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May Trauma MedEd Newsletter Released

The May newsletter is now available! Click the image below or the link at the bottom to download. This month’s topic is “Nursing & Midlevels”.

In this issue you’ll find articles on:

  • What to do when the doc won’t listen!
  • NPs and PAs in US trauma centers
  • Impact of NPs and PAs in Level I centers
  • Forensic nursing
  • Nursing tips for pediatric orthopedic trauma
  • Cardiac contusion (for nurses)

Subscribers received the newsletter on June 1. If you want to subscribe to get early delivery in the future (and download back issues), click here.

Click here to download.

Pop Quiz: The Explanations

Okay, once again here’s the x-ray of an unfortunate trauma patient:

image

Lets walk through the things I found so you can see how I knew:

  • The patient is a female – note the hook and eye clasps in the center of the image.
  • She is still on a backboard – there are parallel vertical lucencies on either side of the spine which are the longitudinal wood feet of old fashioned backboards (this image is 20 years old, before plastic was invented, haha)
  • She was stabbed with a long, professional cooking knife – apparent from the length and shape of the blade
  • The assailant was right handed – the blade was inserted into her left chest
  • The course of the knife is left to right, superior to inferior, and anterior to posterior – this is the typical trajectory from a right-handed assailant
  • She was unstable, either blood pressure or respirations – the patient has an ET tube, but no IV line yet
  • The patient was intubated, most likely due to hypotension and unresponsiveness – same as the last item
  • There is a moderate left hemothorax – the hemithorax is not completely opaque, so this is probably in the vicinity of a liter or so.
  • The mediastinum is shifted to the right – even though there may be slight rotation of the chest
  • A deep sulcus sign is present, either from a pneumothorax that is not easily visible, or from a large hemothorax – the shift and sulcus suggest that there is some tension physiology. Since the hemithorax is not opaque (not a massive amount of blood), there is probably a significant pneumothorax component.
  • Intra-abdominal and diaphragmatic injury is almost certain – from the depth and trajectory of the knife. It can’t miss everything!
  • A pulmonary contusion is present on the left – note the extra opacity surrounding the knife entry. This is bleeding into the lung parenchyma.
  • The stab enters the antero-lateral chest – if it were posterior or more lateral, the patient would be rotated off of it, or the arm would be abducted
  • It does not involve the arm or axilla – given the presumed entry into the chest at the base of the handle, it will be too far anterior to involve the arm or axilla
  • The patient needs a chest tube now – duh!
  • She must be taken to the OR immediately after the tube – double duh!!

Agree or disagree? Tweet or comment below!

Pop Quiz: What I See…

Yesterday, I showed you an x-ray of a trauma patient and asked you to tell me all the pertinent things that you saw. Here’s the x-ray again:

image

And here’s the list of all the things that struck me about it. Tomorrow, I’ll explain how I figured them all out from just this x-ray.

  • The patient is a female
  • She is still on a backboard
  • She was stabbed with a long, professional cooking knife
  • The assailant was right handed
  • The course of the knife is left to right, superior to inferior, and anterior to posterior
  • She was unstable, either blood pressure or respirations
  • The patient was intubated, most likely due to hypotension and unresponsiveness (BTW, the tube is deep and needs to be pulled back)
  • There is a moderate left hemothorax
  • The mediastinum is shifted to the right
  • A deep sulcus sign is present, either from a pneumothorax that is not easily visible, or from a large hemothorax (more likely the first one)
  • Intra-abdominal and diaphragmatic injury is almost certain
  • A pulmonary contusion is present on the left
  • The stab enters the antero-lateral chest
  • It does not involve the arm or axilla
  • The patient needs a chest tube now
  • She must be taken to the OR immediately after the tube

Some of these are easy, some are not. Let me know if you found anything else by tweeting or commenting below.

Pop Quiz: What Do You See?

Sometimes we are way too focused. Commonly, trauma professionals will look at a lab result / image / patient / etc and only see what they are looking for.

Here’s an exercise to help you break out of that trap. I want you to look at this image and make a list of all the non-trivial things you see and think about that are pertinent to the case. Like “there is a knife in, on, or under the patient” and not like “the patient has ribs.”

image

Tomorrow, I’ll go over my list of 16 items. See if you can find them all, or more! On Thursday, I’ll explain how I figured out each item. Good luck!

Hit me with your key findings via Twitter, or comment below!

May Newsletter Released To Subscribers Tonight!

The May Trauma MedEd Newsletter will be released to subscribers tonight. I’ll be covering Nursing & Midlevels. Articles include:

  • What to do when the doc won’t listen!
  • NPs, PAs and trauma care
  • Forensic nursing
  • Nursing tips for managing pediatric orthopedic trauma
  • And more…

Anyone on the subscriber list as of 8PM tonight (CST) will receive it later this evening. I’ll release it to everyone else this Friday via the blog. So sign up for early delivery now by clicking here!

Pick up back issues here!