The June Trauma MedEd Newsletter will be released to subscribers this weekend. I’ll be covering a topic no one wants to think about but everyone wants to know more about: Malpractice and trauma professionals. Articles include:
How often do trauma professionals hear that? Patients intubated in the ED (or before) almost universally have a chest x-ray taken to check endotracheal tube position. And due to variations in body habitus (and sometimes number of teeth), the tube may not end up just where we want it. So look at how deep or shallow it is and adjust it by the number of centimeters out of the correct position it should be, right?
Not so fast! A small, prospective study from Yale looked at endotracheal tube adjustment in ICU patients using tube markings and the patients incisors. Their “ideal” tube position has the tip between 2 and 4 cm from the carina. Any patients with an ET tube outside these parameters was included in the study. Here are the interesting tidbits:
There were only 55 patients who met criteria for the study. No denominator information was give, so we can’t tell how good or bad the intubators were initially.
Most tubes that needed adjustment were too far out. The median starting position was at 7cm above the carina (!),
A smaller number were too deep (median position 0.7cm). These were mostly in women.
The usual intended adjustment was 2cm. The actual distance moved after manipulation was half that (1.1cm).
Bottom line: Endotracheal tube repositioning based on tube markings at the incisors is not as accurate as you may think. Patient body habitus and reluctance to pull a tube out too far probably are factors here. So be prepared to readjust a second time unless you intentionally add an extra centimeter to your intended tube movement.
Fewer and fewer states have good helmet laws any more. Part of the problem is political. But the other part, may be… the end user. Here’s a piece written by a doctor and published in the St. Paul Pioneer Press in 1994 about a case he saw in medical school:
“I was working in a rural emergency room one day when the ambulance brought in a 17-year-old who had been in a motorcycle accident. It had just started raining, and the road was slick; he’d tried to take a corner too fast and had laid the bike down and skidded quite a long way.
“Fortunately, all he had were crapes and bruises. he had no head injury.
“Just as I was finishing up with him, a policeman came in and brought the young man his helmet, which they had taken off him at the scene. it was obviously a fancy and expensive helmet. It was a full-face unit – shiny, multicolored, metal-flake.
“One entire side of the helmet was ruined. It was deeply gouged and had obviously scraped along the asphalt with considerable impact for quite a distance. In some places, it appeared that the entire thickness of the hard shell had been penetrated, and you could see the soft inner lining.
“The young man was obviously very lucky.
“He looked at the helmet, groaned and said: ‘Oh, man! I just bought that a week ago! What a waste of $150!’”
This is my first SMACC. And what a SMACC it is! Holey moley! This is a celebration of the FOAMed community, and it’s almost a festival atmosphere. Check out this photo of the opening ceremony:
The audience is an enthusiastic mix of disciplines and backgrounds, and covers a wide range of topics most appropriate to emergency medicine. But there is information of interest to any resuscitationist, and this includes trauma and critical care professionals. The reception at the end of day 1 as fun, and I’m sure the gala dinner tonight will be something to behold.
One observation: It’s interesting that a group of people that are so into online learning have the need to physically meet from time to time. I think it points out our very human social nature, and demonstrates that online social media/networks will never replace actual face to face contact!
Check out the links below to see if next year’s meeting might be for you!
This meeting starts tomorrow at McCormick Place in Chicago! I’ll be speaking tomorrow in Concurrent Session 6: Trauma at 2:55pm. I’ll also be participating in Concurrent Session 16: It’s A Knockdown, a fun panel at 2:30pm on Thursday with the likes of Cliff Reid, Karel Habig, John Hinds, Karim Brohi, Deb Stein, Bill Knight and Andrew Dixon.
Look me up at the meeting or at the opening reception! I look forward to seeing you!