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:
- Head and neck/cervical spine
- Face – facial skeleton, nose, mouth, eyes, and ears
- Chest – thoracic spine and diaphragm
- Abdomen and pelvic contents – abdominal organs and lumbar spine
- Extremities and pelvic girdle
- External
ISS = A2+ B2+ C2
Where A, B, C are the AIS scores of the three most injured ISS body regions
