The Importance of the RUG

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The Importance of the RUG

It is early on in your residency training, when you receive sign-out of a patient who was involved in an MVC with multiple injuries including a stable pelvic injury. The patient, a middle-aged male, has not voided three hours into his visit and there is no mention of any obvious genital trauma.  He has had a negative FAST exam in addition to the rest of your primary and secondary assessment. The patient mentions to the nurse that he is trying to urinate but cannot void and has some discomfort. The bladder scan shows that the patient has about 500cc of urine and when the nurse goes to place a urinary catheter she pauses as she sees what appears to be dried blood at the urethral opening. After reassessing the patient who is still hemodynamically stable with normal mentation, his findings are discussed with Urology who recommend getting a retrograde urethrogram prior to any additional procedures. 

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Grand Rounds Recap 10.26

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Grand Rounds Recap 10.26

We had another great week at Grand Rounds to wrap up the month of October.  Dr. Betham ran the gamut of medical knowledge in her M&M, teaching us from organophosphate poisoning to rhabdomyolysis.  Drs. Merriam and Curry battled in a CPC about submassive and massive PE.  Dr. Shewakramani taught us about all things dental and Dr. Scupp brought it home with his soapbox about the importance of balance in IV fluid resuscitation.

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Crash and Burn: The Approach to the MVC Patient

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Crash and Burn: The Approach to the MVC Patient

Certain pathology gets a lot of attention in medical school.  Stroke? Sure!  Tests love asking about which vessel is blocked based on clues from the physical exam.  And rightly so; a fund of medical knowledge is certainly valuable when it comes to identifying pathology such as this.  However, when faced with a problem like blunt trauma, i.e. the “MVC”, one may find that there are also many practical and logistical factors that require bedside experience, ranging from marshaling of resources to reconciling patient presentation with reported mechanism of injury...

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Pre-Hospital Trauma Care – Lessons Learned From the Front

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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

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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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"Flights" - A Lonely Road

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"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

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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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Lessons in Transport - Your Friend and the Bleeding Patient's Friend: TXA in trauma

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Lessons in Transport - Your Friend and the Bleeding Patient's Friend: TXA in trauma

TXA… What can be said about TXA that hasn’t already been said.  TXA is good for what ails you.

Nosebleed? No problem.

Menorrhagia? TXA can fix that.

Involved in a motor vehicle crash with multiple pelvic fractures, a busted up spleen, hemorrhaging internally? TXA has your back.

In this podcast, Dr. Hill, Dr. Steuerwald, and Dr. Gerecht sit down and talk through the indications for using TXA in the prehospital environment and briefly discuss some of the evidence for its use.

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