TRAUMA AND CRITICAL CARE CONFERENCE

I recently attended a conference in Minneapolis: "Care Across the Continuum: A Trauma and Critical Care Conference“.  I wanted to share my notes…..Toni Trapp, RN

AIRWAY: TUBE IT:WHAT TO DO IN A PINCH

Presented by Dr. Martin Birch, Asst. Prof, Dept. of Anesthesiology, Univ of MN

8-14% of patients become a difficult intubationOnly 0-1% become difficult in the OR environment12-26% become hypoxemic6-26% become severely hypoxemic

Tips:HAVE A BACK UP PLANUSE THE BOUGIEUSE THE VIDEO (GLIDESCOPE) Trauma considerations:full stomach--should avoid RSIcervical instability--Is there an airway? Remember, a surgical airway is not a failure!these patients are at high risk for extubation, and may be difficult to re-intubate

Take away thoughts: Think about intubation early, BEFORE it becomes emergent. (ie...morbid obese patient, hypotensive, and now is hypoxic on bipap. This is an example of late thinking).

RSI simply means: pre-oxygenate, induce, paralyze, put the tube in

BREATHING: BRACE YOURSELVES: UPDATES IN RIB

FIXATION FOR THORACIC TRAUMA

Presented by Dr. Reza Khodaverdian, Dept of Cardiothoracic Surgery, HCMC

Use of titanium internal fixation devices are proven to decrease pain, decrease risk of developing pneumonia, decrease ventilator days, decrease morbidity and decrease hospital stay.

Indications: >or= 3 rib fractures with flail segment, intractable pain and chest wall deformity.

CIRCULATION: RED RIVERS: REVERSAL OF

ANTICOAGULATION CRITICAL SETTINGS

Presented by Dr. Scott Chapman, PharmD, Assoc. Prof, Dept of Experimental  and Clinical Pharmacology, College of Pharmacy, Univ of MN and North Memorial

Warfarin reversal:

Vit K and FFP are currently the primary choiceIV Vit K is the quickest route of reversal (subcut is not a very predictable onset)PCC-(prothrombin complex concentrate products) amount of factor 7 varies in this product, and the appropriate dosing is still yet to be determined--currently 7units to 50units/kg seems to be effectivestudies show that PCC and Vit K have a rapid onset drop in INR but both had rebound INR---need to re-doseRFVIIa(recombinant factor VIIa)-- after administration, 27 minutes INR from 2.8 down to 1.2, similar onset as PCC, but shows less re-dosing needed than the PCC

PEDIATRIC HEAD TRAUMA UPDATE

Presented by Dr. Christopher Johnson , Dir. PICU at St. Cloud Hospital

------injury is the leading cause of death in PEDS------40% come from head injuries------475,000 TBI a year---30%<4 years oldOverall mortality of all kids presenting to the ED with a head injury =4%

Primary injury=direct injury, and often irreversableSecondary Injury=subsequent injury, preventable and profoundly affected by intervention (ie..prolonged seizure post head injury, uncontrolled ICP, fever control)

Goal: optimizing treatment to prevent secondary injury.

FALLING DOWN STAIRS: ABUSE or BAD LUCK

Presented by Dr. Jeffrey Louie

932,000 pediatric stair falls a year in the US= child falls down the stairs every 6 minutes----97% of those seen in the ED discharge home----76% have head injury (includes lacerations etc…)----11% have an upper extremity injury----4% concussion/intracranial bleed----<1% mortality, AND OF ALL STAIR FALLS NONE = ABDOMINAL INJURY

Age guidelines:6 months old = roll over9 months old = sit up or pull up12 months old = walking18 months old = independent walkingTypical injury with stair falls related to age:<4 years old = head> 4 years old = forearm injury, lower extremity injury, and head

BE AWARE (red flag!!!!): Trunk injuries are rare!!!, Femur fractures are rare. Start thinking about abuse.