Date: April 7th, 2017
Superstar Nurse Brenda Palsa and I had a wonderful time presenting at Talk Trauma 2017 this week in London, Ontario. It is a one day conference for nurses, allied health & EMS professionals involved in providing care for adult and paediatric trauma patients. Talk Trauma is put on by the London Health Science Centre (LHSC). We were honoured to return for a second year in a row to talk about managing trauma patients in the periphery.
Our idea was to demonstrate that you could provide excellent evidence based care before transferring patients to the trauma centre (LHSC). This resulted in Episode II – Tales from the Outer Rim (Talk Trauma Intro Trailer). I was inspired by ZdoggMD and dress up as Doc Vader while Brenda became Nurse Leia.
The entrance went well as we came on stage to the Imperial March with lightsabers drawn (Nurse Leia and Doc Vader). Our presentation consisted of defining evidence based medicine (EBM) followed by six critical reviews of recent papers. The goal was to cut the knowledge translation down to less than ten years and ensure trauma patients get the best care, based on the best evidence no matter where they present.
We promised the attendees that all the information would be made available. Here is a copy of our slides (Tales from the Outer Rim Slides). You will also find the links to the six SGEM critical reviews and the ZdoggMD videos that were shown.
Evidence Based Medicine: “The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” (Dr. David Sackett)
Six SGEM Critical Reviews:
- CPR Man or Machine: Mechanical chest compression devices do not appear superior to manual chest compression for out of hospital cardiac arrest. SGEM#136
- Hypertonic Saline for TBI: Hypertonic saline as a first line treatment for patients with severe traumatic brain injury cannot be recommended at this time. SGEM#150
- Isolated Sternal Fractures: Patients discharged home with isolated sternal fractures have a 12.5% risk of delayed hemothorax. These are painful injuries and patients should be provided with adequate analgesia and follow-up. SGEM#161
- Chest Tube Placement: Put the tube on the correct side, within the triangle of safety, and within the pleural space. SGEM#129 (Featuring Dr. Rick Malthaner from LHSC)
- Ketamine for RSI: Ketamine seems to be a reasonable alternative induction agent for undifferentiated patients requiring RSI in the emergency department. SGEM#93
- Massive Transfusion Strategy: A 1:1:1 transfusion strategy is a reasonable approach to adult patients who require a massive transfusion. SGEM#109
Three Take Home Points:
- You can be a Rural ACE (Academic Centre of Excellence)
- The EBM answer is…It all depends
- Be skeptical of anything you learn, even if you heard it from Brenda and Ken
Brenda and I look forward to coming back next year for Talk Trauma 2018.