Dr. Carey's Trauma Bullets - August 2019

October 25, 2019
Clinical

Dr. Carey's recap of the August 2019 Joint EM - Trauma Conference. High yield learning points inspired by our own trauma patients.

High-yield areas for improvement:

Adult

  • Involvement of the trauma service in injuries after fall mechanisms
  • Failure to recognize early decompensation, avoid focusing solely on the systolic blood pressure, tachycardia is often the first sign of decline
  • If a cervical collar is cleared, always document HOW (ex. NEXUS, Canadian C-spine, etc)
  • If you are obtaining a CT on a patient (especially at an outside hospital), consider scanning the chest and abdomen together – the same contrast load is involved, and concomitant injuries can be overlooked/not addressed
  • CT does not rule out hollow viscus injury, consider serial exams and surgical consultation in seatbelt signs
  • Many burn centers prefer bacitracin with non-adherent gauze wrapped in a dry dressing. Do not use Silvadene, patients are typically debrided almost immediately on arrival


Pediatrics

  • Most common pediatric mechanisms are falls and improperly restrained MVCs
  • Family education on properly restraining children is key
  • All NAT transfers from outside hospitals should be transferred to the Trauma service, who will then consult specialists as needed (ophtho, ENT, etc)


Neurosurgery injury consultations

  • Epidural hematoma
  • Subdural hematomas 1cm or greater
  • ANY midline shift

Orthopedic injury consultations

  • Pelvic fractures with hemodynamic instability
  • Extremity injuries with vascular or neurologic compromise
  • Multiple long-bone fractures associated with hemorrhagic shock

Injury Severity Score (ISS)

  • Score to assess trauma severity.  Higher scores correlate with morbidity, mortality, and duration of hospitalization
  • Major or polytrauma is defined as a score of 15+

Based upon the Abbreviated Injury Scale (AIS)

The body is divided into six regions:

  1. Head and neck/cervical spine
  2. Face – facial skeleton, nose, mouth, eyes, and ears
  3. Chest – thoracic spine and diaphragm
  4. Abdomen and pelvic contents – abdominal organs and lumbar spine
  5. Extremities and pelvic girdle
  6. External

ISS = A2+ B2+ C2

Where A, B, C are the AIS scores of the three most injured ISS body regions

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