Carolinas Case Conference - Dr. Nichols

1) Respect the elderly, but especially in geriatric trauma!      
      -Many of these patients are beta blocked and anticoagulated
      -High risk for occult fracture, higher risk for mortality following any trauma
      -Remember to apply geriatric trauma scoring, and triage conservatively

2) Don't fear the chronic tracheostomy patient in respiratory distress
    -Remember your airway toolbox, gauge how much time you have!
    -A NG tube can be a great placeholder for trach exchange
    -Never forget you can (usually) still intubate these people from above
    -Fiberoptic nasotracheal intubation as a failsafe

3) Consider imaging of the hip in pediatric leg pain
    -SCFE can present as subacute knee pain, patients may still be able to walk!
    -Consider in both boys and girls, obese and average sized
    -Low threshold for imaging of the hips with knee or thigh pain complaints

4) Ensure you examine every trauma patient's eyes, checking for ocular trauma
   -Globe rupture requires immediate optho consultation
   -Do not perform further exams until this is ruled in or out
   -Hyphema is a collection of blood in the anterior chamber, usually traumatic
   -More anterior chamber filling associated with worse visual recovery
   -Emergent consultation with opthomology, elevate head of bed, check for coagulopathy

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