Ronald F. Sing

Femur fractures should not be considered distracting injuries for cervical spine assessment

INTRODUCTIONnThe National Emergency X-Radiography Utilization Study (NEXUS) clinical decision rule is extremely sensitive for clearance of cervical spine (C-spine) injury in blunt trauma patients with distracting injuries.nnnOBJECTIVESnWe sought to determine whether the NEXUS criteria would maintain sensitivity for blunt trauma patients when femur fractures were not considered a distracting injury and an absolute indication for diagnostic imaging.nnnMETHODSnWe retrospectively analyzed blunt trauma patients with at least 1 femur fracture who presented to our emergency department as trauma activations from 2009 to 2011 and underwent C-spine injury evaluation. Presence of C-spine injury requiring surgical intervention was evaluated.nnnRESULTSnOf 566 trauma patients included, 77 (13.6%) were younger than 18 years. Cervical spine injury was diagnosed in 53 (9.4%) of 566. A total of 241 patients (42.6%) had positive NEXUS findings in addition to distracting injury; 51 (21.2%) of these had C-spine injuries. Of 325 patients (57.4%) with femur fractures who were otherwise NEXUS negative, only 2 (0.6%) had C-spine injuries (95% confidence interval [CI], 0.2%-2.2%); both were stable and required no operative intervention. Use of NEXUS criteria, excluding femur fracture as an indication for imaging, detected all significant injuries with a sensitivity for any C-spine injury of 96.2% (95% CI, 85.9%-99.3%) and negative predictive value of 99.4% (95% CI, 97.6%-99.9%).nnnCONCLUSIONSnIn our patient population, all significant C-spine injuries were identified by NEXUS criteria without considering the femur fracture a distracting injury and indication for computed tomographic imaging. Reconsidering femur fracture in this context may decrease radiation exposure and health care expenditure with little risk of missed diagnoses.

MOPEDS: The high cost of cheap and poorly legislated transportation for negligent drivers

INTRODUCTIONnThis study evaluates the impact of moped crashes in North Carolina, a state with lenient moped legislation by(1) describing the characteristics of moped crashes and (2) estimating the cost burden of moped-related injuries.nnnMETHODSnHealth and public records of moped crash subjects treated at our hospital were reviewed. Direct costs were billed hospital charges. Indirect costs based on age and outcomes were calculated.nnnRESULTSnBetween 2008-2013, 368 subjects were involved in 373 moped crashes. 52% of drivers were intoxicated. 38% of drivers had prior DWIs and 26% had prior revoked licenses. Hospitalized subjects (nu202f=u202f305) had a combined 2687 hospital days, 695 ICU days and 449 trips to the operating room for treatment of their injuries. Average hospital charges were

The Multidisciplinary ICU Team

70,561 per subject. Total direct and indirect costs of moped injuries were over

Airway Management in the ICU

26 million and

Rescue Airway Techniques in the ICU

81 million respectively. Medicaid absorbed most of the direct cost (

The Surgical Setting: ICU Versus OR

13.7u202fM). Estimated direct cost of moped crashes across the state totaled

Nasal Packing for Epistaxis

133 million.nnnCONCLUSIONnHealthcare and financial ramifications of moped collisions are substantial. Laws governing moped drivers and stricter penalties for intoxicated drivers are needed.

Bedside Insertion of Vena Cava Filters in the Intensive Care Unit

There are many professional healthcare providers that work in the Intensive Care and Surgical Suite areas. They have various levels of medical education and training and often focus on very specific organ and body systems. These include physicians, surgeons, intensivists, advanced clinical practitioners (Nurse Practitioners and Physician Assistants), registered respiratory therapists, critical care clinical pharmacists, physical therapists, occupational therapists, speech and language pathologists, and clinical nutritionists. They may have as little as a bachelor’s degree or as much as an earned doctorate in their respective fields. Their role and function in the ICU and operating room also vary greatly by institution and facility. This chapter will describe some of the more common roles and functions of each of these providers.

Improvement of treatment outcomes after implementation of a massive transfusion protocol: A level i trauma center experience

The approach to interventional airway management must be consistent and disciplined. This chapter will describe one method to assess the airway and potentially predict which ones could be difficult and require additional interventions to secure and protect. In addition, assessments for difficult bag mask ventilation, laryngoscopy, extraglottic devices, and surgical interventions will be discussed.

COUNTERPOINT: Do the Benefits Outweigh the Risks for Most Patients Under Consideration for Inferior Vena Cava Filters? No.

One of the most stressful events that a provider will encounter in the ICU is the inability to secure an airway. This chapter will focus on the “Plan B”—what techniques and devices could be used if the traditional placement of an endotracheal tube is unsuccessful.