Big thanks to Sue Benjamin for her efforts in putting these reviews together!
Major points of interest:
A) Kudos – Trauma Codes for qualifying cases has improved!
May – September 2020, for cases qualifying for trauma team activation, the rate of calling ‘Trauma Codes’ has improved to 84%. RN trauma note is 93% for the activations.
Many of the missed activations are transfers from peripheral sites
Please review the attached updated simplified activation criteria – notable changes are:
1/ Removal of minor head injuries without signs or symptoms on anticoagulants under “D”
2/ Addition of pulseless extremity under “C”
B) Chest Tubes in trauma – 5 year review
Chest tubes are placed infrequently (~ 1 per month) in our departments.
Review of post procedure x-rays (thanks J ‘Mek1’) showed there was less than optimal tube positioning 60% of the time.
Tube position and function must be critically reviewed post procedure.
Chest tube discussion/demonstration with Dr Russell will take place at next Trauma case review (January 2021)
C) Oh, that patient is just here for Plastics..
‘Distracting’ injuries are called that for a reason. It is hard to look past deformed limbs, but always perform a head to toe assessment (including FAST) to identify associated injuries to others systems.
Trauma transfers should be re-assessed by ED physician at receiving hospital, to also determine if there are any other concerning injuries that have been missed.
Trauma cases being transferred to consultants, outside of NB trauma line, should be identified by charge MD when taking report.
D) “Penetrating neck trauma is en route”
Those words will wake you up in a hurry.
Keys to management are early notification (pre-arrival) of consultants (ENT +/- vascular) and clear airway plans that include a ‘double set’ up for potential need for surgical airway.
E) What kind of monster would order a ‘Panscan’ on a child?
One that can weigh the risks (missed injuries) vs. benefits (minimizing radiation exposure).
Panscans in pediatric patients should never be ordered routinely, but should be considered in cases with high risk for clinically significant multi-system injuries (head, spine, thorax, abdomen).
F) Blunt traumatic cardiac arrest
This population has a grave prognosis.
Airway management, continuous chest compressions, rapid fluid/blood resuscitation and consideration for procedural interventions (thoracostomies, pericardiocentesis) are usual steps in care.
Epinephrine has no role unless medical cause for arrest is suspected.
A more in-depth review will be topic of upcoming SJRH ED rounds.
G) What did this guy have for supper?
Pizza and beer, and lots of it.
Ducanto catheters – large bore suction catheters – are available on all airway carts in the top drawer. They are much more efficient at decontaminating airways soiled with semi-solid material when compared to Yankauer.
H) Updated Trauma checklist:
“SJRH ED Trauma Process Checklist” is in trauma note package in room 19 and is a very useful prompt (see below). K/ T- L spine Traumatic Spine Injury Guidelines also below.
