Emergency Thoracotomy Video
I did get a lead on a decent video of an emergency thoracotomy that combines most of the principles I laid out last week. It shows a nicely done thoracotomy with exposure of the heart. Aortic crossclamping is not performed, but overall it’s pretty good. All narration is in Thai, so many of you may not be able to follow the conversations.
Technology: EEG Monitoring Using A Smartphone App
Remember when EEG monitoring in patients with severe TBI looked like a maze of multicolored spaghetti plugged into a small refrigerator? Well, technology is advancing rapidly and the hardware is shrinking fast.
This EEG monitor uses an EEG headset, which has fewer leads than the old standard. The headset connects to a Nokia smartphone using a wireless connection. And while it can’t compete with a regular EEG on fine detail like localizing seizure foci, it should easily be able to measure something as crude as burst suppression in trauma patients in pentobarb coma.
Expect more advances like this. Computing and monitoring is leaving the realm of the dedicated (and physically large) device, and moving toward handheld monitoring using off-the-shelf hardware like smartphones.
//s3.amazonaws.com/rtovideos/MDC+20110804_controller.swf
Procedural Sedation and Analgesia
The Regions Hospital Multidisciplinary Trauma Conference on August 4 dealt with the use of procedural sedation in the emergency department. The presentation was delivered by Ben Watters MD.
This presentation is 56 minutes long.
Important disclosure information: off-label use of ketamine is discussed.
Hare Traction – Putting It On, Taking It Off
Femoral traction devices have been around for a long time. One reader has asked about the timing of removal of these devices after they arrive at the hospital. I learned a number of things while reviewing the literature to answer this question.
Most importantly, there is really only one indication for applying a traction splint to the femur: an isolated, relatively mid-shaft femur fracture. Unfortunately, there are lots of contraindications. They consist of other injuries or fractures that could sustain further damage from traction. Specifically, these include:
I did find one interesting study from 1999 that looked at how useful these splints really were. Of 4,513 EMS runs, only 16 had mid-thigh trauma and 5 of these appeared to have a femur fracture. Splint application was attempted in 3, and only 2 were successful. This was the experience in only one city (Evanston, IL) for one year. However, it mirrors what I see coming into our trauma center.
Unfortunately, when it comes to removal, there are very few guidelines out there. My advice is to have your orthopedic surgeon evaluate as soon as imaging is complete. They can help decide whether converting to some type of definitive traction is necessary, or whether it can be changed to a more conventional splint. In any case, the objective is to minimize the total amount of time in the traction splint to avoid any further injury to other structures.
Reference: Prehospital midthigh rauma and traction splint use: recommendations for treatment protocols. Am J Emerg Med, 19:137-140, 2001.
Field Concussion Testing For Athletes
Public awareness of concussions, particular those from sports, is on the rise. It’s difficult enough for trauma professionals to diagnose some of the milder forms of head injury. Expecting lay people to do this is just not realistic.
Most people have heard of ImPACT testing for head injury. This involves determining a player’s baseline ability to remember a series of words. It tests memory, attention span and reaction time. A baseline study is required, and the test takes about 20 minutes to administer using a computer.
The King-Devick test is a numerical processing tool that can be administered using an iPad or a deck of cards. A baseline value is required as well, and the test takes about 2 minutes to administer. See the video for details.
Both tests have been validated by a number of scientific studies, and both are only available for purchase. Several hospitals, trauma centers, and schools have purchased the programs and will administer them for free.
Check out these valuable programs and consider providing them at your own local sporting events.
Links:
Related post: TBI screening with the Short Blessed Test