List Archives

Sat Jul 18 02:15:05 BST 2009

Not exactly trauma, but I have no other way of asking medical related questions to hundreds of medical professionals....When I'm not at  the hospital playing trauma queen I teach the Bloodborne pathogens thru the Red Cross to many of the tattoo/piercing ( some do dermals and scarification too) shops in the area -Central NY.  These shops/artists are yet to be regulated by the local DOH. All of them have consent forms verifying age, and ask questions related to the persons medical status. All of them have me look over their consent forms and aftercare instructions. These consent forms contain the same information as any other shop, but when I ask these tattoo/piercers (who also sign the form with the client) what they know about the conditions and/or medications their customer list , none of them have an accurate answer. Now I've been asked to write an article on tattoo after care and help establish new consent forms for some shops.Other then obvious issues , such as infection, blood thinning meds, disease..etc., I 'm trying to gather as much pertinent information  as possible from the medical community involving their profession, including any relevant experience that these people should know??  Thoughts, ideas I need to discuss that I may not think of?? 
Thank you!!
Angela

> From: trauma-list-request at trauma.org
> Subject: trauma-list Digest, Vol 73, Issue 12
> To: trauma-list at trauma.org
> Date: Thu, 16 Jul 2009 12:00:12 +0100
> 
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> Today's Topics:
> 
>    1. National Sepsis Update 2009 Delhi (yash javeri)
>    2. RE: Non invasive Ventilation with Flail Chest (Errington Thompson)
> 
> 
> ----------------------------------------------------------------------
> 
> Message: 1
> Date: Wed, 15 Jul 2009 09:24:13 -0700 (PDT)
> From: yash javeri <dryashjaveri at yahoo.com>
> Subject: National Sepsis Update 2009 Delhi
> To: trauma-list at trauma.org
> Message-ID: <22630.72684.qm at web51312.mail.re2.yahoo.com>
> Content-Type: text/plain; charset=iso-8859-1
> 
> ?
> Dear all,
> We are glad to invite you all for Sepsis Update 2009 on 8/9 August,Delhi.
> Kindly view the? details on www.apcc-india.com
> 
> Best Regards
> Dr Yash Javeri,
> Consultant,
> Critical Care,
> Max Super Speciality Hospital,
> 1,Press Enclave Road,
> Saket,
> Delhi
> Mobile:09818716943
> 
> 
>       
> 
> ------------------------------
> 
> Message: 2
> Date: Wed, 15 Jul 2009 16:46:49 -0400
> From: "Errington Thompson" <errington at erringtonthompson.com>
> Subject: RE: Non invasive Ventilation with Flail Chest
> To: "'Trauma-List [TRAUMA.ORG]'" <trauma-list at trauma.org>
> Message-ID: <007601ca058d$609a8f30$21cfad90$@com>
> Content-Type: text/plain;	charset="us-ascii"
> 
> Michelle - 
> 
> As you know, the patient's response to pain is highly variable.  The classic
> mortality rate quoted for scapular fractures is about 30%.
> 
> Here's some recent data to muddy the waters - 
> 
> *****CRITICAL CARE MEDICINE*****
> 
> (REFERENCE 1 OF 2)
> 
> PMID- 16625122
> 
> Brasel KJ,  Guse CE,  Layde P,  Weigelt JA  
> Rib fractures: relationship with pneumonia and mortality.
> 
> In: Crit Care Med (2006 Jun) 34(6):1642-6
> 
> ISSN: 0090-3493
> 
> OBJECTIVE: In single-institution studies, age is a risk factor for
>   mortality after rib fracture. Sample size has limited the assessment
>   of other risk factors. We used a national database to analyze
>   suspected risk factors contributing to pneumonia and mortality in
>   patients sustaining rib fractures. DESIGN:: Database analysis.
>   PATIENTS: All patients with rib fractures discharged from hospitals
>   submitting information to the Nationwide Inpatient Sample database.
>   INTERVENTIONS: The 1999 Nationwide Inpatient Sample was queried for
>   all patients with rib fracture. Age, gender, number of rib fractures,
>   Injury Severity Score, comorbidities, pneumonia, and mortality were
>   abstracted from the database. Comorbidities were scored according to
>   Elixhauser. Multivariate analysis identified independent risk factors
>   for mortality and pneumonia. MEASUREMENTS AND MAIN RESULTS: We
>   identified 23,426 patients; 17,308 patients had a primary diagnosis
>   of trauma and were included in the analysis. Mean age was 56. Mean
>   Injury Severity Score was 13.1. The number of comorbidities ranged
>   from 0 to 9. Overall mortality was 4%. Six percent of patients had
>   pneumonia. In a multivariate model, age and Injury Severity Score
>   were significantly associated with both mortality and pneumonia.
>   Comorbidity score was associated with pneumonia and mortality only in
>   patients with isolated thoracic trauma. Pneumonia was associated with
>   mortality only in patients with isolated thoracic trauma.
>   CONCLUSIONS: In a model controlling for multiple known risk factors,
>   age and Injury Severity Score were the only important predictors of
>   mortality in patients with rib fractures and multiple-system injury.
>   Pneumonia was significantly associated with mortality only in
>   patients with isolated thoracic trauma.
> 
> Comment in:  Crit Care Med. 2006 Jun;34(6):1828-9
> 
> Institutional address: 
>      Department of Surgery
>      Injury Research Center
>      Medical College of Wisconsin
>      USA.
> 
> 
> *****JOURNAL OF TRAUMA*****
> 
> (REFERENCE 2 OF 2)
> 
> PMID- 18404055
> 
> Livingston DH,  Shogan B,  John P,  Lavery RF  
> CT diagnosis of Rib fractures and the prediction of acute respiratory
>   failure.
> 
> In: J Trauma (2008 Apr) 64(4):905-11
> 
> ISSN: 1529-8809
> 
> BACKGROUND: The number of rib fractures has been reported to
>   correlate with mortality after blunt chest trauma. These reports,
>   however, predate routine truncal helical computed tomographic (CT)
>   scanning and their conclusions are based on data derived from plain
>   chest radiographs (CXR). CT scan provides better anatomic definition
>   of chest injuries than plain CXR, and we hypothesized CT evaluation
>   of rib fracture number and patterns would provide a better prediction
>   of respiratory failure and mortality after chest injury than the data
>   derived from the initial CXR. METHODS: The charts on all patients of
>   16 years or older with one or more rib fractures after blunt trauma
>   admitted from January 2003 through December 2005 were reviewed. Both
>   the initial CXR and the helical CT scans were systematically re-read
>   for the number and location of rib fractures and presence of
>   pulmonary contusions. Anatomic fracture location (anterior,
>   posterior, lateral) was determined using a standardized template.
>   Outcomes data included pneumonia, respiratory failure (>/=3
>   ventilator days), need for trachestomy, and mortality. Logistic
>   regression was performed to identify factors that predicted pulmonary
>   morbidity. RESULTS: Three hundred and eighty eight patients had>/=1
>   rib fracture. The mean (+/-standard deviation) age was 44 +/- 18.
>   injury severity score was 21 +/- 11. Mortality was 6% (22 of 388).
>   Sixty-three (16%) patients developed respiratory failure. The mean
>   number of rib fractures per patient was four (range, 1-23); 21% of
>   patients had one rib fracture and 17% had six or more fractures. 208
>   (54%) of the initial CXRs were read as having no rib fractures. The
>   mean number of rib fractures per patient in this group was 3.1 (CI95
>   2.9-3.2). In 43% (179 of 388) of patients, the CT radiology report
>   incorrectly identified the number and location of the fractured ribs.
>   Of these reports, 72% (129 of 179) differed from the prospective
>   review by more than one fracture. The number of fractures was higher
>   in patients who died (7 +/- 5 vs. 4 +/- 3; p = 0.02) and in those
>   developing respiratory failure (6 +/- 4 vs. 3 +/- 3; p = 0.02). Any
>   rib fracture or pulmonary contusion visible on the initial plain CXR
>   significantly increased the incidence of pulmonary morbidity or
>   mortality. CT determination of fracture location had no effect on
>   respiratory failure, pneumonia, or mortality when fractures were
>   confined to one anatomic location. The presence of rib fracture in
>   more than anatomic region doubled the incidence of respiratory
>   failure (24% vs. 12%; p = 0.002) but had no effect on mortality.
>   Logistic regression identified only injury severity score and
>   presence of a parenchymal injury on plain CXR as independent
>   predictors of subsequent respiratory failure. CONCLUSIONS: Rib
>   fracture mortality was lower than that in the previously published
>   studies and is likely reflect the increased sensitivity of CT scan in
>   diagnosing rib fractures. Screening CXRs miss rib fractures more than
>   50% of the time. Radiology reports are often not sufficiently
>   descriptive or are incomplete with respect to the number and location
>   fracture and reliance on these data will lead to erroneous
>   conclusions. Using CT scanning, only the finding of rib fractures in
>   multiple locations was associated with increased incidence of
>   respiratory failure. In contrast, the presence of any parenchymal
>   injury or visible rib fracture on the screening CXR significantly
>   increases the risk for subsequent pulmonary morbidity (odds ratio,
>   3.8; CI95, 2.2-6.6). Although truncal CT scanning markedly improved
>   the diagnosis and delineation of rib fractures, the screening CXR was
>   a better predictor of subsequent pulmonary morbidity and mortality.
> 
> Institutional address: 
>      Division of Trauma
>      Department of Surgery
>      New Jersey Medical School
>      Newark
>      New Jersey
>      USA. livingst at umdnj.edu
> 
> 
> Errington C. Thompson, MD, FACS, FCCM
> Trauma/Critical Care
> Talk Show Host - WPEK 880 AM
> www.whereistheoutrage.net
> 
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
> On Behalf Of Michelle Bailey
> Sent: Monday, July 13, 2009 1:57 PM
> To: Trauma-List [TRAUMA.ORG]
> Subject: Re: Non invasive Ventilation with Flail Chest
> 
> Hi
> looking for articles related to Rib fractures and when to admit for
> observation. Had a 49 yo patient in the ED with 5 rib fractures (2-6 ) and a
> scapular fracture - plus atelectasis appearing on CT. I tend to be
> conservative and would have admitted him for observation. Looking for any
> evidence regarding rib fractures and delayed complications (pneumo/hemo)
> 
> thanks
> Michelle Bailey PA-C
> Trauma Coordinator
> 
> On Mon, Jul 13, 2009 at 10:48 AM, Gross, Ronald <
> Ronald.Gross at baystatehealth.org> wrote:
> 
>> A mind is a terrible thing to waste!!  I do remember that, but missed your
>> inuendo!  Oh well.  we are still working on putting that study together -
>> will let you know when it comes to be!
>> be well,
>> Ron
>> ________________________________________
>> From: trauma-list-bounces at trauma.org [trauma-list-bounces at trauma.org] On
>> Behalf Of Dr Timothy Hardcastle [dr.tchardcastle at absamail.co.za]
>> Sent: Friday, July 10, 2009 8:49 AM
>> To: Trauma-List [TRAUMA.ORG <http://trauma.org/>]
>> Subject: RE: Non invasive Ventilation with Flail Chest
>>
>> Ron
>>
>> That was said with tongue firmly in cheek - from our previous mails you
>> would recall I would participate in such a study.
>>
>> I don't believe in using metal plates - the absorbable ones work just as
>> well and they give no long-term issues. Having said that I think that the
>> real role is for the flail or "stove-in" chest without significant
>> contusion who would simply require mechanical stability, the cases with
>> real contusion usually require tube and vent - then when they come off the
>> pump after about 7 - 10 days the ribs are usually reletively stable
>> already.
>>
>> Tim
>>
>> Dr T C Hardcastle
>> M.B., Ch.B. (Stell); M. Med. (Chir) (Stell); FCS (SA)
>> Principal Specialist Trauma Surgeon /
>> Honorary Lecturer University of KwaZulu-Natal Dept Surgery
>> Deputy Director - IALCH Trauma Service
>> Durban - South Africa
>>> Tim,
>>> Trunkey, Mayberry and others (including yours truly) would disagree
>>> (respectfully, of course).  Would you be interested in participating in
> a
>>> study using this technology?
>>> Ron
>>>
>>> None
>>>
>>> I think it is still a procedure looking for a pathology!
>>>
>>> Tim
>>>> Dear Dr. Hardcastle,
>>>>
>>>> Your experience with blunt chest injuries is impressive. May I ask how
>>>> many
>>>> of these flails were surgically repaired with metal plates, etc.?
>>
>>
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> End of trauma-list Digest, Vol 73, Issue 12
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