A New Era

This is the first post from a phone I've ever written, and that sure is amazing if you think about it. Of course, the fact that I think it's amazing rather than normal tells you what a dinosaur I really am. Pretty soon my phone will intubate my patients and place central lines while it brews my coffee. Perhaps now I will actually be able to post again, busy as we are on truma. Sorry to all for the layoff.

We sent a lady wothy of buckeye surgeon, another blogger on the sidebar, to the OR today for a small bowel obstruction, and now I get what the surgical emegency is all about. Her belly was like a drum. Fourteen prior surgeries. Tiny little lady with a buddha belly, criss-crossed with scars that she clutched with both hands, fluid pouring out of her NG tube. She would surely be vomiting up a storm without it. I guess those surgeon-type people do some good after all.

Irony

Here's a knee-slapper. What if the very Harley that you rode to traumatic brain injury land without a helmet also technically kept you from qualifying for federal insurance to pay for the nursing home you needed? What if it made you 'over assets' because it was so nice on paper, but really was a twisted heap of metal that no one had officially listed as totaled yet?

Hmmmm.

Trauma Time

Photo Credit

Last day of cardiology call; starting trauma surgery tomorrow.

An article about South Africa's hosting of the 2010 World Cup made me think about the context of penetrating trauma. Johannesberg in particular is an infamous center for trauma research, and one of the most dangerous places in the world, prompting all the concerns about tourists visiting.

Looking around, it certainly seems that the risk of getting shot or stabbed is, ahem, not quite equal. The rates where I train are in the neighborhood of 20 per 100,000 or so, putting us outside the top 25 most dangerous cities in the US in favor of places like Detroit and Compton; on a country averaged rate, though, it puts us between Puerto Rico and Kasakhstan, which is not great. With a stated death rate from intentional trauma of 20, we get more than a gunshot wound a day on average (they do tend to come in groups).

Of course, it gets worse; South Africa has a rate of 38 per 100,000, as high as almost 50 in the last decade. Iraq wins--or loses, whichever. But that's an active war zone; the one that makes me wonder in this list is Jamaica, which people run off to all the time. Imagine if Apple tourism started selling getaway packages to Iraq.

These statistics face the same problems as any public health measure. Any country with a functioning public health system will do a better job of tracking statistics, and the statistics in Sierra Leone or Somalia are likely not quite reliable, whereas ours should be quite reliable. I'm guessing the rates in countries like Somalia, Angola, or Colombia are unreliable to say the least. I'm not sure how a country with no infrastructure deals with such a trauma load, except as depicted in the pictures linked above from Somalia.

According to the Boston Globe article with the photo above, Somalia has lost 17,000 civilians to trauma in the last 2.5 years, or 6,800 a year; if the population is counted right, that's a death rate of 680 a year from penetrating trauma. 680! Makes that picture above seem a bit more poignant. Makes me think I'll take trauma more seriously. Makes me happy I'm not in Somalia. Makes me just overall confused about the state of the world and what we're missing on a daily basis if we don't go looking for it. Imagine the apocolypse we would be filling our airwaves with if our penetrating trauma death rate was thirty times greater than it is now. And yet, it's happening. Just not here.