Improving Time to Angioembolization for Trauma Care: Novel Smartphone Application.

BACKGROUND: Timely angiographic embolization of abdominopelvic injuries is a hallmark of a high-functioning trauma center. Yet, the process depends on the timely mobilization of interventional radiology staff. Smartphone technology to notify and mobilize staff may be a viable option. OBJECTIVE: To describe the incorporation of a smartphone application into our trauma workflow process previously developed for stroke care. METHODS: In 2022, our Level I trauma center implemented a smartphone application with three simultaneously occurring functions: (a) high-definition image viewing on the phone; (b) text messaging thread for all parties; and (c) a single-call activation system for staff mobilization. The application was initially developed to notify interventional radiologists of large-vessel occlusions in victims of stroke and, at our request, was modified to fit our trauma workflow process. The smartphone application company developed a new program, installed the application on trauma service smartphones, and provided educational in-services over a 1-month period. The application was then integrated into our trauma workflow process. RESULTS: The trauma surgeon and the interventional radiologist can now simultaneously view high-definition images on their smartphones. Text messages are accessible to all team members. The staff is notified and mobilized with the singlecall smartphone application, preventing the placing and returning of phone calls. CONCLUSION: Smartphone technology enhances timely interventional radiology staff response for hemorrhagic patients requiring emergent angioembolization.

Process improvement using telemedicine consultation to prevent unnecessary interfacility transfers for low-severity blunt head trauma.

OBJECTIVE: Mild traumatic brain injuries (MTBI) associated with intracranial haemorrhage are commonly transferred to tertiary care centres. Recent studies have shown that transfers for low-severity traumatic brain injuries may be unnecessary. Trauma systems can be overwhelmed by low acuity patients justifying standardisation of MTBI transfers. We sought to evaluate the impact of telemedicine services on mitigating unnecessary transfers for those presenting with low-severity blunt head trauma after sustaining a ground level fall (GLF). METHOD: A process improvement plan was developed by a task force of transfer centre (TC) administrators, emergency department physicians (EDP), trauma surgeons and neurosurgeons (NS) to facilitate the requesting EDP and the NS on-call to converse directly to mitigate unnecessary transfers. Consecutive retrospective chart review was performed on neurosurgical transfer requests between 1 January 2021 and 31 January 2022. A comparison of transfers preintervention and postintervention (1 January 2021 to 12 September 2021)/(13 September 2021 to 31 January 2022) was performed. RESULTS: The TC received 1091 neurological-based transfer requests during the study period (preintervention group: 406 neurosurgical requests; postintervention group: 353 neurosurgical requests). After consultation with the NS on-call, the number of MTBI patients remaining at their respective ED's with no neurological degradation more than doubled from 15 in the preintervention group to 37 in the postintervention group. CONCLUSION: TC-mediated telemedicine conversations between the NS and the referring EDP can prevent unnecessary transfers for stable MTBI patients sustaining a GLF if needed. Outlying EDPs should be educated on this process to increase efficacy.

Bison Goring Resulting in Abdominal Evisceration and Cervical Fracture: A Case Report.

BACKGROUND: Handling livestock can be dangerous, and livestock-related injuries are increasing. CASE PRESENTATION: An 83-year-old man who was gored and thrown by a bison bull during feeding is presented. The traumatic event resulted in two major injuries: an abdominal laceration with intestinal evisceration and cervical fractures after being lifted and forcefully thrown. The patient's hospital course included emergent surgery using the damage control approach resulting in an open abdomen, postoperatively, intensive care unit placement, and physiological management of the lethal diamond (acidosis, coagulopathy, hypothermia, and hypocalcemia). Finally, the patient's injuries required repeated abdominoplasties, colostomy, and surgical cervical stabilization. Despite a complicated hospitalization, the patient returned to his previous lifestyle within 2 months. CONCLUSION: The geriatric population, despite multiple comorbidities, is active, and their dynamic lifestyle can result in severe injuries. Positive outcomes for this population are possible. Even if severely injured, the geriatric population has the propensity to rebound and survive with early aggressive management.