Miscellaneous Trauma

DVT Prophylaxis in Trauma

The fellow should be able to:

Demonstrate an understanding of the problem of DVT/VTE in trauma patients
Demonstrate an understanding of the role of DVT prophylaxis in solid organ injuries
Recognize the controversies and role of DVT prophylaxis in patients with TBI
Describe different dosing strategies and medications used in DVT prophylaxis in trauma
Understand the role of IVC filters in trauma patients

Resources

Topic Summary
Meet the Mentors - Post-Traumatic Pulmonary Emboli
Additional Resources:
- Amanda L. Teichman, MD, FACS; Bryan A. Cotton, MD, MPH; et al., J Trauma Acute Care Surg. 2023. Approaches for optimizing venous thromboembolism prevention in injured patients: Findings from the consensus conference to implement optimal venous thromboembolism prophylaxis in trauma
- Brian K. Yorkgitis, PA_C, DO, FACS; Allison E. Berndtson, MD, FACS; et al., .J Trauma Acute Care Surg. 2022. American Association for the Surgery of Trauma/American College of Surgeons –Committee on Trauma Clinical Protocol for inpatient venous thromboembolism prophylaxis after trauma
- Eric J. Ley, MD; Carlos V.R. Brown, MD; et al., J Trauma Acute Care Surg.2020. Updated guidelines to reduce venous thromboembolism in trauma patients: A Western Trauma Association critical decisions algorithm
- O’Toole RV, Stein DM, O’Hara NN, et al. Aspirin or Low-Molecular-Weight Heparin for Thromboprophylaxis after a Fracture. 2023;388:203-13.
- Murphy PB, de Moya M, Karam B, et al. Optimal timing of venous thromboembolic chemoprophylaxis initiation following blunt solid organ injury: meta-analysis and systematic review. Eur J Trauma Emerg Surg. 2022;48(3):2039-2046.
- Yu-Tung Wu, MD; Chih-Ying Chien, MD; et al., J Trauma Acute Care Surg. 2023. Early venous thromboembolism prophylaxis in patients with trauma intracranial hemorrhage: Analysis of the prospective multicenter Consortium of Leaders in Traumatic Thromboembolism study
- Asanthi M. Ratnasekera, DO, FACS; Daniel Kim, MD; et al., J Trauma Acute Care Surg. 2023. Early VTE prophylaxis in severe traumatic brain injury: A propensity score weighted EAST multicenter study
- Lui A, Park C, Chryssikos T, et al. Safety and comparative efficacy of initiating low-molecular-weight-heparin within 24 hours of injury or surgery for venous thromboembolism prophylaxis in patients with spinal cord injury: a prospective TRACK-SCI registry study. Neurosurg Focus. 2023;55(4):E17.
- Arash Mahajerin, MD, MSCr; John K. Petty, MD; et al., J Trauma Acute Care Surg. 2017. Prophylaxis against venous thromboembolism in pediatric trauma: A practice management guideline from the Eastern Association for the Surgery of Trauma and the Pediatric Trauma Society

Trauma System Administration and Injury Prevention

The fellow should be able to:

Demonstrate an understanding of how trauma systems are classified
Describe how trauma systems determine where to direct injured patients
Demonstrate an understanding of the role of the trauma director and program manager
Describe the role of ACS verification in trauma center designation
Understand the role of trauma programs and injury prevention
Understand the basics of precess and quality improvement in trauma

Resources

Topic Summary
AAST Education Module - Administration of a Level 1 Trauma Program
AAST Education Module - Process Improvement
AAST Education Module - Trauma Systems Development: The Level III Center
Meet the Mentors - Trauma System Development: Principles and Practice
Meet the Mentors - Wicked Problems: Tackling System-Level Challenges in Trauma Surgery
April 2024 Journal Club - Trauma Care Centers

Disaster Response and Triage

The fellow should be able to:

Demonstrate an understanding of the role of the hospital in the community’s response to a disaster or mass casualty
Describe the phases of disaster response
Demonstrate an understanding of the principles of triage in mass casualty events
Recognize the ethical controversies associated with triage

Resources

Topic Summary
Overview Article:
- Belinda J. Gabbe; William Veitch; et al., British Journal of Anaesthesia 2022. Review of the requirements for effective mass casualty preparedness for trauma systems. A disaster waiting to happen?
Additional Resources:
- Alan D. Kaye, MD, PhD; Elyse M. Cornett, PhD; et al., Elsevier 2021. Framework for creating incident command during crises
- Michael D. Christian, MD, MSc, FRCPC., Crit Care Clin 2019. Triage review
- Christian Elleby Marcussen; Karoline Bendix Brauner; et al., Elsevier 2022. Accuracy of prehospital triage systems for mass casualty incidents in trauma register studies - A systematic review and meta-analysis of diagnostic test accuracy studies

Firearm Injury and Ballistics

The fellow should be able to:

Demonstrate an understanding of the types of firearms and how they are classified
Demonstrate an understanding of the differences between shotgun, rifle, and handgun injuries
Describe the concept of cavitation and blast injury as it relates to tissue trauma

Resources

Topic Summary
Meet the Mentors - Firearm Injury Prevention
Meet the Mentors - Firearm Injury Prevention
Meet the Mentors - The Surgeon's Role in Firearm Injury
Overview Article:
- Stefanopoulos PK, Hadjigeorgiou GF, Filippakis K, Gyftokostas D. Gunshot wounds: A review of ballistics related to penetrating trauma. Journal of Acute Disease 2014: 178-185
Additional Resources:
- Dienstknecht T, Horst K, Sellei RM, Berner A, Nerlich M, Hardcastle TC. Indications for bullet removal: overview of the literature, and clinical practice guidelines for European trauma surgeons. Eur J Trauma Emerg Surg. 2012 Apr;38(2):89-93.
- Anisha Apte, MD; Kevin Bradford, MLS; et al., J Trauma Acute Care Surg. 2019. Lead toxicity from retained bullet fragments: A systematic review and meta-analysis
- Simpson, Bonnie M. MD; Wilson, Robert H. MD; Grant, Richard E. MD. Antibiotic Therapy in Gunshot Wound Injuries. Clinical Orthopaedics and Related Research. 2003; 408: 82-85.
- Faber NA, Kathe NH, Myers RJ, Collins JN. Duration of Antibiotic Prophylaxis for Ballistic Fractures to the Extremities. Am Surg. 2023 Jul;89(7):3047-3051.
- Dehne LM, Foertsch MJ, Droege CA, Makley AT, Mosher DR, Philpott CD, Sagi HC, Mueller EW, Droege ME. Antibiotic Duration Following Abdominal Gunshot Injuries With Associated Pelvis or Spine Involvement: A 20-Year Single-Center Experience. J Surg Res. 2023;291:97-104.
- Schellenberg M, Inaba K, Heindel P, Forestiere MJ, Clark D, Matsushima K, Lam L, Demetriades D. The diagnostic dilemma of shotgun injuries. Eur J Trauma Emerg Surg. 2020 Dec;46(6):1351-1356.