The SCRAP Rule: Indications for chest CT in blunt trauma

CT_Scanner_01.jpg2d5efea2-a1b7-4c15-848e-4d6c5567eecfLarger At my institution, trauma patients frequently receive the “Pan Scan,” to rule out acute injury. Recently, Payrastre et al published the SCRAP Rule article in CJEM 2012 ¹ looking to derive and internally validate a clinical decision rule that would identify blunt trauma patients at very low risk for major thoracic injury with 100% sensitivity, thereby eliminating need for a chest CT. Currently, the decision on whether to perform a chest CT is made mostly by clinical judgment.

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By Salim Rezaie, MD|2019-09-10T13:38:17-07:00Apr 25, 2013|Radiology, Trauma|

Is ATLS wrong about palpable blood pressure estimates?

In Advanced Trauma Life Support (ATLS), we learned that a carotid, femoral, and radial pulse correlates to a certain systolic blood pressure (SBP) in hypotensive trauma patients. Specifically ATLS stated:

Carotid pulse only = SBP 60 – 70 mmHg
Carotid & Femoral pulse only = SBP 70 – 80 mmHg
Radial pulse present = SBP >80 mmHg

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By Salim Rezaie, MD|2017-02-13T14:56:13-08:00Mar 31, 2013|Trauma|

Patwari Academy videos: Chest trauma

In the third and fourth video in the Trauma series (first two videos = primary and secondary survey), Dr. Rahul Patwari discusses about chest trauma, divided into blunt and penetrating mechanisms. What is “the box” that everyone keeps referring to?

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By Michelle Lin, MD|2019-01-28T22:04:15-08:00Mar 10, 2013|Patwari Videos, Trauma|

Patwari Academy videos: Trauma primary and secondary survey

What’s the primary and secondary survey in the assessment of the trauma patient? This is a great review of the methodical approach and insight in the thought processes by Dr. Rahul Patwari.

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By Michelle Lin, MD|2019-01-28T22:04:30-08:00Mar 3, 2013|Patwari Videos, Trauma|

P-video: Remembering NEXUS criteria

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By Michelle Lin, MD|2019-01-28T22:08:17-08:00Jan 17, 2013|Orthopedic, P-videos, Trauma|

Trick of Trade: Rule of 10’s for burn fluid resuscitation

A patient presents with burns to both his arms, chest, and abdomen (anteriorly only) from a flash fire. That’s about 27% total body surface area (TBSA). So how much IV fluid should be given?

Be aware of a phenomenon known as “fluid creep”, where patients actually get WAY too much IV fluids than they should, which can cause delayed complications such as ACS, pulmonary edema, and compartment syndrome. Don’t forget that patients often get a lot of IV fluids in the prehospital setting, which should also be factored in.

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By Michelle Lin, MD|2019-01-28T22:08:28-08:00Jan 15, 2013|Trauma, Tricks of the Trade|

Patwari Academy videos: Primary and secondary assessment

Deer in headlights

That was me as a medical student, when I first encountered an undifferentiated patient in moderate distress. The trick is to have a standardized primary and secondary survey approach. Sometimes it takes just a little kick-start to get you thinking and doing.

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By Michelle Lin, MD|2016-10-26T17:05:06-07:00Jan 6, 2013|Patwari Videos, Trauma|

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