Ambulance 2.0: The “Super Ambulance” of the Future
Lifebot Technology has been working to upgrade the prehospital environment and connect it more closely with trauma professionals in the trauma center. They have done this by developing a so-called “super ambulance.” These ambulances are outfitted with new variations of tried and true technology. This includes a special Hewlett-Packard Slate tablet computer, multiple cameras inside the ambulance, cameras that are wearable by medics, and a state-of-the-art telemedicine system.
The Slate tablet allows for hand-held patient monitoring, GPS positioning, high resolution imaging via its built-in camera, patient medical record charting, and connection to the trauma center base station. At the base, the emergency physician or trauma surgeon can view monitoring information, control any camera in the ambulance to focus in on the action, and even draw on the Slate’s screen to show the crew areas of interest (telestration).
The system is pricey ($50,000 US), but is extremely valuable in rural areas where the nearest trauma center may be quite far away. In theory, a doctor could walk a medic through a procedure to resolve a problem that may kill their patient before they can get to the hospital. The system is already in use in select areas in Arizona, Florida and Texas.
Reference: Displayed at the HIMSS 2011 (Healthcare Information and Management Systems Society) annual meeting, February 20-24, 2011 in Orlando, FL.
Disclosure: I have no financial interest in Lifebot Technology or Hewlett Packard
Wii-habilitation: The New Rehab for Trauma Patients
Rehab is a critical care component for multiply injured or brain injured patients. A good rehab program optimizes physical, psychological and social function, and allows the patient to return to the highest level they are capable of.
Virtual reality technology is advancing rapidly, and hardware is now very inexpensive. This allows for integration of products such as the Nintendo Wii and Microsoft Kinect for Xbox 360 into patient care.
The Wii was first used for rehabilitation beginning in 2007, primarily for stroke rehab. More recently it has been used for brain injury rehab. The Wii balance board is very useful and a recent research paper showed a significant improvement in static balance in patients with acute brain injury.
As this technology continues to advance, expect to see further integration into both outpatient rehab and inpatient therapy services.
Wii-habilitation: is there a role in trauma? Injury 41:883-885, 2010.
Effectiveness of a Wii balance board-based system (eBaViR) for balance rehabilitation: a pilot randomized clinical trial in patients with acquired brain injury. J Neuroengineering and Rehab 8:30, May 2011.
Algorithm For Clearing the Pediatric Cervical Spine
I previously wrote about a straightforward way to clear the cervical spine in children. Click here to see the article. Alfred I. DuPont Children’s Hospital has condensed their clearance technique into a relatively simple algorithm that can be used in conjunction with my previous tips.
Some notes on this algorithm:
Can be performed only by attending physicians or a trauma resident in consultation with the attending trauma surgeon
Clinical clearance alone may be carried out in select cases
If radiographs are required, cross-table lateral, anterior/posterior, and odontoid views should be obtained (age 8 and above, non-intubated)
Flexion / extension views should only be ordered in consultation with neurosurgery
Management of severe traumatic brain injury (TBI) routinely involves monitoring and control of cerebral perfusion pressure. Monitoring is typically accomplished with an invasive monitor, with the extraventricular drain (EVD) and fiberoptic intraparenchymal monitors (IP) being the most common.
The extraventricular drain is preferred in many centers because it not only monitors pressures, but it can also be used to drain cerebrospinal fluid (CSF) to actively try to decrease intracranial pressure (ICP). But could less really be more? Surgeons at Massachusetts General reviewed 229 patients with one of these monitors, looking at outcomes and complications. They found the following interesting results:
There was no difference in mortality between the two monitor types
The EVD patients did not require surgical decompression as often, possibly because of the ability to decrease ICP through drainage
The EVD patients were monitored longer, and had a longer ICU length of stay. This was also associated with a longer hospital length of stay.
Complications were much more common in the extraventricular drain group (31%). The most common complications were no drainage / thrombosis (15%) and malposition (10%). Hemorrhage only occurred in 1.6% of patients.
Fiberoptic monitors had a lower complication rate (8%). The most common was malfunction leading to loss of monitoring (12%). Hemorrhage only occurred in 0.6% of patients.
Bottom line: Don’t change your monitoring technique yet. Much more work needs to be done to flesh out this small retrospective study. But it should prompt us to take a critical look for better indications and contraindications for each type of monitor.
Reference: Intraparenchymal versus extracranial ventricular drain intracranial pressure monitors in traumatic brain injury: less is more? Presented at the 34th Annual Residents Trauma Papers Competition at the American College of Surgeons 89th Annual Meeting, March 10, 2011, Washington DC.
It’s warm weather time (in the Northern hemisphere) and the windows are opening. Unfortunately, many parents forget that window screens are not strong enough to keep a child in if they put their weight against it.
Please share the following prevention tips with your patients to keep their children safe:
Install window guards on all windows above the first floor
Windows without guards should only be opened from the top
Keep beds, cribs, sofas and other furniture away from windows so children can’t play near open windows
Lock closed windows and do not let children sit or play near open windows