Trauma Take-aways

October 18th, 2017

Oct. 16, 2017 — More than 275 medical professionals attended JPS Health Network’s 2017 Trauma Symposium on Friday for a day-long review of current debates and best practices in the care of critically injured patients. The annual event, hosted by the Level I Trauma Center at the Trinity River Campus of Tarrant County College, attracts surgeons and other medical experts to Fort Worth.

L.D. Britt, MD

L.D. Britt, MD, presenting best practices in management of penetrating trauma at the 2017 Trauma Symposium.

L. D. Britt, MD, Eastern Virginia Medical College

For patients with penetrating trauma — gunshot or stab wounds — survival depends on a decision surgeons make BEFORE the operating room. Some patients would do better without going to the O.R. at all. For others, delaying surgery will be fatal. In a roomful of surgeons, not all will agree.

Then there are regional variations in surgical practice. “I tell my wife, if you’re going to shoot me, don’t shoot me in Los Angeles, because they’re not going to operate on me,” joked Britt. Himself a proponent of exploratory surgery over ‘wait-and-see’ in many cases, Britt said, “If you miss a bowel injury (by foregoing exploratory surgery) that can be devastating.”

Robert Maxwell, MD, Erlanger Health System, University of Tennessee

Anyone who’s suffered broken ribs will tell you how painful it is and how long it takes to heal. It happens up to 850 times a day in the United States. (That’s the number of people who sustain chest wall injuries in motor vehicle crashes.) Up to 12 percent of patients won’t survive; 70 percent will take narcotics at least 30 days, putting them at risk for addiction, Maxwell said.

Surgeons should consider rib plating whenever feasible, Maxwell said. Rib plating — reconstructing broken ribs with titanium rods, clips and screws — significantly reduces the time patients remain immobile on a ventilator in the ICU and the risk of life-threatening complications like pneumonia. Rib plating can be done for patients of almost any age, Maxwell said, reporting recent success on several patients in their ‘80s.

Jill Volgraf, RN, Temple University Hospital, Philadelphia

When Amtrak 188 derailed in North Philadelphia, first responders called Temple University Hospital to ask, ‘How many patients can you take?’ The answer was four. Within 87 minutes, the hospital received 51, including 24 trauma patients.

The 2015 crash illuminated numerous opportunities for improvement in Philadelphia’s emergency preparedness plans. It also brought to light a quirky consequence of society’s shift from land line telephones to smart phones. Having become separated from their phones in the crash, wounded passengers were unable to tell hospital staff how to reach their next-of-kin. “Nobody knows phone numbers any more!” exclaimed Volgraf. “I bet my daughter doesn’t.”

Mayur Narayan, MD

Asking military veterans to stand, Mayur Narayan, MD, talks about the military’s contributions to civilian medicine.

Filling out the program were presentations by:

Jill Cherry-Bukowiec, MD, University of Michigan Health System

Nathanial McQuay, MD, University Hospitals, Cleveland Medical Center

Michael Gooch, DNP, Vanderbilt University School of Nursing

Mayur Narayan, MD, New York Presbyterian, Weill Cornell Medical College

Jeffrey Tessier, MD, Antimicrobial Stewardship Director, JPS

Dr. Narayan interrupted his own presentation on topical hemostatic agents to ask, “How many former or active military do we have here? Please stand.” Joining in a long round of applause, he explained, “I don’t think we can get through a trauma talk without doing that,” because lessons learned on the battlefield have contributed so much to civilian medicine. “We’ve learned some great lessons from our military,” Narayan said.

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