Trauma Resuscitation Demonstration in a Stable Patient with a Minor Perforating Wound
Priya Prakash, MD
UChicago Medicine
This is the case study of a 17-year-old male Reserve Officers’ Training Corps (ROTC) cadet who suffered a superficial perforating saber wound to the medial part of the right knee during a routine practice session. This video demonstrates the step-by-step patient assessment process and subsequent saber removal.
Airway Assessment for Trauma Patients
Stephen Estime, MD; Abdullah Hasan Pratt, MD; Nicholas G. Ludmer, MD
UChicago Medicine
Airway injury remains a leading cause of early mortality in patients with trauma. Despite its rarity, direct traumatic airway injury and tracheobronchial injury (TBI) pose significant challenges for emergency clinicians, with an estimated incidence of 0.5–2% among trauma patients. Blunt or penetrating injuries to the head, oropharynx, neck, or upper chest can result in immediate or delayed airway blockage. Trauma can cause airway obstruction by itself or by blood clots, tissue edema, or gastric contents clogging the airway lumen. The added complexity of associated spinal injuries further underscores the need for precise and timely airway assessment.
In the context of trauma patients, a fundamental aspect of care involves prompt airway assessment. The Advanced Trauma Life Support (ATLS) algorithm, a cornerstone in trauma care, outlines a systematic approach focusing on a sequential assessment and management of Airway, Breathing, Circulation, Disability, and Exposure (ABCDE), as part of the initial evaluation of the injured individual. While adapted for battle and disaster environments, the ATLS algorithm consistently emphasizes the timely assessment and treatment of life-threatening airway and breathing issues before shifting focus to circulation problems. The CAB sequence has become more widely embraced in the last ten years, surpassing the airway-breathing-circulation (ABC) model for individuals with serious bleeding injuries. When bleeding is severe or life-threatening, prioritizing control of the bleeding takes precedence over interventions related to airway and breathing․
Exploratory Laparotomy and Splenectomy for Ruptured Spleen Following Blunt Force Trauma
Sebastian K. Chung, MD1; Ashley Suah, MD2; Daven Patel, MD, MPH2; Nadim Michael Hafez, MD2; Brian Williams, MD2
1University of Massachusetts Medical School
2UChicago Medicine
The spleen is highly vascular, is the largest secondary lymphoid organ, and is the most commonly injured organ in the setting of blunt abdominal trauma. Patients may present asymptomatically or with abdominal pain, nausea and vomiting, or signs of hemodynamic instability. Although many splenic injuries caused by blunt abdominal trauma may be managed conservatively, free intra-abdominal fluid with hemodynamic instability warrant surgical management in the form of exploratory laparotomy and splenectomy.
This video report demonstrates the management of a patient who was assaulted, sustaining blunt abdominal trauma and a hemodynamically significant grade IV splenic laceration. An exploratory laparotomy and splenectomy were performed.
Retrograde Femoral Intramedullary Nail for a Midshaft Femoral Fracture with an Ipsilateral Subtrochanteric Fracture
Jason P. Den Haese Jr.1; Michael J. Weaver, MD2
1Lake Erie College of Osteopathic Medicine
2Brigham and Women’s Hospital
This case illustrates a midshaft femoral fracture with an ipsilateral subtrochanteric fracture that is repaired with a retrograde femoral intramedullary nail technique. The annual incidence of midshaft femur fractures is approximately 10 per 100,000 person-years (most commonly low-energy falls in elderly females). Generally, these patients will present with pain, inflammation, and shortening of the leg.
Retrograde femoral intramedullary nail placement is one of the most prevalent methods for treatment. It was initially discovered in 1970 and refined in 1995 to have improved surgery time, bleeding, and postoperative adverse outcomes. This procedure has proven to be particularly beneficial in obese and non-ambulatory patients, and those with multisystem injuries; it also has shown some benefit in pregnant women due to decreased pelvic radiation exposure.
This case presents a woman with a femoral shaft fracture and an ipsilateral subtrochanteric fracture. Given this patient’s multiple ipsilateral femur fractures, it was favorable to intervene with a retrograde femoral intramedullary nail. The procedure was done in a supine position due to favorable imaging throughout the operation.
Open Reduction and Internal Fixation of a Trimalleolar Ankle Fracture
Michael J. Weaver, MD
Brigham and Women’s Hospital
The goal of ankle fracture management is to restore a stable and congruent joint. Operative management is recommended for most displaced fractures, fractures with dislocations, and open fractures.
This video article walks through the surgical management of a 23-year-old male who sustained a trimalleolar ankle fracture with concomitant dislocation and syndesmotic injury following a motor vehicle collision. Dr. Weaver discusses the surgical landmarks and approaches to the ankle, the methods of fixing the malleoli and the syndesmosis, and common concerns that arise during the surgical management of ankle fractures.
Airway Techniques and Equipment
UChicago Medicine
Dany Accilien, MD
Emergency Medicine Resident
The University of Chicago Pritzker School of Medicine
Dexter C. Graves, MD
Emergency Medicine Resident
The University of Chicago Pritzker School of Medicine
Nicholas Ludmer, MD
Assistant Professor of Emergency Medicine
The University of Chicago Pritzker School of Medicine
Stephen Estime, MD
Assistant Professor of Anesthesiology and Critical Care
The University of Chicago Pritzker School of Medicine
Abdullah Hasan Pratt, MD
Assistant Professor of Emergency Medicine
The University of Chicago Pritzker School of Medicine
In this video, Dr. Pratt goes over airway management techniques in trauma resuscitation. It outlines the preparation and equipment used in patients with impending airway failure that require manual or mechanical ventilation. Also discussed are the innovative airway towers used in the University of Chicago emergency room as well as the general approach to airway management. The different types of laryngoscopy, assist devices, and cricothyroidotomy surgical airway procedures are also presented.
Extended Focused Assessment with Sonography for Trauma (EFAST) Exam
UChicago Medicine
Daven Patel, MD, MPH
Resident Physician
Emergency Medicine
Kristin Lewis, MD, MA
Resident Physician
Emergency Medicine
Allyson Peterson, MD
Resident Physician
Emergency Medicine
Nadim Michael Hafez, MD
Assistant Professor of Medicine
Emergency Medicine
This video covers information related to the FAST exam, which evaluates the pericardial, hepatorenal, splenorenal, and suprapubic regions for free fluid in a trauma patient as well as the extended version, which includes an additional evaluation of the pleural spaces for a pneumothorax. It goes through probe selection, probe placement and image acquisition, image optimization, and pitfalls and pearls for the subxiphoid/subcostal, right upper quadrant, left upper quadrant, suprapubic, and pleural views.
Nicholas Ludmer, MD
Assistant Professor of Emergency Medicine
UChicago Medicine
Abdullah Hasan Pratt, MD
Assistant Professor of Emergency Medicine
UChicago Medicine
Stephen Estime, MD
Assistant Professor of Anesthesia and Trauma Critical Care
UChicago Medicine
In this video, Dr. Ludmer at UChicago Medicine describes the airway equipment that they have available for when a patient has an airway problem.
Airway Assessment for Trauma Patient
Nicholas Ludmer, MD
Assistant Professor of Emergency Medicine
UChicago Medicine
Abdullah Hasan Pratt, MD
Assistant Professor of Emergency Medicine
UChicago Medicine
Stephen Estime, MD
Assistant Professor of Anesthesia and Trauma Critical Care
UChicago Medicine
In this video, Dr. Ludmer at UChicago Medicine describes the airway assessment for a trauma patient.
Pharmacology for Rapid Sequence Intubation (RSI) Airway Management in Trauma Patients
UChicago Medicine
Laura Celmins, PharmD, BCPS, BCCCP
Clinical Pharmacy Specialist
Emergency Medicine
In this video, Laura Celmins, a clinical pharmacist in the emergency department at UChicago Medicine, discusses rapid sequence intubation (RSI) medications as part of the airway management for trauma patients.
