faye chiou tan, md chief pmr, harris health professor pmr, baylor college of medicine what is...
TRANSCRIPT
Faye Chiou Tan, MD
Chief PMR, Harris Health
Professor PMR, Baylor College of Medicine
WHAT IS TRAUMATOLOGY?
Definitions for Traumatology
• American Heritage Dictionary – “ The branch of medicine that deals with the treatment of serious wounds, injuries, and disabilities”• Random House – “A branch of medicine dealing with major wounds caused by accidents or violence”
History
Edwin Smith Surgical Papyrus• Edwin Smith, pioneer Egyptologist, purchased the
papyrus which bears his name at Luxor in 1862. The original text was written about 3000 B.C.
• It is the oldest known surgical (and scientific) treatise. 47 different cases of injuries and affections of the head, nose and mouth, together with methods of bandaging.
• Ref: Zimmerman & Veith's "Great ideas in the history of surgery" (1967; pp 3-13).
History• “Nei Ching” – Canon of Medicine – 2,600 BC
by Yu Hsiang, debridement of ulcers• Ancient Indian – 2,500 to 1500 BC
Sushruta, leading physician- described surgical tools
• Greek – 2nd century, BCHippocrates – “iatros” – extractor of arrows“Wound” in Greek = Tραvμα is where the word Trauma is derived
History
• American Heritage Dictionary – “ The branch of medicine that deals with the treatment of serious wounds, injuries, and disabilities”• Random House – “A branch of medicine dealing with major wounds caused by accidents or violence”
History
Roman Empire – 5th century AD• Theodoric, Bishop of Cervia (surgeon)
Healing by secondary intention: “It is not necessary,… as modern surgeons profess, that pus should be generated in wounds. No error can be greater than this. Such a practice,… hinder(s), prolong(s), … and prevent(s) consolidation of the wound.
• Anaesthesia: “Opium, juice of morel, hyoscyamus, mandrake, ivy, hemlock, and lettuce”. “Hold it under the nostrils of the patient until he goes to sleep”.
History• Persian empire – preserved Greek and Roman
knowledge after the fall of Rome• Arabs preserved above after Mohammedans captured
Alexandria – 640 AD• Rhazes, Arab surgeon used cat gut to suture
wounds (850-932 AD)• Middle ages – 1453 AD – regulation of training,
licensing exams, Royal College of Surgeons (15th century), hospitals, nursing care, compassionate care.
History
17th and 18th centuries• De Motu Cordis – William Harvey,
circulation of blood• 1666 – Lower – blood transfusions
• Cavitation – like a game of pool or bowling (Norman McSwaim, Jr in Textbook Trauma)
• Permanent cavity and temporary one• Muscle spread without tearing• Liver and spleen inelastic and rupture
Kinematics of Trauma
Kinematics of Trauma
Bullet bow shock wave – Shadowgraph or Schlieren images
Types of TraumatologistsOrthopedic surgeons
• Polytrauma – no consensus on definition of this term – two separate body areas
• Subspecialty of Orthopedics - Trauma Surgery“Because of the complex nature of injuries seen today, a special area of orthopaedics is now related to the management of persons with critical or multiple injuries to the musculoskeletal system. This specialty is largely surgical in nature and involves close cooperative efforts with many other specialties in surgery.” American College of Surgeons
Types of Traumatologists
Emergency Medicine / Critical care:ACCME accredited fellowships
General Trauma SurgeonsTextbook “TRAUMA” 4th edition, Mattox, Feliciano, MooreFluids, nutrition, organ repair, swelling, fasciotomy, DIC
Types of Traumatologists
Types of Traumatologists
Mental health professionals• 2004 Green Cross Academy of
Traumatologists• Organized in 1995 after the bombing of
Oklahoma City Murrah Federal Building.• International• Non-profit
Green Cross AcademyStages of help
Wave I (Day 1-10) – Crisis stabilizationWave II (Day 5-15) – Stress management, social supportWave III (Day 10-20) – Training, referrals, resourcesWave IV (Day 15-40) – Grief and loss counseling
Green Cross Accreditation• Compassion fatigue educator – teaching self
care and compassion fatigue stress mgmt• Compassion fatigue therapist – fatigue
prevention, PTSD• Certified Traumatologist – must pass trauma
theory (dissociative and DESNOS phenomena, Herman triphasic treatment, compare and contrast 6 treatments of PTSD)
Disorders of Extreme Stress, Not Otherwise Specified (DESNOS).
DESNOS phenomena
Herman’s Stages of Recovery
• Stage 1: dealing with and overcoming such problems, and of any helpful therapy or counseling.
• Stage 2: ‘remembrance and mourning.’• Stage 3:reconnecting with people,
meaningful activities, and other aspects of life.
Types of Traumatologists
• Forensic physicians/pathologists –• Study nature, size, impact of force (blunt,
penetrating), type of agent (chemical, caustic)
Types of Traumatologists
Trauma Nurse Practitioner (TNP)Not agreed upon core competencies
Physical Medicine and Rehabilitation – NEW!• Expertise in handling complex, multiple injuries• Fracture healing, skin, metabolic, compartment
syndrome, hematoma, delayed manifestations on rehabilitation unit
• Increasing function – “Exercise is Medicine” walking, ADL’s
• Decreasing sequelae – secondary late complications such as arthritis, contractures, atrophy
Types of Traumatologists
Rehabilitation Traumatology – proposed definition
• Traumatology -– “ The branch of medicine that deals with the treatment of serious wounds, injuries, and disabilities” (American Heritage® Dictionary)
• Rehabilitation – “To restore to good health or useful life, as through therapy and education” (American Heritage® Dictionary)
Traumatology program at Baylor• Level 1 Trauma Center – hospital with leadership role
in optimal trauma care, QI, education, and research.• Trauma survey – for level 1 trauma center –
rehabilitation is a mandatory component. Continuity of care of the trauma patient.
• Multidisciplinary Traumatology meetings – trauma surgeons, neurosurgeons, orthopedic surgeons, trauma nurses, rehabilitation traumatologists.
• Research program • Educational program
Center for Excellence in Trauma Rehabilitaton Research
• Founded in 2000 at Harris Health and Baylor• “Dum spectas volare”• Production of rehabilitation traumatology
related peer-reviewed articles, case reportsJ Computerized Axial Tomography – Anatomic seriesElectrodiagnostic medicine in trauma rehabilitation in
EMG Secrets, Tan, editor.
• Two tracks – SCI and TBI• Two year research program with up to 20% clinical5 Research Fellows over 6 year grant• Offerings include – neuropsychology, robotic
rehabilitation• Collaboration and electives with other facilities
including – Rice University, University of Houston masters of public health program, etc.
• Clinical rounds with physicians
Training of NIDRR- ARRT research fellows (2002-2014)
Education component
• Dr. Pandit – Education Director• Resident Traumatology Program and
Rotation• Traumatology Journal Club• Traumatology Fellowship Program
Application
Rehabilitation TraumatologyFellowship funding
• Texas Higher Education Coordinating Board
• Emergency and Trauma Care Education Partnership Program
• Baylor receives $475K for• Emergency medicine residency• Surgical critical care fellowship
Example Rehabilitation Traumatology EMG Questions:
Can you perform NCS and needle on a skin graft?Yes, once surgeon says graft has “taken”, usually at least 5 days
What are clinical signs of peripheral nerve injury due to hematoma?Painful ROM, tenderness to palpation, sensory deficit, decreased peripheral pulses
What are symptoms of anterior compartment syndrome?Severe limb pain, weak dorsiflexors, sensory deficit, pain with passive stretch of compartment muscles, tenderness to palpation. Tissue pressure > 60 mmHg (NL < 15 mmHg).
What is the most common traumatic nerve injury? Radial nerve
Suggested References
Traumatology Journal of TraumatologyOrthopaedic and Trauma SurgeryOrthopaedics and TraumatologyTRAUMA – Mattox et al.Trauma rehabilitation – Robinson, Larry
• Please stay for a Traumatology SIG: Q and A immediately after this meeting
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