The Annual Assembly for EAST is just around the corner! I’ve selected a baker’s dozen of papers, quickshots, and posters to discuss every day through the end of the meeting.
I will carefully analyze each abstract, provide some context and analysis, and then provide some suggestions and comments for the author. This will allow them to more fully prepare for their presentation at the meeting.
As always, I welcome your comments and suggestions. Leave comments using the system at the very bottom of the post, or on Twitter using #TraumaPro to get my attention.
See you at the meeting!
Best of EAST 2017
- EAST 2017 #1: Accuracy of CT Scans Done Outside The Trauma Center - Imaging prior to transfer to a trauma center has been the subject of debate for years. The focus has primarily been on the necessity of these scans, and the sheer numbers that are done. For the most part, the discussion has been driven by the potential for radiation exposure. This ...Continue Reading
- EAST 2017 #2: CT Scan After Recent Operative Exploration for Penetrating Trauma - The general rule for penetrating trauma, especially gunshots to the abdomen, is that you don't need to obtain a CT scan to help you decide to go to the OR. (Of course, there are a few exceptions.) And the corollary has always been that you don't need to get a CT ...Continue Reading
- EAST 2017 #3: My Neck Is Broken And It Doesn’t Hurt? - Clinical clearance of the cervical spine is a standard of care. It is usually the first method to determine if there might be an injury in patients who are awake, cooperative, and don't have other painful distracting injuries. But appreciation of pain may be different in elderly patients, and they ...Continue Reading
- EAST 2017 #4: A More Restrictive Transfusion Trigger? - For many years, patients were automatically given not one, but two units of blood anytime they got "anemic" while in the hospital. And anemia was defined as a hemoglobin (Hgb) value < 10. Wow! Then we recognized that blood was a dangerous drug, with many potential complications. We've come a ...Continue Reading
- EAST 2017 #5: Subarachnoid Hemorrhage, Neurosurgical Consults, and Repeat Head CT - Neurosurgical involvement in the management of simple traumatic brain injury (TBI) has been slowly dwindling over the past several years. This is the result of the general consensus that very few of these patients progress to need neurosurgical procedures. A group at Wright State University in Dayton sought to define the ...Continue Reading
- EAST 2017 #6: FAST Exam After Rolling to the Right - The FAST exam is an integral part of trauma evaluation. Even after experience and credentialing of providers, there tends to be some variability in performance. This is especially true when the abnormal findings (or amount of fluid present) is relatively small. Can we improve this by doing something as simple ...Continue Reading
- EAST 2017 #7: Pigtail vs Chest Tube – Does Size Matter? - I've been somewhat old school when it comes to chest tubes. Unlike some, I don't believe that you have any control of where a chest tube goes if you are placing it in a closed chest. Only in the OR with an open one. And I've got plenty of x-rays ...Continue Reading
- EAST 2017 #8: When Is “Mild TBI” Not So Mild? - Traumatic brain injury (TBI) is very common, with the majority falling into the "mild" category. This is usually defined as patients with injury to the head and a GCS of 13-15. These uncomplicated patients are frequently discharged from the emergency department, or undergo only a brief evaluation if admitted for ...Continue Reading
- EAST 2017 #9: Geographic Location and Fatal Car Crashes - Trauma resources (centers and helicopter services) are not geographically evenly distributed across the US. The East and West coasts are saturated with resources, maybe overly so. At the other extreme, some northern states (Alaska and the north central US) have very few trauma resources, and injured patients may have to ...Continue Reading
- EAST 2017 #10: A Simple Way To Predict Complications After Rib Fracture? - Rib fractures are a common injury, and a very common cause of morbidity. Every time I admit an elderly patient with rib fractures, I debate whether they should go to the ICU or a ward bed. Could there be a more objective way of determining the likelihood of complications, aggressiveness ...Continue Reading
- EAST 2017 #11: Use of Incompatible (Type A) Plasma For Massive Transfusion - Type AB plasma is considered "universal donor" plasma, as it contains no antibodies to red cells with either A or B antigens on their surface. Unfortunately, only about 4% of the US population have this blood type and can provide the product. Due to this shortage, some trauma centers have ...Continue Reading
- EAST 2017 #12: Revaccination Compliance After Splenectomy - The incidence of overwhelming post-splenectomy sepsis, and the need and effectiveness for vaccination after splenectomy is still subject to debate. However, the administration of three vaccines to protect against encapsulated bacteria is a standard of care. For decades, this was a one time thing and the vaccines were usually given ...Continue Reading
- EAST 2017 #13: An Extra Trauma Activation Tier For Geriatric Trauma - Our elderly population is growing rapidly, and the average age of the patients on the trauma service is escalating. These patients offer a number of challenges throughout their presentation to the hospital and the rest of their stay. Some trauma centers are now organizing special teams or response types to ...Continue Reading