All posts by TheTraumaPro

AAST 2016 Is Coming Soon!

The 75th annual meeting of the American Association for the Surgery of Trauma (AAST) is just around the corner. It’s being held on the big island of Hawaii, which pretty much guarantees a large turnout. Hard to resist a little vacation time tacked on to the meeting!

Starting tomorrow, there are 17 weekdays left until the end of the meeting. This year, there are a lot of interesting abstracts, and I’ll be posting info and my commentary about the best of the best (and maybe some worst of the worst?).

Here are some of the topics I’ll be covering:

  • Which is better for pulmonary embolism prevention: Unfractionated vs low molecular weight heparin?
  • The cardiac “box”
  • Which ICU is better for neurotrauma patients: neuro-ICU, trauma-ICU, or med/surg-ICU?
  • A scoring system for identifying appropriate patients for air transport
  • The Cribari Matrix and over/undertriage
  • Preperitoneal pelvic packing
  • Are graduating surgery residents qualified to take trauma call?
  • VTE prophylaxis in children
  • and about 9 more!!

Stay tuned starting tomorrow!

July Trauma MedEd Newsletter Topic: Field Amputation

This is probably one of the worst calls a trauma surgeon can get: “Please dispatch a surgeon to the scene. We need a field amputation to extricate the patient.”

For trauma professionals in any discipline, this is probably a once in a career event. And for that reason, there is likely to be a lot of confusion.

The next newsletter will cover this topic in detail. Topics include:

  • Statistics on how often field amputation is needed
  • Indications for the procedure
  • Logistics: getting to the scene and staying safe
  • Essential equipment
  • Sample policies
  • And more!

If you haven’t already, subscribe to my Trauma MedEd newsletter so you can get this edition when it’s released on September 1. Otherwise, it will be released here later in the month.

Click here to subscribe and download back issues!

New Technology: The AED Drone

The media tends to give drones a bad name. And certainly, there are careless operators out there who may give drone operators a bad name. But it seems that everyone is getting in the game. Amazon wants to use drones to deliver your orders. Police use them to find missing people, and criminals. Parks use them to protect animals and property.

But how about some medical uses? Sure, they can be used to access austere environments, and potentially to deliver medical supplies. But here is an example of a very creative use. It’s an AED drone!

This drone was designed from the ground up to provide emergency assistance for cardiac arrest. It’s got audio, video, and is a flying defibrillator. Watch this 3 minute video to see how it works and how it was made.

Timed PI Audit Filters: When Does The Clock Start?

This is a question that comes up frequently in trauma performance improvement programs. Several of the performance improvement (PI) audit filters typically used at trauma centers include a time parameter. Some of these include:

  • Craniotomy > 4 hrs
  • Laparotomy > 4 hrs
  • OR for open fracture > 8 hrs (although this is now outdated)
  • OR for compartment syndrome > 2 hrs

The question that needs to be asked is: 2 or 4 or 8 hours after what?

There are several possible points at which to start the clock:

  • Time of the scene of the traumatic event
  • Recognition at an outside hospital (for referred patients)
  • Arrival in your  ED
  • When the diagnosis is made in your ED
  • When the decision to operate occurs

The answer is certainly open to interpretation. 

Here is my opinion on it:

The purpose of a PI filter is to measure system performance. There are a myriad of system problems that can delay taking a patient to the OR. These include care delays in the ED, delays in getting or interpreting diagnostic tests, delays in contact or response for consultants, delays in diagnosis, delays in OR scheduling or availability, and more. Does it make sense to limit the evaluation of your system by setting one of the later decision points as your start time?

Bottom line: I recommend starting the audit filter clock at the time of patient arrival in your ED. This enables the PI program to evaluate every system in your hospital that can possibly enable or impede your patient’s progress to the OR. However, if the issue was recognized at an outside hospital, scrutiny of their processes also needs to occur. Their trauma PI coordinator needs to know so they can make sure the transfer to definitive care occurred as quickly as possible.