Falls are the most common mechanism of injury at a majority of trauma centers these days. And due to the escalating number of comorbidities in our older population, more and more are taking some kind of anticoagulant or antiplatelet medication. And as all trauma professionals know, falling down and failure to... Read more
Published on: 2021-01-11
In my last post, I went through some of the basics of whole blood transfusion. However, the focus was more on compatibility than function. Today, I’ll review an abstract that explored functionality of that blood transfused. In theory, whole blood contains the usual array of clotting factors. It has been... Read more
Published on: 2021-01-08
What goes around comes around. Fifty plus years ago, the only transfusion product available was whole blood. Then the major blood banks discovered that more patients could be treated for specific problems if the blood were fractionated. Packed red cells then became the standard for trauma transfusion and persists to... Read more
Published on: 2021-01-07
Elderly falls have become a huge problem. There isn’t a night that goes by that we don’t admit at least two or three at our trauma center. There are at least a dozen factors that have been identified that are associated with falls, including: Medications Bone and muscle loss Underlying... Read more
Published on: 2021-01-06
Level I and II trauma centers are regularly on the receiving end of what may be termed as “futile transfers.” These are patients who have sustained unsalvageable injuries and are initially seen at a lower level center. They are then transferred upstream where they succumb shortly (0-48 hours) after arrival.... Read more
Published on: 2021-01-05
In 2015, EAST published their practice guidelines for spine clearance in the obtunded blunt trauma patient. Click here to view them. They stated that a high-quality CT scan can be used to remove (clear) the cervical collar in these patients. This avoids the use of the expensive and personnel-intensive MRI... Read more
Published on: 2021-01-04
This abstract falls into the “interesting, but how can we use this bit of information” category. We’ve known that transfusing packed red cells raises nosocomial infection rates for at least 15 years. The group led by MetroHealth in Cleveland combined forces with the Vanderbilt trauma group to re-look at their... Read more
Published on: 2021-01-03
All right, let’s kick of this EASTfest with an abstract from one of the Eastern Association for the Surgery of Trauma multicenter studies. This one looked at outcomes after what they term “ultra-massive” resuscitation. There are a number of definitions for “massive transfusion” which I’ve discussed before. They are basically... Read more
Published on: 2021-01-02
The Eastern Association for the Surgery of Trauma annual meeting starts in just 2 weeks! Keeping to tradition, I’m going to start reviewing some of the more interesting (to me) abstracts to be presented at the meeting and sharing my thoughts with you. There are 33 regular abstracts and 17... Read more
Published on: 2021-01-01
So you’re faced with a chest tube that “someone else” inserted, and the followup chest xray shows that the last drain hole is outside the chest. What to do? Well, as I mentioned, there is very little written on this topic, just dogma. So here are some practical tips on... Read more
Published on: 2020-12-30
Yesterday I presented the problem of the malpositioned chest tube, specifically one that is not completely in the pleural space. This one is way out: So what do the doctor books say? Well, the first thing you will discover if you try to look it up is that THERE IS... Read more
Published on: 2020-12-29
It happens from time to time. Your patient has a hemothorax or pneumothorax and you insert a chest tube. Well done! But then the xray comes back: The last hole in the drain is outside the chest! What to do??? Here are the questions that need to be answered: Pull... Read more
Published on: 2020-12-28
Trauma patients tend to try to bleed to death. And trauma professionals try to stop that bleeding. They also frequently have to replace the blood products that were lost, which includes red blood cells, plasma, platelets, and more. From a red blood cell standpoint, we have a long history of... Read more
Published on: 2020-12-22