Tag: trauma

Procedures for consultant education

Hi guys.

Here are some videos relating to the procedures we covered during the consultant education this month.

Enjoy!

Stacy

I-gel 2nd generation supraglottic airway

Surgical Airway – Scalpel

RIC line

MAC line

Humeral IO

CT6 femoral splint

SAM pelvic splint

 

ANZAC DAY – self directed learning

ANZAC Day commemorates all Australians and New Zealanders “who served and died in all wars, conflicts, and peacekeeping operations” and “the contribution and suffering of all those who have served”.

Although I personally find it difficult to celebrate the outcomes of war, acts of aggression are a part of our lives and we, as Emergency Physicians, need to be prepared to treat individual victims as well as prepare our departments in case of a disaster.  Additionally, many of you have been, or will be, invovled in working in conflict areas.  Please take a moment during the public holiday to reflect on the victims as well as the strength and courage of the many who protect the innocent, strive to create peace and treat the victims of aggression.

 

We have added some relevant educational links:

BURNS

Major burns are often transferred to the tertiary centres in Melbourne.

The issues to consider include:

  • Fluid Resuscitation – caution in fluid overload, reassessment and special patients at risk of pulmonary oedema
  • Airway management – early intubation in inhalation injuries associated with respiratory distress, elderly or COPD with minimal respiratory reserve or those requiring transfer to a tertiary centre

 

EMCrit RACC Podcast 219 – Critical Burn Patients in the ED/ICU – Part I with Dennis Djogovic

EMCrit RACC Podcast 221 – Burns Part II with Dennis Djogovic – Airway, Lungs, Tubes and Stuff

 

ANALGESIA IN TRAUMA

It is easy to forget to provide adequate and appropriate pain releif while focussing on the resuscitation of the patient and the management of severe injuries.

The key issues:

  • Adequate analgesia promotes healing, reduces post-traumatic stress response, improves morbidity and mortality and reduces length of stay
  • Appropriate assessment tool depending on age, cultural background and language
  • Reassessment of pain score
  • Use of multimodal analgesia and consider early PCA and nerve blocks

 

Pain Management in Trauma A review Study_Injury and Violence 2016

 

DISASTER PREPAREDNESS

Disaster Medicine Review

Often asked in OSCEs, preparing for a disaster or mass casualty event is not just a hypothetical.

Key Issues:

  • Details of the event and special situations/injuries – ie: burns, exposure to cold, chemical injuries
  • Prepare your team, your department and your hospital
  • Post-disaster debreif and hospital recovery

 

Treating the Enemy – the ethics of war

Treating the Doctor

 

Trauma day 2018

Thanks to ED physicians Dr Karen Winter, Dr Ruth Hew, Dr Stacy Turner, Dr Raj Patel, Dr Terence Yuen and radiology fellow Dr Aaron Ow for co-ordinating the 2018 trauma session.

 

 

Review the following posts relevant to the workshop stations:

Pelvic Binder

Femoral splint – CT6 and Donway

 

Review the presentations by Dr Karen Winter and Dr Ruth Hew below:

 

 

Review the massive transfusion protocol and get familiar with the fluid warmer (avoid the lethal triad: acidosis, coagulopathy, hypothermia)

 

enFlow fluid warmer

SMS Teaching: Traumatic Cardiac Arrest

Here’s the video from March 2018’s consultant education, on the theme of traumatic arrest.

It includes a case discussion of a gunshot wound to the chest in a young women with cardiac arrest, a talk on the management of traumatic arrest and the utility of CPR, and finally a discussion on ED thoracotomy.

The quality’s not great and we lost the AV halfway through, so I’ve patched in a PowerPoint presentation of the second part.

There’s also a video from the Alfred procedures course on thoracotomy- please don’t distribute this further, as it’s released to candidates on the course only.

Hope you enjoy, please post any comments or questions and we’ll attempt to answer them.

Thanks.

Further reading:

EMCrit

EMRAP – the quiet chest in trauma

ANZCOR guidelines

St Emlyn’s – CPR in TCA?

ACLS 2.0

In 2015 the European Resuscitation Council changed their recommendations, slightly new algorithms, rates and the usual arguments about adrenaline and amiodarone. In my mind this detracts us from what is important. Scott Weingart is famous for saying we should be able to resuscitate better than a dermatologist who will attend the same ACLS course as yourself.

So how do we improve?

  1. Remove the cognitive load: We will be using our nursing staff to run the algorithms autonomously, timings, compressions, adrenaline and amiodarone  dosing. Albeit ultimate responsibility lies with the doctor team leader you will have this option to use the nursing staff to run the algorithms.
  2. ACLS does not fix the problem. While the nurses are running the algorithms you need to find the cause of the arrest and fix it. See the power point presentation below for some thoughts and ideas and what the world of FOAM has to say on the issue.
  3. Support each other and the nursing staff during an arrest and also reflect on what can be done differently next time, even if this is during the weekly scenarios that will take place.
  4. Introduce yourselves to the nursing resus team at the beginning of your shift. If you are on airway, let them know your preferences.
  5. Dont run away from sick patients, this is what we train for and you will not improve if you do not challenge yourself.
resus

 

Resources in the slides:

Reid – When Should Resuscitation Stop?

Podcast 204 – The Nurse-Led Code with Joe Bellezzo

ttp://rebelem.com/classic-journal-review-the-opals-study/

Beyond ACLS: Dual Simultaneous External Defibrillation

Beyond ACLS: Cognitively Offloading During a Cardiac Arrest

Beyond ACLS: Pre-Charging the Defibrillator

Beyond ACLS – POCUS in Cardiac Arrest

Beyond ACLS: CPR, Defibrillation, and Epinephrine

Beyond ACLS: From CPR to Cath – The New ACC/AHA Cardiac Arrest Algorithm

Impact of POCUS During Cardiac Arrest Resuscitation on Compression Pauses

September 2016 REBEL Cast: Refractory Ventricular Fibrillation

Plastics: Hand injuries

Thanks to Plastics registrars Dr Daniel Reilly and Dr Felicity Connon for their presentation.

 

Assessment and Management of Hand Injuries

 

Points

  1. remember that despite the rise of technology, solid basic descriptions are still the bedrock of a good referral. Use appropriate and precise terminology eg. radial / ulnar
  2. The hand examination includes motor, sensory and tendon function components
  3. Early washout in ED may prevent later complications – consider using 500-1000mL bags of NaCl 0.9% on pump set with a drawing up needle to facilitate large volumes of fluid under good pressure
  4. Ensure your slabs are of appropriate weight so they do not fall apart before the first plastics clinic review
  5. The Plastics team are keen to see all hand fractures, even ones that will be managed conservatively, so that patients can have access to a hand therapist
  6. Nail bed injuries can be described by how proximal / distal to bone and nail bed, and if they are oblique