Several of you figured this one out! The patient was involved in a high speed car crash and was brought to the ED in respiratory distress. Decreased left sided breath sounds were noted. The following xray was obtained.
Opacity is noted in the left lung field, and a modest pneumothorax is seen on the right. Bilateral first ribs are fractured, and the left second through fourth ribs are also broken. The patient was intubated and bilateral chest tubes were inserted.
There was minimal blood from the left chest tube, and a small amount of air from the right. Note the extensive subcutaneous emphysema.
What should we do next? Are any other diagnostic tests indicated? Could the endotracheal tube placement be part of the problem?
Intracranial Hypertension In Pediatric Head Trauma
This 44 minute video is a good introduction to pediatric head trauma and intracranial hypertension. It covers physiology, diagnosis, as well as management using medications, position, decompression and hypothermia.
Presented at Multidisciplinary Trauma Conference at Regions Hospital on May 3, 2012 by Debbie Song MD, a pediatric neurosurgeon.
AAST 2011: Video-Assisted Intubation Edges Out Direct Lanyngoscopy
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 inexperienced users, junior residents. They compared success rates of video assisted (VA) intubation in an ICU (74 patients) with direct laryngoscopic (DL) intubation performed in an ED (54 patients).
All patients were successfully intubated by the junior resident, or by a more senior backup if they were unsuccessful (fellow or attending). The junior residents were successful in 96% of the VA intubations, but in only 76% of DL intubations. Less experienced residents (<20 intubations) were successful in all 96% of the VA intubations but in only 40% of the DL. And the least experienced, those who had done less than 5 intubations, obtained an airway with VA 37% of the time vs 7% for DL. The number of desaturations to less than 80% and hospital mortality was the same for the two groups.
Bottom line: Video assisted intubation is superior to the old-fashioned direct laryngoscopic technique. Even inexperienced providers have a better success rate with the video assisted technique. Over the next few years, it will become the standard for intubating patients, both in the field by medics and in the hospital.
This short video shows a day in the ED at the largest and busiest hospital in the world. The hospital is located in South Africa and is massive, with nearly 3000 beds and covering 173 acres. Over 2,000 patients per day are seen at the hospital, and a large number are trauma victims.
The Trauma Professional's Blog provides information on injury-related topics to trauma professionals. It is written by Michael McGonigal MD, the Director of Trauma Services at Regions Hospital in St. Paul, MN. Regions is a Level I Adult Trauma Center, and has partnered with Gillette Children's Specialty Hospital to become the first Level I Pediatric Trauma Center in the Upper Midwest.