As a followup to my hip dislocation post on Tuesday, here is a short 5 minute video that goes through the entire process of reducing hip dislocations. There are lots of little tips and tricks. Enjoy!
In the next post, a novel variant of the hip reduction technique, the Captain Morgan.
Originally shown at Trauma Education: The Next Generation 2013 in St. Paul MN
Although posterior hip dislocation is an uncommon injury, the consequences of delayed recognition or treatment can be dire. The majority are caused by head-on car crashes, and 90% of these are posterior dislocations. The femoral head is forced across the back wall of the acetabulum, either by the knee striking the dash, or by forces moving up the leg when the knee is locked. This occurs most commonly on the right side when the driver is standing on the brake pedal, desperately trying to stop.
On exam, the patient presents with the hip flexed, internally rotated and somewhat adducted. Range of motion is limited, and increasing resistance is felt when you try to move it out of position. An AP pelvic X-ray will show the femoral head out of the socket, but it may take a lateral or Judet view to tell if it is posterior vs anterior.
These injuries need to be reduced as soon as possible to decrease the chance of avascular necrosis of the femoral head. Procedural sedation is required for all reductions, since it makes the patient much more comfortable and reduces muscle tone. The ED cart needs to be able to handle both the patient’s weight and your own. I also recommend a spotter on each side of the cart.
Standing on the cart near the patient’s feet, begin to apply traction to the femur and slowly flex the hip to about 90 degrees. Then gently adduct the thigh to help jump the femoral head over the acetabular rim. You will feel a satisfying clunk as the head drops into place. Straighten the leg and keep it adducted. If you are unsuccessful after two tries, there is probably a bony fragment keeping the head out of the socket. See an instructional video on this in my next post.
Regardless of success, consult your orthopedic surgeon for further instructions. And be sure to thoroughly evaluate the rest of the patient. It takes a lot of energy to cause this injury, and it is flowing through the rest of the patient, breaking other things as well.
In the last post, I discussed what to do if your hospital is thinking about switching to an electronic trauma flow sheet (eTFS). Today I’ll give you some tips on what to do if the cat’s already out of the bag and it’s already been implemented.
The number one priority is to show the impact of the eTFS on the trauma program. This involves the same two components I’ve already written about:
Once your hospital has taken the plunge and adopted the eTFS, it is very difficult to go back. Many centers are convinced that “this next update is going to make it so much better.” It never does! I have visited programs that have been tweaking their processes and reports for almost 8 years! None have been able to improve it significantly.
Your hospital administration will ultimately need to decide how to proceed, depending on how damaging the eTFS is to the trauma PI program and how much it will cost to continue to tweak it vs returning to a paper flow sheet. Good luck!
I’ve spent several posts showing you the major problems inherent in using an electronic trauma flow sheet (eTFS). It boils down to Garbage In / Garbage Out and time. It costs a lot of money and weakens an otherwise robust trauma performance improvement process.
Here’s the real bottom line:
” A hospital using an electronic trauma flow sheet is paying a lot of money for a product that forces them to pay even more money for people to essentially transcribe inaccurate data back onto a paper trauma flow sheet.”
So what can be done about it? That depends on whether the eTFS has already been implemented. Today, I’ll discuss what to do if it’s still in the planning stages.
You’ve just heard that your hospital is considering switching to an eTFS. Here’s what you should do:
But what if they don’t? Or what if you’ve walked into a program already using it? I’ll talk about that in the next post on Friday.
In my last post, I wrote about how the electronic trauma flow sheet (eTFS) practically assures a garbage in situation. Today, I’ll dig into what happens on the back end, and how it also creates a garbage out situation.
There are two ways to view the eTFS on the back end (abstraction phase): read a paper report (timeline), or view it live in the electronic health record (EHR). Let’s look at each:
The final result of all of the shortcomings listed above is this: it increases trauma flow sheet abstraction time by three-fold or more! If you are a trauma center with a two-tier trauma activation system, you probably have a lot of TTAs. Therefore, it takes a lot of time to abstract all those flow sheets. Which ultimately means that you (this really means your hospital) will have to pay for more registrars / PI coordinators / nurses!
Hopefully, I’ve convinced you that the eTFS is not a great way to go. In the next post, I’ll discuss strategies to use if your hospital is “considering” moving to an eTFS. And next week, I’ll wrap up with what to do if you’ve already been burdened with it.