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 my first pediatric-specific law. Any time I give a pediatric talk, I mention it. This one applies to anyone who takes care of children, and is particularly important to EMS / prehospital providers and emergency physicians.

On occasion, medics are called to a home to treat a child in extremis, or occasionally in arrest. Similarly, extremely sick children are often brought to the ED by parents or other caregivers.

Here’s the fifth law:

A previously healthy child who is in arrest, or nearly so, is a victim of child abuse until proven otherwise.

Bottom line: It’s so easy to go down the sepsis path with sick kids, especially those who can’t talk yet. But healthy children tend to stay healthy, and don’t easily get sick to the point of physiologic collapse. If you encounter one as a prehospital provider, glance around at the environment, and evaluate the caregivers. In the ED, ask pointed questions about the circumstances and do a full body examination. What you hear and what you see may drastically alter how you evaluate the patient and may save their life.

You’ve just received a young male who had been stabbed under his right arm in your emergency department. He’s awake, talking, and very friendly. He met your trauma activation criteria, so you are cruising through the full evaluation. Lines in, blood drawn, clothes off. He wonders aloud if all this is really necessary.

Then, on FAST exam, you see it. A pericardial stripe that looks like a mix of liquid and clotted blood. Your colleague steps in and verifies the exam. But vital signs are normal, and the patient is fine.

What next? CT of the chest to further define this? A formal echo to confirm? Your surgeon says no, we’re going to the OR, now! Reluctantly, you package the patient and send him on his way. In the OR, the anesthesiologist takes his time, putting in an arterial line, asking the patient unrelated questions. A thoracotomy? Really? The patient remains awake and alert through all of this.

So here’s the fourth law of trauma:

Even awake, alert, and stable patients die. And it hurts that much more when they do.

Bottom line: You know the diagnosis in this case. And you know what needs to be done. But the awake and alert patient fools us. Fakes us out. Somehow, we equate the ability to talk intelligently with being fine. But evil things can be going on inside that don’t rear their ugly head until it’s too late. Don’t get suckered! Believe your exam, not what the patient thinks they are telling you.

Trauma patients don’t always behave the way we would like. They continually surprise us, sometimes for the better, when they recover more quickly and completely than we thought. But sometimes, it’s for the worse. They occasionally crash when we think everything is going so well.

The crashing patient is obviously in need of help, and most trauma professionals know what to do. But then there’s the hypotensive patient. The BP just dropped to 84, and it’s not budging. Many don’t see this for what it is: a slow-motion crash. And they want to do things they wouldn’t think of doing to a crashing patient. Like go to CT, do some more stuff in the ED because that BP cuff just has to be wrong, or call interventional radiology and wait for 45 minutes.

But here’s the third law of trauma:

The only place an unstable trauma patient can go is to the OR.

Bottom line: By definition, an unstable trauma patient is bleeding to death until proven otherwise (the second law, remember?). Radiation can’t fix that. Neither can playing around in the resuscitation room unless the bleeding is spraying you in the face. The surgeon must quickly figure out which body cavity is the culprit and address it immediately. And the only place with the proper tools to do that is an operating room.