Yes, I’ve been writing this blog for sixteen years! It continues to be a place where I can write about topics that I am curious about, learn something new, or share things I find very interesting.
Here’s to yet another year of fun and learning!
Michael
You’ve just been pre-notified of an incoming trauma activation: gunshot to the face. No other information. How concerned should you be? Here are some things to think about as you wait for the patient to arrive:
Once the patient arrives, it’s best to think through things via the ATLS framework.
Related posts:
Scammers are everywhere!
I received a phone call from a phone number with the caller ID “US GOV DEA” in Manassas, Virginia. It was screened by my Robokiller robocall app, and the caller left the following message:
“Good morning, this is Officer Alan Matthew with DEA the drug enforcement administration and my ID is M as in Mary, A as in apple, number 9173. This message is for Dr. Michael McGonigal. The reason of this call is to inform you Dr. Michael is that your NPI number which is <redacted> and your medical license number which is <redacted>. Your NPI and your medical license number involved in some fraudulent activities in San Antonio, Texas and that’s the reason we are trying to reach you to make you aware about the situation. So when you receive this message if you’re not aware about this please give us a call back as soon as possible. The department direct line which is 571-532-0076. I repeat the number is 571-532-0076. Thank you so much, have a good day.”
Some people might be fooled by the caller ID, but these can very easily be spoofed. In general, the DEA, like other Federal agencies, will not contact you primarily by phone. US Mail is the preferred route. That was the first clue that this was not a legitimate call.
Next, I listened to the message. The speaker had a pronounced accent, which in and of itself is not unusual. However, his grammar was not very good. My NPI and medical license number are available from public records, so I ignored that. Interestingly, he did not recite my DEA number, which is not public.
But the caller then tried to make the situation sound urgent by saying it involved fraudulent use of these numbers. This is a classic tactic used by scammers to elicit an emotional response and cause their mark to lower their cognitive defenses.
When I did an internet search on the number, the first item that came up was:
“DEA warns of scammers impersonating DEA employees”
from June of 2020.
The DEA warns that the scanners may:
What should you do if you receive a call like this? First, completely ignore it. Do not call the number! The DEA points out that it is a federal crime to impersonate a DEA agent, and has a reporting link on their website. However, it just provides a little more information and directs you to an FBI reporting site. This web page is geared toward reporting if you have been a financial victim. Unfortunately, I doubt the agency has the time or resources to pursue mere phone calls unless you have suffered personal or financial harm.
Bottom line: All of this is classic scam action. This has been going on for five years, and continues to this day. Don’t be fooled and fall for this scheme!
Gee, the hybrid OR sounds like a great idea for specific trauma patients. We’ve seen this before; it’s a great idea but doesn’t always translate into a positive result. Is there any literature?
Unfortunately, very little until a few years ago. A group from the University of Calgary in Alberta published a very detailed paper on the nuts and bolts of how they designed their hybrid room from scratch. This paper is very detailed, and the hospital personnel were thoughtful as they approached the time-consuming and expensive task of designing and building their hybrid room. Of course, they chose a silly acronym as so many do. They called it their RAPTOR room (Resuscitation with Angiography, Percutaneous Treatments, and Operative Resuscitations). Sigh!
Next, they retrospectively analyzed their experience with persistently hypotensive patients arriving at their Level I trauma center over a 17-year period before their hybrid room opened.
Here are the factoids:
Sounds good so far! But we need some more data. Unfortunately, there’s not a lot of it yet. A Japanese group described their experience treating patients in OR then IR, versus a “hybrid procedure.” This did not involve the use of a true hybrid OR. They moved a C-arm fluoroscopy unit into an OR, and part of the procedure was carried out by an interventional radiologist.
And the factoids:
Okay, sounds promising. A second Japanese paper was published last year with much larger numbers. Their hybrid OR was actually a hybrid ER! They installed a multi-slice interventional radiology/CT unit in their resuscitation room! Here are the key findings:
Here’s an image of their setup:
Key: A – mobile CT scanner, B – CT / OR table, C – mobile C-arm, D – 56” monitor, E – ultrasound, F- ventilator
Bottom line: This is quite a unique room. Unfortunately, it is not ideal because it is small and cramped. It looks like it would be difficult to fit more than one surgical team in the room. However, the results look good.
We are finally seeing objective data involving a reasonable number of patients. A minority of trauma programs have a hybrid OR available to them, and the number of patients who would benefit from it is low. But if a patient needs it, this setup can be life-saving. So who are those patients, exactly?
In my next post, I will review some of the most recent (and favorable) papers supporting the use of the hybrid OR for trauma.
References:
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!