Today’s events started bright an early with a breakfast and learn session. The topic discussed was Geriatric Trauma Service (GTS): Practices, Pitfalls, and Outcomes which was presented wonderfully by Dr. Douglas J.E. Schuerer. Dr. Schuerer is the Trauma Medical Director from BJC Healthcare in St. Louis, MO. Dr. Schuerer discussed in great length this morning the trials, tribulations, and successes that his facility encountered trying to develop a sustainable Geriatric Trauma Service. As many of us know, mortality related to trauma increases dramatically once an individual reaches the age of 55. The most common associated mechanism of injuries for the “Geriatric” population are falls, motor vehicle collisions, and penetrating wounds. Along with managing the common injuries associated with these mechanisms of injuries, healthcare providers are often faced with trying to balance trauma and multiple co-morbidities such as hypertension, heart disease, diabetes, stroke, chronic obstructive pulmonary disease, dementia, arrhythmias, and endocrine dysfunction (just to name a few). The problem with medical management of this sensitive older population often in most organizations, a struggle of power between multiple disciplines (trauma verses cardiology, ortho, neurology, pulmonary, medical, etc.). What Dr. Schuerer and his colleagues determined was that they felt as if “they” (being the trauma surgeons) could best manage these patients independently and seek assistance of other disciplines when necessary and at their discretion. This facility determined criteria of which any patient greater then age 55 with a significant injury related to trauma, would thus be admitted and primarily management by the dedicated Geriatric Trauma Service (same group of trauma surgeons, with dedicated APRN coverage for these patients). Some of the other initiates that Dr. Schuerer determined his facility needed were consults to the hospitals geriatricians when applicable and provided guidelines as to when they should be involved in a particular patient case. They expanded PT/OT coverage to 10 hour shifts to allow more coverage of patient needs to evening time hours, weekends, holidays, and allowed this group of patients to receive PT/OT therapy twice a day to promote independence and encourage recovery. Increased the size for the SICU from 24-36 beds to allow for more patients and prevent over flow of trauma patients to the MICU. Social work and case managent teams were formed that care for patients throughout their hospital stay to assist with transitions and prepare for discharge. Dr. Schuerer and his team worked with the department of anesthesia to determine mutually agreed upon guidelines for patient testing/screening prior to OR time. This helped to expedite and prevent unnecessary delays or testing when operative intervention should be timely in the geriatric population. The GTS services performs medications reviews of all patients utilizing Beer’s Criteria and have discussions with patients PCP’s regarding medication adjustments or changes. They developed numerous protocols and standard work ups for common injuries or diagnosis (including syncope, rib fracture, head bleeds, etc).
The paper lectures this morning were also extremely intriguing. I found the lecture by Dr. Christine Leeper from University of Pittsburgh Medical Center quit fascinating. Dr. Leeper and her colleagues performed a retrospective review of trauma induced coagulopathy in pediatric trauma patients. Dr. Leeper’s study revealed that coagulopathy (defined as INR ≥1.3) is often common in severely injured pediatric patients and is the strongest independent factor of mortality. INR on admission, at 24 hours post admission, and trending throughout hospital stay can be a valuable tool in determining patient’s outcomes. Her research proves that if a patients INR can be reversed (brought below 1.3) within first 24 hours after injury, outcomes and risk for survival will improve. The research also noted that 1/3 of the patients that were adequately resuscitation and transfused correct their INR within 24 hours. I personally believe that this research is extremely valuable in the efforts of caring for pediatric patients. A test as simple as an INR can be a great predictor in survivability and mortality in pediatrics as well as adults. I often feel that this simple lab test can easily be forgotten.
The lecture given by Dr. Olubode Olufajo from Brigham and Women’s Hospital was also very interesting. This lecture discussed how long a patients risk of venous thromboembolism persists after a patient has suffered a traumatic brain injury (TBI). The researchers looked at some retrospective data on patients who had suffered from a TBI and did some chart reviews to determine in the patient developed a VTE during their hospital stay, within 30, 60, 90, 120 and 365 days post discharge. Their research suggests that the risk of VTE developed persists long after discharge in a significant proportion of patients with TBI injuries. Contributing factors that can increase a patients risk for VTE developed after TBI include age and individuals who are discharge to an extended care facility. The research teams recommendations are for careful consideration of long term management to prevent VTE in patients who have suffered a TBI.
Today’s Presidential Address was given by outgoing EAST President Dr. Stanley Kurek. His presidential address was discussing resilience. He defined resilience simply as how people respond to change and their ability to “bounce back” after change or adversity. He stated that “success in the world is based largely on ability to cope with adversity.” He described three characteristics of resilient people: those who accept reality, those who believe like is meaningful, and those who have the ability to improvise. He also described eight steps to success:
1. Accept Change
2. Perceive and Believe (“excuses are the poetry of failure)
3. Manage Your Emotions (use the 24 hour rule before addressing high emotions)
4. Self-Empowerment (take charge of YOUR OWN LIFE)
5. Prepare (also be prepared and on time)
6. Stay Busy, Busy, Busy (if your busy your mind doesn’t have time to wander)
7. Professional Networks (know who you can call for help)
8. Give Help
These simple eight rules of life can help anyone be successful. I felt that this wonderful speech was easily relatable to anyone could in professional and personal aspects of their life.
Lastly, to finish off this amazing trip I spent the afternoon playing dodgeball (YES DODGEBALL!!!!) with hundreds of amazing surgeon, emergency medicine physicians, and nursing professionals. For those of you who do not know, EAST has an annual Dodgeball Tournament to support the EAST Foundation. This is a VERY serious event that is hosted by the one and only Dr. Glen Tinkoff (picture below) who comes prepared with his very thorough list of official rules (which you may not in his picture, he proudly wears around his neck while refereeing). This year’s dodgeball tournament hosted 16 different teams; I participated as a member of the STN team (GO BLUNT FORCE!!!!). I am sad to say that even with great effort we did not win, but that’s ok neither did the three teams from Shock Trauma!!! This was a wonderful event that allowed EAST members and family to participate!