Thanks to Dr. Andrew Lohoar and Sue Benjamin for leading the discussions this month
Major points of interest:
A) Blood is important stuff…so keep track of it.
Recent ATLS guidelines are suggesting switching to blood for resuscitation after one litre crystalloid bolus, not two. We will be using blood more often and it is important to keep track of amount ordered and infused. Give clear orders, document, and send any unused units back to transfusion medicine.
B) Analgesia/anti-emetics prior to leaving for diagnostic imaging
Moving on/off DI tables can increase pain or provoke nausea in some patients.
C) Who put that thing there?
If you decide to put something into your patient, such as a chest tube or ET tube, then write a procedure note, including details of placement confirmation.
D) Trauma patients you know will require consultants
When services are known to be required for patients prior to arrival (intubated, critical ortho injuries, penetrating trauma, transfers etc.) call a level A activation – consultants should meet patient with you. Give the consultants notice when patient is 15 minutes out.
In pediatric traumas that cannot be managed locally use the NB Trauma TCP to coordinate transfers to IWK.
E) Yo-yoing to DI for yet another film
“Pan-scanning” a younger patient can be a difficult decision, but if there is a high energy MOI and indication for spine imaging, CT scan is the superior imaging choice.
F) Pregnancy tests for everybody
Do not forget this in ‘older’ pediatric age group.
G) “Moving all limbs”..
..is NOT an acceptable documentation of exam findings in a patient with suspected neurologic injury. Thorough exam to detect any deficits is needed for neurologic baseline and for comparison later. Dermatome level of sensory dysfunction, key muscle group strength (0-5 scale) and anal sphincter tone should all be recorded, with time of exam.
H) Severe traumatic brain injury
Remember the CRASH 3 study – adult with TBI < 3hrs from time of injury.
I) Motorcycle + cocaine + EtOH + no helmet…
Equals an agitated head injured patient very difficult to sedate after intubation. Consider fentanyl infusion in addition to sedation infusion.