TRAUMA AND CRITICAL CARE CONFERENCE

1. 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

2. Presented by Dr. Martin Birch, Asst. Prof, Dept. of Anesthesiology, Univ of MN AIRWAY: TUBE IT:WHAT TO DO IN A PINCH

3. 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 PLAN USE THE BOUGIE USE THE VIDEO (GLIDESCOPE)  Trauma considerations: full stomach--should avoid RSI cervical 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

4. RSI simply means: pre-oxygenate, induce, paralyze, put the tube in Take away thoughts:  Think about intubation early, BEFOREit becomes emergent. (ie...morbid obese patient, hypotensive, and now is hypoxic on bipap. This is an example of late thinking).

5. Presented by Dr. Reza Khodaverdian, Dept of Cardiothoracic Surgery, HCMC BREATHING: BRACE YOURSELVES: UPDATES IN RIB FIXATION FOR THORACIC TRAUMA

6. 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.

7. Presented by Dr. Scott Chapman, PharmD, Assoc. Prof, Dept of Experimental  and Clinical Pharmacology, College of Pharmacy, Univ of MN and North Memorial CIRCULATION: RED RIVERS: REVERSAL OF ANTICOAGULATION CRITICAL SETTINGS

8. Warfarin reversal: Vit K and FFP are currently the primary choice IV 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 effective studies show that PCC and Vit K have a rapid onset drop in INR but both had rebound INR---need to re-dose RFVIIa(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

9. Presented by Dr. Christopher Johnson , Dir. PICU at St. Cloud Hospital PEDIATRIC HEAD TRAUMA UPDATE

10. ------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 irreversable Secondary 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.

11. Presented by Dr. Jeffrey Louie FALLING DOWN STAIRS: ABUSE or BAD LUCK

12. 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 over 9 months old = sit up or pull up 12 months old = walking 18 months old = independent walking Typical 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.