Every Fourth of July, someone just has to try an “off label” use for fireworks.
Don’t try this at home. Even “trained professionals” would never do anything like this.
All posts by The Trauma Pro
Can Prehospital Providers Accurately Estimate Blood Loss?
EMS providers are the trauma professional’s eyes and ears when providing transportation from the scene of an accident. We rely on their assessment of the mechanism of injury and the amount of blood lost. We tend to believe in the accuracy of those assessments.
A study was carried out that tested EMS personnel on their ability to accurately estimate specific amounts of blood that were left at a simulated accident scene. The blood volumes tested were 500cc, 1000cc, 1500cc and 2100cc. A total of 92 professionals participated, and there was an even split into basic EMTs (34%), intermediate/critical care EMTs (33%) and paramedics (31%). Experience levels were as follows: 0-5 years 43%, 6-10 years 30%, >10 years 31%.
The results were as follows:
- 87% underestimated the quantity of blood
- 9% overestimated
- 4% guessed the exact amount
- Experience or credentialing level did not matter
Only 8% of the subjects were within 20% of the actual volume, and an additional 19% were within 50%. In general, most medics underestimated the amount of blood lost, and their guesses were worse with higher volumes. The median guess for the 2100cc loss group was only 700cc!
Bottom line: Visual estimates of blood loss are extremely inaccurate, and are most likely underestimates. Physicians in the ED should rely on exam and physiology to help determine the amount of blood loss. For safe measure, multiply the reported blood loss of the EMT or paramedic by 2 or 3 to get a realistic number.
Reference: Patton et al. Accuracy of Estimation of External Blood Loss by EMS Personnel. J Trauma 50(5), 914, 2001.
What The Heck? CT Imaging Problem: The Answer
I received some good guesses about this image yesterday, but no one got the right answer.
The patient had sustained blunt trauma and was undergoing CT imaging. The scout for the abdominal CT showed some kind of weird debris that interfered with the image, but when we uncovered and looked at the patient, nothing was visible:
What the heck? If you look carefully at the left side of the image, you can see that the “debris field” is on the surface of the patient. We can’t see in 3-D on images, but the difference in appearance on the left and right sides looks like it this stuff is wrapping around the patient.
She was brought in by EMS with a warming blanket in place. On closer inspection, this was a thin, disposable blanket that heats up when removed from an airtight plastic pouch. These blankets contain thin pockets of a mineral mixture that looks like gravel. When exposed to air it heats up.
But on CT it looks like bone density material! When we looked at the patient, we were just lifting off the blanket that contained the offending material. Hence, we couldn’t find it.
Here’s a picture of one of these products. Note the six mineral pouches embedded in it., Don’t let this happen to you!
What The Heck? CT Imaging Problem
Here’s one for you. A patient is brought to you after a motor vehicle crash. You’ve completed your evaluation in the trauma resuscitation room, and you move off to CT for some imaging.
As the techs are preparing to do the abdominal CT, they perform the scout image to set up the study. This is what you see:
The arm was left down due to a fracture (note the splint along the forearm). But what is all that debris on the image? Other than a few abrasions here and there, nothing is visible on the skin in those areas.
What the heck? What do you think these are? Will they interfere with imaging? And what can you do about it?
Tweet or comment with your answers. I will explain all tomorrow.
The July Trauma MedEd Newsletter Is Coming Soon: The Receiving Trauma Center
I’m going to send out the next edition of the Trauma MedEd newsletter over the holiday weekend. This is a follow-on newsletter to the previous one on hospitals that have to transfer patients out to other trauma centers. The emphasis in this one is on the receiving trauma center.
Here are some of the topics:
- CT scans: to repeat or not
- Reducing radiation exposure
- Radiologist reinterpretation of imaging from referring hospitals
- Providing feedback to your referring hospitals
- And more!
And I’ll provide a Word document of a sample feedback form that you can adapt to your needs.
As always, this issue will go to all of my subscribers first. If you are not yet one of them, click this link to sign up and/or download back issues.
Unfortunately, non-subscribers will have to wait until I release the issue on this blog, about 10 days later. So sign up now!