Our team discuss the papers from our January 2023 Journal Club: A paediatric theme this month looking at immobilisation of torus fractures, mid-arm point for paediatric ICC insertion, and screen time in paediatric concussion.
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A 30 year old bricklayer has fallen 3m off scaffolding onto the hard ground below and has been unable to mobilise since the incident. The patient presents complaining of back pain with associated altered motor function and sensation to his lower limbs. He is GCS 15 and his vital signs read a BP 80/40 mmHg, Heart Rate 47bpm, Oxygen Saturations of 100% on room air and his temperature is 37 degrees Celsius. He has warm hands and feet. On examination you notice that power of his lower limbs is 0/5 in all myotomes and he cannot appreciate sensation below the dermatome level of T4.
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In part 1 we described some of the key concepts of identifying signs of raised ICP and discussed some of the herniation syndromes. Now let’s take a look at the key concepts of managing patients with raised ICP in the ED.
During your primary survey, you noticed his left pupil is dilated and non-reactive.
A 37-year-old man has been ejected from his car after crashing at high speed. He was initially mildly confused but then rapidly dropped his GCS to 8. The ambulance crew on scene have intubated him and whisk him into your emergency department.
During your primary survey, you noticed his left pupil is dilated and non-reactive.
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As the decades have rolled by, the management of splenic trauma has changed significantly. The long-practiced tradition of removing the spleen for the slightest insult has been consigned to the history books, alongside similarly traumatic memories like the Oasis break up (come on Noel!).
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It’s a typical Saturday late shift, ticked over midnight to Sunday morning. A young intoxicated man stumbles into triage complaining of severe abdominal pain. He tells you he has had “Quite a few” (read as “a lot”) of drinks tonight and shares that a few hours ago, while playfighting with his mate (as one does following “quite a few”), his mate had fallen onto his abdomen.
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A 60yo M presents to the trauma centre after his 4WD vehicle collided with a semi-trailer at 90km/hr. He was entrapped in the vehicle for more than 1 hour. At scene he has an unrecordable blood pressure and has had bilateral finger thoracostomies. He has received 4 units of blood en-route. On arrival to the ED he has suspected chest and head injuries and a large bore MAC line is inserted into his left subclavian vein, a massive transfusion protocol is commenced, chest drains inserted and upon stabilisation he is intubated for transfer to CT for a pan scan. En-route the ED registrar asks if we should image his carotid arteries to exclude a carotid injury?
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Pelvic fractures are pretty common, particularly if you work in a trauma centre. From a trauma resuscitation perspective, we’re usually most concerned with whether a pelvic injury is unstable with disruption of the pelvic ring, and if there is active arterial
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