Okay, here’s another one! But it’s a doozy. It’s the most important one I live by. It ensures that you don’t get bogged down by habit, custom, dogma, ignorance, or just plain laziness.
If someone ever says, “but that’s the way I/we always do it,” or “that’s what the policy says,” or even “I read a good paper/chapter on this,” take it with a really big grain of salt. Or a salt lick (if you know what that is; otherwise look it up).
And here’s a corollary:
Don’t believe everything you think!
Consider that one for a minute.
Bottom line: It’s up to you to decide what is right for your patients. Others may not have done the leg-work and may not be as knowledgeable as you think. Always check the facts!
All trauma professionals need to keep up with the current thinking in their field. There are a variety of ways to do this, including lectures, courses, online curricula, meetings, and reading journal articles.
The last method requires a bit of skill and patience. Many research papers are dry, long, and hard to read. Quite a few people do not have the patience to wade through them, and get lost in all the details. The natural tendency is to just read the abstract. It’s quick, easy, and the conclusion is right there, right?
Read the entire paper!
Unfortunately, there is a lot of opportunity for mayhem when reading scientific papers. The title might not match up with the conclusions. The conclusions may not fully agree with the data. And the abstract generally does not give enough information to draw a conclusion. You must read the entire thing and think critically about it!
Bottom line: Yes, it takes practice. But you will find that it gets easier over time. And you will be surprised at how many times the abstract actually says the opposite of what was outlined in the body of the paper.
Healthcare is a complex affair, and sometimes things don’t go entirely as planned. Occasionally, an elective OR may not be available the next day. This is especially true now in the COVID age with hospitals decreasing their OR capabilities. Or it may take longer than usual to medically clear a frail patient for surgery. But here is something to keep at top of mind:
Your patient is at their healthiest as they roll in through the emergency department door
Yes, major trauma patients are sick, but they are going to get sicker over the next few hours to days. No matter how bad they look now, they will tolerate more at the time you first see them than they will tomorrow.
Too often, we look at them and delay because “they are too sick to operate.” This is usually not the case.
Bottom line: Move quickly, get surgical clearances done promptly, and perform all interventions (especially major surgery) early before your trauma patient gets really sick!
Here’s another one. I’ve seen the clinical problems and poor outcomes that can arise from ignoring it many times over the years.
You’ve ordered a CT or a conventional x-ray image. The result comes back in your EMR. You take a quick glance at the summary at the bottom of the report. No abnormal findings are listed. So now, in your own mind and in any sign-outs that you provide, the image is normal.
Here’s the rub. Saying something is not abnormal doesn’t necessarily mean that it’s normal. Hence the sixth law:
Always look at the image yourself.
Sometimes, the radiologist misses key findings on the image. Sometimes they see them and make a note of them in the body of the report. But they don’t get the clinical significance and don’t mention it in the summary (which is the only thing you looked at, remember?).
Bottom line: Always make a point to pull up the actual images and take a look. You have the full clinical picture, so you may appreciate findings that the radiologist may not. Sure, you may not have much experience or skill reading more sophisticated studies, but how do you think you develop that? Read it yourself!
The next Trauma MedEd newsletter is coming soon! It is a continuation of my COVID and Trauma Professionals series.
COVID has turned our usual teaching model on its head. There are now limits on group size and time together, mask requirements, and disinfection requirements, to name a few. All of these serve to make providing an in-person, physical contact course very difficult.
We recently produced our first ATLS course at the Regions Hospital EMS Education offices. There were many hoops to jump through and several changes that were required. But it turned out to be a great success.
In the next Trauma MedEd Newsletter, I will share the details of how we did it. Hopefully this information will help your center successfully continue to produce this valuable and sought-after course.
Existing subscribers will receive automatically later this week. It will be published on my trauma performance improvement website, TraumaMedEd.com, at the same time. All others will be able to find it on this blog next week. So subscribe now by clicking this link right away to sign up and/or download back issues.
Tomorrow, back to the Laws of Trauma!