Tag Archives: video

TETNG Video Week: You Think You Know…

This week, I’m going to post a series of videos from our Trauma Education: The Next Generation (TETNG) conference from last September. Regions Hospital, in conjunction with the Healthpartners Institute for Medical Education, created this conference to be new, different, and very TED-like. There were 20-minute live presentations, interspersed with fun 5-minute how-to videos. We dropped the staid and stodgy PowerPoint deck with tons of bullet points, moving to showing a few select graphic images that would drive home the point. No note taking!

I am the presenter for today’s video. It’s a little less than 20 minutes long, and deals with a problem that we all face: thinking we understand stuff that we really don’t. It’s another version of “you don’t know what you don’t know.” I talk about why this phenomenon occurs, and what you can do to avoid it.

Tomorrow: Field Amputation: Indications, Challenges, Techniques

Submental Intubation – The Video!

Yesterday, I described a technique for providing a secure yet short-term airway tailored to patients who can’t have a tube in their mouth or nose. Patients undergoing multiple facial fracture repair are probably the best candidates for this procedure.

A picture may be worth a thousand words, but a video is even better. Please note that it is explicit and shows the blow by blow surgical procedure. Of note, it is a quick and relatively simple advanced airway technique.

Related post:

Answer: What The Heck Video! Part 1

Several of you figured this one out! The patient was involved in a high speed car crash and was brought to the ED in respiratory distress.  Decreased left sided breath sounds were noted. The following xray was obtained.

Opacity is noted in the left lung field, and a modest pneumothorax is seen on the right. Bilateral first ribs are fractured, and the left second through fourth ribs are also broken. The patient was intubated and bilateral chest tubes were inserted.

There was minimal blood from the left chest tube, and a small amount of air from the right. Note the extensive subcutaneous emphysema.

What should we do next? Are any other diagnostic tests indicated? Could the endotracheal tube placement be part of the problem?

Related posts:

Intracranial Hypertension In Pediatric Head Trauma

This 44 minute video is a good introduction to pediatric head trauma and intracranial hypertension. It covers physiology, diagnosis, as well as management using medications, position, decompression and hypothermia.

Presented at Multidisciplinary Trauma Conference at Regions Hospital on May 3, 2012 by Debbie Song MD, a pediatric neurosurgeon.

Damage Control Dressing: The ABThera (Video)

In the late 1980’s, when we started the work that would be published in the first damage control paper from Penn, we used the vacuum pack dressing. This was first described in a paper from the University of Tennessee at Chattanooga in 1995. Prior to that, the so-called Bogota bag was the usual technique. This consisted of slicing opening up a sterile IV bag (either the standard 1 liter or the urology 3 liter bag for big jobs) and sewing it into the wound. This worked, but it freaked out the nurses, who could see the intestines through the print on the clear plastic bag.

The vacuum pack was patient friendly, with a layer of plastic on the bottom, some absorbent towels in the middle with a drain in place to remove fluid and apply suction, and an adherent plastic layer on top to keep the bed clean. As you can imagine, this was a little complicated to apply correctly. One misstep and things stuck to the bowel or leaked out onto the bed.

In the past few years, a commercial product was developed that incorporated all these principles and was easy to apply. This is the KCI ABThera (note: I have no financial interest in KCI or this product; I just wish I had invented it). The only downside is that there is a small learning curve when first using this product.

The video above shows a demonstration of the application on an abdominal mannikin. It is not as slick as the company videos, but I think it’s more practical, with some good tips.

References:

  • Damage control: an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma 35(3):375-382, 1993.
  • Temporary closure of open abdominal wounds. Am Surg 61(1):30-35, 1995.