It’s been a while since I visited the topic of the electronic trauma flow sheet (eTFS) for trauma activations. A few years have passed, the software engineers have gotten smarter (hopefully), so let’s look at it again.
Next week, I’ll be covering the eTFS in detail again. Here is what I will touch on:
eTFS: Why Hospitals Want To Switch
What Does(n’t) Work
Oops! Now What Are My Options?
I’d also like to spend a day on Q&A. To that end, please start emailing, commenting, or tweeting your questions so I can answer them in detail at the end of the week. Let the games begin!
Nurses have a complementary role with physicians in caring for children with orthopedic injuries. Typically, the child will have been evaluated and had some sort of fracture management implemented. In children, nursing management is easer than in adults since a child is less likely to need an invasive surgical procedure. Many fractures can be dealt with using casts and splints alone.
Here are a few tips for providing the best care for your pediatric patients:
Ensure adequate splinting / casting. You will have an opportunity to see the child at their usual level of activity. If it appears likely that their activity may defeat the purpose of the cast or splint, inform the surgeon or extender so they can apply a better one.
Focus on pain control. Nothing aggravates parents more than seeing their child in pain! Make sure acetominophen or ibuprofen is available prn if pain is very mild, or scheduled if more significant. Ensure that mild narcotics are available if pain levels are higher. Remember, stool softeners are mandatory if narcotics are given.
Monitor compartments frequently. If a cast is used, check the distal part of the extremity for pain, unwillingness to move, numbness or swelling. If any are present, call the physician or extender and expect prompt attention to the problem.
Always think about the possibility of abuse. Fractures are rarely seen in children under 3, and almost never if less than 1 year old. If you have concerns about the physical findings or parent interactions, let the physician and social workers know immediately.
Several readers asked me to dust off this video again. Enjoy this parody of the Dos Equis “Most Important Man In The World” commercials. This video was part of the Trauma Education: The Next Generation conference produced a few years ago. Enjoy, and please comment or give it a thumbs up on YouTube!
Virtual reality headsets have been all the rage for some time. They immerse the wearer in a complete virtual world, and are typically used for gaming. Augmented reality, on the other hand, overlays virtual items on the real world so both are visible at the same time. Think the notorious Pokemon Go app:
What if this technology could be used for medical purposes? You could overlay diagnostic or anatomic information on your patient to help guide therapy, surgery, etc.
A group at the University of Alberta in Canada have been playing with this technology. ProjectDR takes any kind of image-related information and projects it directly on a patient.The patient is first scanned using surface markers like they do when making movies:
Obviously, no fancy suit or huge number of markers is needed. Once this is accomplished, the diagnostic information can be projected onto the patient. The patient can move, and the projector will compensate and keep the projection anatomically correct.
Here is a short video that demonstrates the system:
So is this useful? Unfortunately, not yet. It may eventually be good for office-based trauma professionals, but it needs further refinement. This version uses an actual digital projector, which means it will be subject to shadows which will interfere with viewing, especially if a surgeon gets his or her big head in the way.
Here’s how it will really have to work: The system could function quite well in surgical procedures. Imagine the surgeon being able to don a VR headset (lightweight, please!) and see the surgical field with key information overlaid on the display. Or even easier, incorporate it in the DaVinci robotic system display. Add vital signs in the upper corner and details of anatomic structures that have not been surgically exposed yet. It could help show anatomic anomalies in great detail, such as vascular variants. And heck, why not throw in some on-demand magnification as well?
As with most new and exciting tech that hits the general media, a version that is actually usable by clinicians is several years away. But it should be fun when it finally gets here!