Pre-Hospital Trauma Care – Lessons Learned From the Front

Pre-Hospital Trauma Care – Lessons Learned From the Front

The UC Division of EMS has recorded a series of podcasts to celebrate EMS Week 2016.  We are honored to be able to engage EMS Providers throughout the world with this forum.  If you practice pre-hospital medicine, we would like to say thank you and that we appreciate everything you do to provide a high level of care to ill and injured patients in a wide variety of austere environments.  For this podcast, we were joined by Dr. Jay Johannigman, Chief of the Division of Trauma and Critical Care at the University of Cincinnati.  Dr. Johannigman has over thirty years of military experience which includes 6 deployments to Iraq and Afghanistan.  Dr. Johannigman joined us to discuss how the military experience has changed civilian trauma care in the United States.    

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A Lonely Road - Recap and Expert Commentary

A Lonely Road - Recap and Expert Commentary

A couple of weeks back, we kicked off our “Flights” portion of our Air Care Orientation Curriculum.  Dr. Latimer outlined a challenging patient case for use to consider and an excellent discussion ensued.  As a reminder of the case, here’s how it was posed:

Your patient is a 56 year-old male with unknown medical history who was an un-helmeted motorcyclist found in a ditch roughly 40 feet from his motorcycle which was discovered in the middle of the road by a passing motorist. The accident was un-witnessed, but the bike was found just beyond a sharp downhill curve in the rural farm road. EMS has BLS capabilities only and they have placed the patient on a backboard and loaded him into the unit.

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Grand Rounds Recap 2/10/16

Grand Rounds Recap 2/10/16

R4 QUARTERLY SIMULATION with Drs. Curry, Loftus, Ostro and Strong

We presented a case of a 42 y/o female who presented with altered mental status, hypotension and bradycardia. She was ultimately found to have an unintentional labetalol overdose which she had been taking PRN for headache.

Beta-Blocker Overdose Take-Home Points...

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"Flights" - A Lonely Road

"Flights" - A Lonely Road

It is mid July and your first shift as the coveted H2 Doc at Air Care 2 is finally upon you.  It has been an especially warm and beautiful Saturday and you ponder the possible flights for the evening as you take the scenic drive to Butler County Regional Airport. 

You finish checking the aircraft with the flight nurse and sit down to begin the 20:30 brief with the flight crew when the tones drop and you are dispatched for your first flight of the evening, a scene flight to Franklin County, Indiana for an “un-helmeted motorcyclist”. You grab the blood cooler, perform a safety walk-around the aircraft and strap yourself in back

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Flights - A Blow to the Head

Flights - A Blow to the Head

You’re working as the Pod-Doc, having just taken the radio from the off-going UH-doc, you just finish admitting the patient in C40 for NSTEMI when the tones go off.

“Air Care 1 and Pod Doc respond to a scene for motorcycle crash, Northern Kentucky”

You call the B-Pod attending, sign out the pod, grab the blood from the blood cooler and head to the helipad.  Flying over the river, landing at a local firehouse’s parking lot you hop out of the back of the helicopter and head to the awaiting squad.

Your patient is a 29 year-old male who was riding his motorcycle (without a helmet) on a local country road.  Coming around a blind corner he unexpectedly found a car stopped in the middle of the road.  Striking the car from behind at ~35mph, he flew over the handlebars and impacted the back of the car.

On EMS’s arrival he was initially unconscious, but since their arrival has become increasingly combative

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Flights - One Road too Far - Curated Comments & Expert Commentary

Flights - One Road too Far - Curated Comments & Expert Commentary

Thanks to everyone who chimed in for our first ever "Flight"!!  If you didn't get a chance to read the case, take a look here.  There was some excellent discussion on how best to care for the blunt polytrauma patient.  Below is the curated comments from the community and Dr. Hinckley's take on the questions posed to the community.

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Flights - One Road too Far

Flights - One Road too Far

You are working as the UH-doc.  Driving into your shift with the windows down and music playing, you figured the first warm day of the year would result in a busy day for you and the rest of the Air Care 1 crew.  You arrive for your shift, grabbing the radio from the Pod doc when the tones go off for your first flight of the day.  You grab the blood cooler head to helipad, checking your pager you find you’ll be responding to Southeastern Indiana for a “MVC rollover, entraped.”

You strap into the helicopter and fly over the city and to the rolling hills of Southeastern Indiana.  Landing on the 4 lane divided state road, you unstrap and head to your patient who is waiting with the BLS squad.

You open the side door of the EMS truck and head to the head of the bed to assess your patient...

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Evaluating Blunt Trauma Patients

Evaluating Blunt Trauma Patients

A quick and thorough evaluation of patients with traumatic injuries is extremely important.  The ideal approach is regimented, practiced, expeditious, and flexible to the environment in which it is performed.   Advanced Trauma Life Support (ATLS) courses do a great job of teaching the guiding principles to the approach to the trauma patient.  However, while it is relatively simple to become facile with the exam of victims of trauma in the (relatively) controlled setting of the trauma bay, it can be especially challenging to examine the same patient in the field.

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