT in Trauma
We have long assumed that pulmonary emboli start as clots in the deep veins of the legs (or pelvis), then break off and float into the branches of the pulmonary artery in the lungs. A huge industry has developed around how best to deal with or prevent this problem, including mechanical devices (sequential compression devices), chemical prophylaxis (heparin products), and physical devices (IVC...
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Best Of: What You Need To Know About Falls From a...
Falls from a height can be either accidental or intentional (suicide attempt). There are several prognostic factors for survival that have been identified:
Height
Age
Type of surface
Body part that touches the ground first
Two other factors are important, but do not have a significant effect on mortality:
Circumstances of the fall (suicide, accident, escape)
Initial impact with an object...
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Best Of: Spine Immobilization in Penetrating...
The EMS standard of care for blunt trauma patients has been to fully immobilize the spine before transporting to an emergency department. This is such a common practice that it is frequently applied to victims of penetrating trauma prior to transport.
A recent study in the Journal of Trauma calls this practice in question, and suggests that it may increase mortality! The authors reviewed data...
