knife n' gun club

WELCOME TO THE KNIFE & GUN WELCOME TO THE KNIFE & GUN CLUBCLUBDavid Marcus, MD

LIJ EM/IM October 2, 2013

GOALSATLS Review

Free Associations

Spaced Repetition@RegionsTrauma

Regionstraumapro.com

@shocktrauma (meh)

@traumadoctors (AAST)

@KarimBrohi

References/Sources

• Videos: Trauma Bay, by Vanderbilt EM: http://traumabay.vanderbiltem.com/cases.html

• Trauma Case: http://www.trauma.org/index.php/main/case/1465/

• Trauma Tribulation 33a - What Would Weingart Do? http://lifeinthefastlane.com/2012/12/trauma-tribulation-033a/

• Various images: trauma.org

IT'S 4AM AT NUMC, AND THE IT'S 4AM AT NUMC, AND THE TRAUMA PHONE RINGS...TRAUMA PHONE RINGS...

Thoughts?

• Debrief

• Do you do any of this?

• Good/Bad?

• Um, NUMC?

The Primary Survey....Quick, Quick, Quick...

The Primary Survey

Airway + C-SpineBreathing + VentilationCirculation DisabilityExposure + Environment

DEAL WITH A PROBLEM BEFORE MOVING ON

Airway + C-SpineBreathing + VentilationCirculation DisabilityExposure + Environment

DEAL WITH A PROBLEM BEFORE MOVING ON

Thoughts?

• Debrief the Primary Survey

• Good/Bad?

• Same/Different?

• Keep the medics?

• Um, NUMC?

Life in the Fast LaneTrauma Tribulation 33

+What Would Weingart

Do?

The Secondary Survey....A Thorough Exploration...

The Secondary Survey

Thorough Head-to-Toe examStart from the scalp and make your way down to the toesExamine all cavities & orificesExplore all woundsIncludes: • FAST• Pelvis• Everything else

Thorough Head-to-Toe examStart from the scalp and make your way down to the toesExamine all cavities & orificesExplore all woundsIncludes: • FAST• Pelvis• Everything else

Thoughts?

• Debrief the Secondary Survey

• Good/Bad?

• Same/Different?

• Tagging ballistic wounds?

• Board?

• Um, NUMC?

ATLS Overview

• The Primary Survey

• A

• B

• C

• D

• E

• Address problems as they arise

• The Secondary Survey

• In depth

• Head to toe

• Orifices and wounds

• Pelvis

• FAST?

• Plan to fix all problems

It's Like a CPC

• A skydiver lost control parachuting and landed in shallow water. At scene the attending doctor noted he was suffering only from a pain in his right knee. The patient denied LOC or any neurological symptoms and was referred to the nearest trauma center for further evaluation.

It's Like a CPC

• At the trauma center further interrogation revealed the patient had fallen on his right side and twisted his right knee. He had no past medical history, took no medication and was an occasional smoker and consumer of alcohol.

It's Like a CPC

• On examination the patient was hemodynamically stable, GCS 15 with a pain score of 4/10.

• He had a swollen right knee which was tender on the lateral aspect without suggestion of neurovascular injury. A radiograph of the right showed avulsion of the lateral tibial plateau and fracture of the right head of fibula. Findings were confirmed on CT within 3 hours of injury.

It's Like a CPC

• The patient was sent for blood testing following the CT, at this stage his condition deteriorated. He became irritable and began salivating excessively.

• A primary survey was repeated showing a patent airway, good bilateral air entry to the chest with saturations of 100% on 10L of oxygen via mask. His blood pressure was 127/82 with a heart rate of 86 BPM. By this point he was GCS 13 with bilateral size 3mm pupils which were reactive to light.

It's Like a CPC

• The secondary survey showed a left sided upper motor neuron facial palsy with left sided hemiplegia.

• A diagnostic study was done...

Differential Diagnosis?

CT Head

Final Diagnosis

• Post-Traumatic right middle cerebral artery thrombosis.

• Re-interviewing the MD at the scene revealed that the patient had landed with the parachute twisted around his neck at impact, causing compression of the right side of his neck.

ONE LAST VIDEO...ONE LAST VIDEO...THANK YOU!THANK YOU!