Trauma professionals are always on the lookout for injuries that can kill you. Thoracic aortic injury from blunt trauma is one of those injuries. Thankfully, it is uncommon, but it can certainly be deadly. One of the screening tests used to detect aortic injury is the old-fashioned chest xray. This... Read more
Published on: 2020-09-23
I love challenging dogma. I spoke last week (virtually) at an excellent event at the Intermountain Medical Center in Utah. One of my talks there addressed trauma myths and dogma. I bring this up because there is an interesting article in the Journal of Trauma this month that questions the... Read more
Published on: 2020-09-21
When is the last time this has happened to you? You are called to the ED for a trauma activation. The patient was involved in a motorcycle crash and is doing fine, but he has a large midline scar on his abdomen. You inquire as to what it is. He... Read more
Published on: 2020-09-14
Okay, so this abstract is a bit more on the touchy-feely side. But it is extremely important because it speaks to the balancing act we all have to perform in order to achieve a satisfying harmony between work and everything else. Older generations of surgeons threw nearly all of their... Read more
Published on: 2020-09-10
The management of blunt spleen injury has evolved significant over the time I’ve been in practice. Initially, the usual formula was: Spleen injury = splenectomy This began to change in the late 1980’s, and beginning in the early 90’s nonoperative management became the rage. We spent the next 10-15 years... Read more
Published on: 2020-09-09
The next abstract in this series poses a challenge to long-held dogma. More than three decades ago, examination of vascular injuries was divided into “hard signs” vs “soft signs.” Hard signs consisted of findings like pulsatile hemorrhage, expanding hematoma, absent distal pulses, thrill, or bruit. These were believed to be... Read more
Published on: 2020-09-04
The next abstract is an interesting demonstration of the use of technology is trauma resuscitation. Pretty much all technology imaginable. It details the use of a “hybrid ER” room, which combines resuscitation space with all sorts of imaging and even interventional angiographic procedures. Here’s an image of the room when... Read more
Published on: 2020-09-02
Blunt carotid and vertebral artery injuries (BCVI) are an under-appreciated problem after blunt trauma. Several screening tools have been published over the years, but they tend to be unevenly applied at individual trauma centers. For an unfortunate few, the only indication of BCVI is a stroke while in hospital. The... Read more
Published on: 2020-09-01
To screen on not to screen, that is the question. If you do more testing, you will find more cases. But does it make a difference clinically? Sounds like some of the questions coming up in our current discussion of the Coronavirus. But that’s what we really need to know.... Read more
Published on: 2020-08-31
The use of tranexamic acid (TXA) in trauma patients has escalated dramatically since the CRASH-2 trial was published ten years ago. It has become a frequent addition to the massive transfusion protocols used by trauma centers. And we are now even seeing TXA given by prehospital provides when life-threatening bleeding... Read more
Published on: 2020-08-28
Venous thromboembolism (VTE) and pulmonary embolism (PE) have caused major problems for trauma professionals for at least 50 years. Interestingly, despite advances in chemical and mechanical prophylaxis, the mortality rates for both have remained about the same. The group at St. Joseph Mercy Hospital in Ann Arbor looked at the... Read more
Published on: 2020-08-27
The use of mean arterial pressure (MAP) goals in the management of spinal cord injury is commonplace. But hit the literature some time and try to find out what the ideal MAP is, or if they even make a difference. It’s very difficult to come up with really solid data.... Read more
Published on: 2020-08-26
More and more people are taking antiplatelet or antithrombotic agents for a variety of medical conditions. One of the dreaded side effects of these medications is undesirable bleeding, particularly after injury. This is especially true if the bleeding occurs inside the skull after any kind of head trauma. Which agents,... Read more
Published on: 2020-08-24
Over the years, the operative vs nonoperative management pendulum has swung to and fro. For solid organ injuries, operative management was routine until about 30 years ago. Since then, it has moved to the opposite end of the spectrum. Similar swings have occurred in pediatric trauma management as well. Most... Read more
Published on: 2020-08-21
REBOA is the new kid on the block. Human papers first started appearing in the trauma resuscitation literature about six years ago. Since then, we’ve been refining the details: how to use it, who to use it in, as well as a lot of the technical tidbits. The group at... Read more
Published on: 2020-08-20