Thomas L. Wachtel

Video Recording Trauma Resuscitations: An Effective Teaching Technique

Since the initial hour after injury is the most crucial time for trauma patients, resuscitation technique is of vital importance. Standardized courses for first-hour management (ATLAS) have been widely accepted. A teaching format based upon video recording of every resuscitation has been developed. Tapes are reviewed by the staff and by the individuals involved in a particular resuscitation. In a weekly resuscitation review conference, actual footage is presented to the trauma team members, specific aspects of a resuscitation are critiqued, and supplemental didactic information is presented. Legal problems have been avoided by making the review and conference a part of the quality assurance process. Patient anonymity is preserved by positioning the video camera at the foot of the resuscitation bed. Tapes are erased after each conference. Video recording allows analysis of: 1) priorities during the resuscitation; 2) cognitive integration of the workup by the team leader; 3) physical integration of the workup by the team leader; 4) team member adherence to assigned responsibilities, resuscitation time, errors or breaks in technique; and 5) behavior change over time. In 3 1/2 years, more than 2,500 resuscitations have been recorded. Over a 3-month period, average resuscitation time to definitive care decreased for age- and injury severity-matched patient groups cared for by one team. Resuscitations have become more efficient and adherence to assigned responsibilities better. Weekly review of resuscitation contributes to improved technique and trauma care.

Fluid resuscitation in a porcine burn shock model

Abstract Miniature swine are sensitive and responsive animals for the study of burn shock resuscitation. In this model the sodium loads requisite for resuscitation of burned swine can exert roughly the same effect although with slower restoration of cardiac output when administered in volumes of 50–75% less than those commonly employed clinically. Sodium excretion is more dependent upon the sodium load than upon the concentration of the saline solution. Plasma had no demonstrable resuscitative effect over and above that provided by its volume and sodium content.

Hyperglucagonemia and hepatic ketogenesis in burned swine.

A porcine burn model demonstrates hypoglycemia in spite of hyperglucagonemia. The ketone response to free fatty acids is defined for the normal and burned pig. Ketogenesis is augmented beyond that expected from free fatty acids during the postburn period. These metabolic changes may be related to the hyperglucagonemia and/or the relative hypoinsulinemia observed in the burned pig.

Glucagon, insulin, and glucose relationships in a porcine experimental burn model

Abstract A porcine experimental burn model demonstrating hormonal and metabolic alterations similar to those reported in human thermal injury is described. In particular, increased glucagon and suppressed insulin secretion are associated with disturbed lipid and carbohydrate regulation. Hyperglucagonemia is exaggerated after arginine stimulation. With appropriate fluid resuscitation, correction of hormonal-metabolic aberrations is demonstrated suggesting that this controlled model of thermal injury may be appropriate not only to describe the pathophysiology of the burn state but also to explore alternative considerations for therapy.