The November newsletter is now available! Click the image below or the link at the bottom to download. This month’s topic is Extremities.
In this issue you’ll find articles on:
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The usual thinking is that most unstable trauma patients need a quick trip to the OR to stop the bleeding from something. In the US and Europe, patients with nasty pelvic fractures are no exception, especially those with hemoperitoneum. But many of these patients are bleeding from vessels associated with the pelvic fractures and not so much from associated intra-abdominal injuries. And operative management of pelvic fracture bleeding is far from satisfying, even when using preperitoneal packing.
Well, things are a little different in Japan. In many cases, unstable patients are taken to interventional radiology for angio and possible embolization. Is this prudent, or is it dangerous? A Japanese group decided to critically look at this practice by examining the Japan Trauma Data Bank for answers.
Here are the factoids:
Bottom line: Whoa! This is a sweeping statement for a study with so few subjects. Yes, it can be very difficult to determine whether initial bleeding is from the pelvis vs a solid organ or mesenteric injury while in the ED. But it is all too easy to fritter away time (and the patient’s blood/life) in the angiography suite. I recommend trying to stabilize your patient as best you can with fluid and/or blood. If you can maintain a “reasonable” blood pressure, proceed to CT for a quick look at the torso. Then go to the most appropriate location to take care of the problem. And if your patient decompensates in CT or angio, immediately proceed to the operating room!
Most will agree that practice guidelines can be a good thing. Here are some of the benefits:
To top it off, trauma verification agencies like the American College of Surgeons require trauma centers to implement ones that apply to them.
But here’s another of my pet peeves. Why does every trauma program decide to reinvent the wheel when it comes to developing them? Many organizations, particularly the Eastern Association for the Surgery of Trauma (www.east.org) have done a lot of work in preparing well-researched guidelines. And I’ve published a bunch that my program has developed. Why does a hospital have to convene a work group and design guidelines from scratch?
Bottom line: If you want to use some guidelines, look at what is already out there and use that as a basis for your protocols. Yes, you will need to modify them a bit to suit your local needs. But don’t waste a lot of your time and energy when someone has already done a lot of the leg work! Don’t reinvent the wheel!
The November issue of Trauma MedEd is ready! Subscribers will receive it tonight. This issue is devoted to extremity injury.
Included are articles on:
As mentioned above, subscribers will get the issue delivered Monday night to their preferred email address. It will be available to everybody else at the end of next week on the blog.
Check out back issues, and subscribe now! Get it first by clicking here!