Chest Trauma and Prehospital Trauma Audit

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Come along this Thursday 18th April to hear some of luminaries of trauma care in Qld talk about current controversies in prehospital and chest trauma.

Join Dr Daryl Wall and the RBWH trauma team, as well as trauma surgeon Dr Cliff Pollard and of course our ED consultants and trainees in the audience, as we explore controversies in chest trauma.

Tune in to hear QAS Medical Director Dr Steve Rashford presenting his insights on the last 12 months of prehospital trauma data.

Ever wondered why all the fun stuff is already done by the time patients turn up to ED? RSI, bilateral decompressive thoracostomies, FAST scans, even thoracotomies are all now routinely performed pre-hospital, in large part due to the leadership provided by Dr Rashford.

Thought trauma care was just primary survey, EMST and log rolls? Not even close!

Following Dr Rashford we will have several of our leading registrars breaking down some of the controversial areas in chest trauma, including what to do with ‘occult’ pneumothoraces, how to diagnose pneumothorax on USS, and what complications we are causing with our ICC insertions.

Expect to see some debate from some of the leading authorities in trauma in one of the most exciting TEd sessions for 2013 so far!

See you there Thursday 0830

Nigel Moore

April 4, 2013: Resuscitation and shock

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Resuscitation and shock.

Sometimes when you’ve got your head down on the assembly line of modern emergency medicine, meeting time targets, conforming to local guidelines, supervising residents….. You can forget that the reason you originally got into this was the good stuff. Stuff like resuscitation and shock.

That tube.

That central line.

And especially, beyond any single procedure, resuscitation of that really sick shocked patient who looked like they were going to die  but somehow, hopefully in part related to your decisions, did not.

There was a little discussion recently at SMACC of the bias towards or predominance of topics of this nature in the educational social media around emergency medicine and critical care (as ironically compared to an unsuccessful search on hand hygiene). I’m not going to state the obvious or skim over the issues involved.

But airways, resuscitation and shock are more than just topics. They’re the monsters lurking in the shadows of your practice as a resident or trainee (and beyond). They’re the defining moments of your evolution as a critical care practitioner. They’re the decisions and actions that you dissect and debrief after the event. Is it any wonder that we circle that candle like moths?

Tomorrow the TEd hosts a 90 minute discussion on resuscitation and shock. Cath Hurn runs us through a recent case and we welcome Scott Weingart, of emcrit fame, along to share his perspective on inotropes via weblink.

I met Scott in person at SMACC and he made a big impression. That may be a sign that I don’t really pay much attention to the podcasts for which I claim CPD.

But Scott has thought very hard about these topics, read very widely and taken care of enough patients in these situations to be rightfully acknowledged as an expert. Beyond that, his presentation and communication is even better live than via podcast.

Join the conversation if you can at 8:30am AEST.

March 12, 2013: Respiratory issues

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This week on the TEd we take a look at some of the respiratory issues we face in emergency. Is oxygen the stuff of life or a terrible toxin? When should we use non-invasive ventilation? How do we use NIV? Admit? Discharge? One thing I do know for sure is that you can distinguish between cardiac and respiratory issues with a simple blood test. Can’t you?

08:30 Respiratory issues

  • Natriuretic peptide binding site

•Distinguishing between cardiac and pulmonary causes of shortness of breath
• How much oxygen is too much oxygen?
• Role of noninvasive ventilation.
• Setting up CPAP/BiPAP.
• Outpatient versus inpatient management

Heres the case for the session. This might even be real….  Theres also some pre-, peri- or post-reading here.

66 year old female presents with acute SOB, chest tightness and palpitations. Saw her GP 1/52 with cough and fevers who diagnosed her with an URTI and commenced augmentin. Over the last 2-3 days she has been experiencing increasing SOB and feeling more unwell. She called an ambulance today because she developed central chest pain and was having more difficulty breathing.

She has a number of comorbidities which you find on an old discharge summary the patient brings with her. They include
- COPD – last admitted 2 years ago, (CO2 retainer), not on home o2
- Rheumatic fever age 3
- CABG 2 vessel disease plus AV replacement for severe AS 2010
- Breast CA 2004, radiotherapy and surgical excision. No chemotherapy.
- HTN
- High cholesterol

Her medications are slow K, atenolol, aspirin, lercanidine, frusemide, diazepam, salbutamol, seretide 250/25, hydrochlorothiazide, simvastatin

On examination you find her in respiratory distress talking at best with one word answers. Her observations are O2 sats 90% 6L NP, RR 26, PR 120, BP 150/90. On examination of her chest she is widespread expiratory wheezes and crackles and you are unable to hear any murmurs. She has mild peripheral oedema.

Questions

1) What features in the case help distinguish between an exacerbation of COAD and APO?
2) What investigations should we perform?
3) What treatment should we commence?

 

Feb 28, 2013: C-spine injuries

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yum.C-spine injuries and suspicion of same are our bread and butter.

Working in private.

Working in public.

Running a trauma centre.

Hanging in a community hospital.

On the road pre-hospital or chilling the short stay unit.

It doesn’t matter, you have to have c-spine injuries down pat.

This Thursday on the TEd we’ll take a 90 minute look at c-spine injuries:

  • Case presentations (yup, real cases – crikey!)
  • Protocols
  • Imaging
  • Interventions in emergency
  • Airways and c-spine injuries

Your mission, should you choose to accept it, is to check out the pre-reading. It’s a nice mix of the seminal (NEXUS) and the comprehensive (Evaluation and Management of Acute Cervical Spine Trauma).

And have a think about your own process – your own C-spine injury protocol. How do you approach it? Do you follow a defined process? What makes you venture away from it?