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 bad!”
It’s just human nature. We are drawn to extremes, and that goes for trauma care as well. And it doesn’t matter what your level of training or expertise, we are all susceptible to it. The problem is that we get so engrossed (!) in the disfiguring injury that we ignore the fact that the patient is turning blue. Or bleeding to death from a small puncture wound somewhere else. We forget to focus on the other life threatening things that may be going on.
How do we avoid this common pitfall? It takes a little forethought and mental preparation. Here’s what to do:
- If you know in advance that one of these injuries is present, prepare your crew or team. Tell them what to expect so they can guard against this phenomenon.
- Quickly assess to see if it is life threatening. If it bleeds or sucks, it needs immediate attention. Take care of it immediately.
- If it’s not life threatening, cover it and focus on the usual priorities (a la ATLS, for example).
- When it’s time to address the injury in the usual order of things, uncover, assess and treat.
Don’t get caught off guard! Just being aware of this common pitfall can save you and your patient!
Yesterday I requested your help in figuring out how big a trauma resuscitation room should be. As promised, I brought in my trusty tape measure today to check out my trauma bays at Regions Hospital. I came up with several helpful measurements to help gauge the relative utility of the rooms.
Here are the indices that I came up with:
- TBTA: Trauma Bay Total Area. This is the total square footage (meterage?) measured wall to wall.
- TBWA: Trauma Bay Working Area. This is the area that excludes equipment carts next to a wall, and areas under countertops that extend away from the wall.
- TBAA: Trauma Bay Available Area. This is the TBWA less any other unusable areas in the room. We have an equipment post near one corner that eats up 16.5 sq ft of space. Also remember to subtract the area taken up by the patient bed, as this area is not available to the trauma team, either.
- TBSI: Trauma Bay Space Index. This value is derived by dividing the TBAA by the number of team members in the room. It gives an indication of how much space is available for each one to work in.
Values in my trauma center:
- TBTA: 291 sq ft
- TBWA: 220.5 sq ft
- TBAA: 186.5 sq ft
- TBSI: 15.5
What does it all mean? Hard to say without more info from you for comparison. For my team, it means we each have a 4×4 foot square to move around in, on average.
Keep on sending info on your trauma resuscitation rooms! Leave comments below, or tweet/email me the values for the metrics listed above. Once I get a critical mass of them, I’ll write a detailed post on the results!
I was just asked the question: how big should a trauma bay be? Interestingly, the state of California requires any newly constructed/renovated trauma room to be at least 280 square feet in size (26 sq meters). Today, I’d like to get your opinion. How big is your trauma bay? And is that big enough?
I’d like all my readers to chime in on this one. Take a moment to look at your resuscitation room, measure it if you can, and then judge it.
Then take a moment to either leave a comment below, tweet you answers, or email me at [email protected]. I’ll compile the answers at the end of the week and see if there is a consensus to be had.
I need three pieces of information:
- How big is the room (wall to wall)?
- How big is the floor area excluding equipment carts (usually much smaller)?
- How many people are on your team and in the room? (Don’t include the patient; I assume that’s why you are in there)
This should be an interesting discussion!
The shift in management of adult solid organ injury from primarily operative to mostly nonoperative began in the late 1980s. For the last decade or so, we’ve been refining this management, figuring out failure criteria, the role of interventional radiology, and developing practice guidelines. We know we’ve been able to reduce the number of people that undergo operative management, with an acceptably low failure rate. But is there a financial impact as well?
Surgeons at the MedStar Hospital Center in Washington DC tapped into a huge hospital discharge database from 1994 to 2010. They focused on patients with admitting diagnoses of spleen or liver injury. They looked at relative costs compared to 1994 practice patterns (still quite a bit of operative management), hospital length of stay, and mortality risk.
Here are the factoids:
- Nearly 30,000 spleen injury records and 15,000 liver injury records were reviewed
- Nonop management of spleen injury increased from 38% to 67%, and for liver injury from 62% to 81%
- In-hospital cost of care decreased by over $8,000 for each patient over the study period
- Hospital length of stay decreased by about 2 days for each patient
- Mortality in high risk patients dropped significantly (from 64% to 18% for liver, 30% to 20% for spleen)
- Mortality in low risk patients remained unchanged (2-3%)
Bottom line: Yes, this study suffers from the usual pitfalls of massaging any large multi-institutional database. But what impresses me is that significant changes have been identified, despite huge variations in how nonoperative management is delivered at so many hospitals. As I have mentioned before, at my hospital we were able to show that just adhering to a standardized solid organ injury protocol squeezes yet another $1000 in costs out of each patient treated, on average. Time to adopt a protocol and adhere to it. Your hospital administrators will love you even more!
Reference: The impact of solid organ injury management on the US healthcare system. J Trauma 77(2):310-314, 2014.
The July newsletter is now available! Click the image below or the link at the bottom to download. This month’s topic is TBI.
In this issue you’ll find articles on:
- Concussion testing apps
- Diffuse axonal injury
- (In)appropriate neurosurgical consultation
- And more!
Subscribers received the newsletter first on Monday. If you want to subscribe (and download back issues), click here.
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