August 2012
21 posts
6 tags
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...
2 tags
By Popular Demand: CIWA Demystified
What exactly is the CIWA protocol? For one, it’s the most popular search term on this blog! Here’s a recap.
It is a tool used commonly in the US that helps clinicians assess and treat potential alcohol withdrawal. A significant amount of injury in this country is due to the overuse of alcohol. A subset of these patients are admitted and do not have access to alcohol. They may begin to...
4 tags
Shift Work And Fatigue In Air Medical Crews
Most trauma professionals are shift workers to one degree or another. It is well documented that sleep problems and fatigue can occur with this type of work, depending on the structure of the shift. A number of studies have been carried out in physicians and prehospital providers. But what about prehospital air crews?
Air medical providers are faced with two challenges: critically ill and injured...
3 tags
How To Remove An Impaling Object
The books all say “transport the patient with an impaling object in place” and “only take the impaling object out in the operating room.” Is this realistic? How do you actually take that knife out?
First, you need to decide if the patient belongs in the OR right now. Are they hemodynamically unstable? Is there obvious arterial bleeding? If so, don’t dawdle. Proceed...
1 tag
Where Do You Resuscitate Your Trauma Patients?
Sounds like an easy question, right? In the trauma resuscitation room! But how long can (should) they stay there? Can they leave for testing and come back? As you may expect, there are a lot of variables to consider.
All major trauma patients should start in the resuscitation room. In a few institutions around the world this may be an OR, but this is uncommon. I’m talking about major...
2 tags
Trauma Center Level And Outcome
All designating/verifying agencies differentiate between highest level trauma centers (regional resource, or Level I in the US) and an intermediate level center (Level II in the US). For most, the differences are not huge on paper. Level I’s usually require a significant education and research component, as well as continuously available specialists in all disciplines. There are usually...
3 tags
Best Of: How To Read A Stab Wound
Most emergency departments do not see much penetrating trauma. But it is helpful to be able to learn as much as possible from the appearance of these piercing injuries when you do see them. This post will describe the basics of reading stab wounds.
Important: This information will allow some basic interpretation of wounds. It will not qualify you as a forensics expert by any means. I do not...
2 tags
Tips For Surgeons: Abdominal Packing
One of the tenets of trauma surgery, handed down for generations, is that we should pack the abdomen to help manage major abdominal hemorrhage. “All four quadrants were packed” reads the typical operative note. But how exactly do you do that? Sounds easy, right?
Well, there are nuances not found in the surgery textbooks. Here are some practical tips for the trauma surgeon:
...
3 tags
Enoxaparin And Pregnancy
Pregnant women get seriously injured, too. And pregnancy is an independent risk factor for deep venous thrombosis. We reflexively start at-risk patients on prophylactic agents for DVT, the most common being enoxaparin. But is it safe to give enoxaparin during pregnancy?
Studies have looked at drug levels in cord blood when the mother is receiving enoxaparin, and none has been found. No specific...
2 tags
How I Keep Up With The Trauma Literature
Medicine advances quickly. How can one keep up with new developments in their field? Well, there’s an app for that! You can also do it without a handheld device, but it’s not quite as convenient. Let me show you how I do it.
Most regularly updated online content is syndicated for RSS (Rich Site Summary). You know, those cute little icons on web pages. There are loads of RSS readers...
3 tags
Who Travels By Air?
Getting seriously injured trauma patients to a trauma center quickly is generally believed to be a good thing. And helicopters are usually faster than ground ambulances. So sending severely injured patients by air is a good thing, right?
Not quite so fast, there. There are other concerns as well. Helicopter transport is significantly more expensive. Quarters are very cramped, and you can’t...
2 tags
Pop Quiz! DPL - The Answer!
You’re doing one of those (very rare) DPLs and get a surprise result. Not blood, not obvious intestinal content, but just a small amount of mysterious sediment. What to do?
Well, this is obviously not normal. Therefore, this has to be considered a positive diagnostic peritoneal lavage. Since DPL is a qualitative test (meaning that the answer is only yes or no), the patient must go to the...
2 tags
Pop Quiz! DPL Hint
So the catheter is in, the aspirate was negative (nothing came out), and a liter of crystalloid infused easily. But toward the end of draining the fluid back out, some faint sediment became visible in the tubing.
A lot of you guessed bladder, but most people don’t have sediment there. Plus, if I dumped a liter of fluid into your bladder, you’d really get the urge to go. This awake...
2 tags
Pop Quiz! DPL
Ahh, remember the good old days of DPL? Probably not! But here’s an interesting case that presents a real diagnostic dilemma. Hint: this case occurred B.F. (before FAST) and B.G.C.T. (before good CT). That’s why we used DPL!
The patient was a middle aged woman who was involved in a car crash. She had mild, diffuse abdominal pain and a faint seat belt sign. She was prepared for DPL in...
1 tag
Fracture Blisters Demystified
Fracture blisters pop up (!) in trauma patients now and then, and nobody seems to know what to do with them. Here’s a primer on dealing with them.
A fracture blister typically occurs near fractures where the skin has little subcutaneous tissue between it and bone. These include elbows, knees, ankles and wrists. They tend to complicate fracture management because they interfere with...
1 tag
The Soft Cervical Collar
They are the cliches of the courtroom. The defendant appears before the jury with a cane, a cast, and a soft cervical collar. Looks good, but are they of any use? There are really two questions to answer: does a soft collar limit mobility and does it reduce pain? Amazingly, there’s very little literature on this ubiquitous neck appliance.
First, the mobility question. It’s a soft...
1 tag
Communicating With Our Patients
Although you may not agree with this at first, communicating with our patients is one of the most important things we do as trauma professionals. You can be the “best” doctor, nurse or paramedic in the world, but if you can’t communicate well your patients will have nothing good to say about your care of them.
The most important skill needed for good communication is empathy....
1 tag
The "Dang!" Factor
This tip is for all trauma professionals: prehospital, doctors, nurses, etc. Anyone who touches a trauma patient. You’ve probably seen this phenomenon in action. A patient sustains a very disfiguring injury. It could be a mangled extremity, a shotgun blast to the torso, or some really severe facial trauma. People cluster around the injured part and say “Dang! That looks really...
2 tags
Treating Numbers: Pulse Oximetry
How many times has this happened to you? You walk into a young, healthy trauma patient’s room and discover that they have nasal prongs and oxygen in place. Or better yet, these items appear overnight on a patient who never needed them previously. And the reason? The pulse oximeter reading had been low at some point.
This phenomenon of treating numbers without forethought has become one of...
4 tags
DVT Prophylaxis After Solid Organ Injury
Nonoperative management of solid organ injury is the norm, and has reduced the operative rate significantly. At the same time, the recognition that development of deep venous thrombosis (DVT) in trauma patients is commonplace creates uncertainty? Is it safe to give chemical prophylaxis with low molecular weight heparin (LMWH)? How soon after injury?
The trauma group at USC+LAC published the...
1 tag
TraumaMedEd Newsletter for July
The newest edition of the TraumaMedEd newsletter is out! The topic is DVT, with some interesting and unexpected info on this common problem.
If you would like to subscribe to the newsletter by email, go to http://www.regionstrauma.org/tme
Comments and requests are welcome!
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