In my last post, I wrote about the accepted management of and delay in flying due to traumatic pneumothorax. I republished the post because of the publication of a paper from Oregon Health Science University in Portland. The authors specifically tried to assess timing of chest tube removal and long-distance... Read more
Published on: 2023-03-17
Today, I’m dusting off an old post on flying and diving after pneumothorax. This shows the thinking up until a few years ago. In my next post, I’ll write about a more recent paper that suggests that we can shorten the “no-fly” time considerably. Hint: no changes to the diving... Read more
Published on: 2023-03-15
Minor complications from nasogastric tube insertion occur relatively frequently. Emesis is fairly common when the gag reflex is stimulated by the tube in the back of the oropharynx. An infrequent but possibly fatal one is insertion through the cribriform plate.  The cribriform plate is located directly posterior to the nares... Read more
Published on: 2023-03-13
Nausea and vomiting are common problems in trauma patients, particularly those in a trauma activation. Inciting factors include pain, full stomach from food eaten before the event or blood swallowed after, or reaction to pain medications. For years, trauma professionals reached for the lowly gastric tube to evacuate stomach contents... Read more
Published on: 2023-03-10
In my last post, I discussed a paper describing the incidence of colonic pseudo-obstruction (CPO), or Ogilvie syndrome, in trauma patients. The paper confirmed my bias that this condition could be a problem in a specific subset of trauma patients. They are generally older men with pelvic or spine fractures,... Read more
Published on: 2023-03-08
A funny thing happened eight years ago. During one of our morbidity and mortality conferences at Regions Hospital, we got the first hint of an emerging pattern. We noted occasional trauma patients who developed colonic pseudo-obstruction (CPO), also known as Ogilvie’s syndrome. In reviewing our experience, it seemed to occur... Read more
Published on: 2023-03-06
As all trauma professionals know, traumatic injuries are a major cause of death across all age groups. Well-trained trauma teams use all their skills to attempt to save critically injured patients. But, unfortunately, there are occasions in which they die despite all our efforts. In most of these cases, the... Read more
Published on: 2023-03-03
Nonsurgical admissions are a concern for most verified/designated trauma centers. Under the current 2014 Resources for Optimal Care of the Injured Patient, all trauma patient admissions to a nonsurgical service must be concurrently reviewed by the trauma program. This process guards against trauma patients sneaking into the hospital on medicine... Read more
Published on: 2023-03-01
Trauma service staffing is important to maintaining trauma center status. Teaching centers in the US have been grappling with resident work hour rules, and non-teaching centers have always had to deal with how to adequately staff their trauma service. What is the impact of staffing a trauma center with midlevel... Read more
Published on: 2023-02-27
Several days ago, in my post on “How Common Is BCVI?” I mentioned a paper recognizing the increasing incidence of BCVI in pediatric patients and the very high stroke rate (37%) and death rate (13%). These numbers are very concerning! Previous work shows that the Memphis and Denver criteria are... Read more
Published on: 2023-02-24
In my last post, I reviewed the grading system for blunt carotid and vertebral artery injury (BCVI). Today, we’ll discuss treatment, and in the next post, we will wrap up with pediatric-specific information. There are basically three modalities at our disposal for managing BCVI: antithrombotic medication (heparin and/or antiplatelet agents), surgery, and endovascular procedures.... Read more
Published on: 2023-02-22
In my last post, I reviewed the three screening systems for blunt carotid and vertebral artery injury (BCVI). Today, we’ll look at grading them. Just ten years ago, it was a major production to identify BCVI. Then, CT angiography was still in its early days, and scanner resolution and radiologist... Read more
Published on: 2023-02-20