OK. So this is the, this is the access to the, to the uh launch pad. Uh, one of my colleagues, uh, Leroy Mattingly, who is the architect for the, the entire app here is on, I wanted to thank him and about objects, which is the team that's uh been very helpful to us to put this together. Uh, the beauty of this is that uh we can change it overnight or within a week and put new Information on. The idea here is that this is to increase the quality of the patient's care and create a safe environment. In the United States, the 3rd leading cause of death for everybody are medical errors. So, we make mistakes, and the reason is because people don't know what the next step is. So we've created some, some. Checklists that help you find out what to do next with the patient. I'm just gonna show you, I'm gonna click up here on my patient list. If you have, if you have this with you, it'd be good, but I'm gonna click on it. And what it does is it brings up up to 25 patients you can put on here. And what I've done is I've already preloaded this 6-year-old, 21 kg with an explosion injury. And this youngster's got an epidural hematoma, and we're gonna, I'm gonna click on that, and it's gonna take me. I'm gonna take, this is the checklist, and it shows you the resuscitation. I'm gonna click on resuscitation, and you can see the components, the seven phases of care that you do for a patient through, from resuscitation all the way through surgery, post-op care, uh, down into discharge. I'm gonna, I'm gonna stay focused here on the resuscitation. The other thing I wanted to show you is that, let me see if I can move this. It's up here just a little bit. Well, I'm gonna, I'm gonna click down here on this icon that says profile. And the profile now allows me to have the 6 year old that I've put in here already, 6 years old, 21 kg, the normal ranges, and then it gives you a series of pieces of information. Remember now, I'm gonna, I'm, most people have never seen a blast injury. They've never seen an explosion. So I'm gonna click on that. And the first thing that pops up is what type of injury. These are the mechanisms of injury, and I've clicked off at this point. I'm gonna click that. And I think you recall this slide. OK, so it's in your hand, so that you can read what the mechanisms of injuries are here, and then what types of injuries you're gonna have, and then if you go down a little further, it tells you what the pattern is when you have barrel trauma. So in 11 screen, you've got a tremendous amount of information. The other thing is if you look at the sources up here, I'm gonna click on that. You click on that, it takes you to the bibliography. And it's got a bibliography here which you can click on and you can have a reference that you can bring up. This is called a clinical decision support system. So, I'm gonna go back. And so, the other part of this, let's see here. I've, I've loaded the diagnosis on this patient cause we just went through this patient, uh, and I'm gonna pull that up. And so you can see, I've got all these diagnoses on here, and I've got the operation, schedule the operation, when it's gonna happen. And then if I wanted to add something down, I'm just gonna show you one thing. Down here is damage control, which is I'm gonna show you in a minute. Uh, but if you click up here, It gives you all the diagnoses, and let's say you want head injury. Or let's say we're going down here to the abdomen. So if you click on one of these, It's telling me not to forget to pick something. See, I picked abdominal trauma. I'm gonna, I'm just gonna click on that just to show you this. So what it does is it brings up what the operation should be, damage control laparotomy, initial. Damage control laparotomy, second look, which is when you, when after you've actually done the operation, you wanna go back. So you, you click on one of these, I'm gonna click on the damage control, and it pops up, and you can see it down here, it comes up. OK? So it helps you keep track of everything you want. If you wanted to schedule the surgery. You click on this, it brings up the date. Let's just do, let's just put today's, I don't know. 2 2:54 p.m. we're gonna put that on there. I'm gonna hit done. So now it's scheduled, and so you can keep this uh in your hand the whole time. All right. So the other thing that's important is that if, it tells you the number of procedures that you've done on this patient, if you click on that, it gives you, we have 12 procedures that have been done on this child, procedure, sedation and pain management. It was done at 1933 on 5/12, and we didn't complete the whole process. Uh, you can see the number of procedures that were done, vacuum-assisted closure. As you go through that. So I'm gonna put indications. The thing about indications is this, this is your problem list. These are all the problems that the patient had, uh, that you took care of as you went through, and it keeps, it keeps it organized for you. OK, let's go to the checklist. The checklist is a way now for you to take a patient who's got uh an explosion injury in a six year old, and we go through and it says, do a quick screen of the patient. When you click on that, I mean, I'm sorry, on the primary survey, this is the first step, and you can see it's measuring how far I am into this process. So I'm gonna click on that. And the first thing you see is stop the bleeding. So you click that. And what pops up Is the algorithm for taking care of explosion injury. And if you look here, it tells you the hemorrhage control, the physiology of the patient, the anatomic injury, and what you should do for the nursing care. And you slide this up. And it gives you all the information. Chest tubes bilaterally for decreased breath sounds, we just talked about that. OK, if you, if you need to decompress the chest for some reason, you do a thoracotomy. These are all the things that the nursing teams and probably you need to do to get all this ready for this child to go to surgery. So, you've got it all in one place. That lecture I just gave you is in one place on this, on this particular uh document. Now, what I'm gonna do is I'm gonna go back, 011 thing I wanna show you. See these little bumps up here? This is called a breadcrumb. So if you click on it, it tells you exactly in the process of resuscitation of the patient where you are. And this just keeps going, so that if you're, if you get lost, it's easy to figure out where you are um in the patient's care. OK. The other thing I wanted to show you, which I think is really neat, you got this airway and cervical spine. I'm gonna click on that. And then up here, it says confirm. That there is a patent airway. Well, you got signs of aspirated foreign body, and you also have, I'm gonna click on this, which is a lecture on the principles of anesthesia and pain management for a child. So you click on that. So, it's good to see you. Please go ahead. Thank you, Marty. You're welcome. Thank you for the. Problems and Finally come to an end and, and, um, as was pointed out by uh um two authors and. So, so the point is that it, it gives you information that you can look at and find out about anytime you want it, anyplace you are. So it's, it's one of the things that I think is one of the most, uh, the, the strengths of this. You can see the videos and as well as the procedures. All right, let's just go through here. I wanna go to uh I'm gonna go down. I'm gonna go from resuscitation. I'm going into surgery, since we've got a lot of surgery people here. Um, what you do now is if you screen this up, you see how the color changes here. This is a blue, this is a highlighted blue area, and these are the injuries that this child has, the thoracic injury, the head injury, abdominal. So what I'm gonna do is I'm gonna hit abdominal, and it tells me how far I've been through the assessment of the patient. So I'm gonna click on that. And then what I want to make sure is that every time I click on this, Just I'm gonna click here. This is the management option for a patient who's got no abdominal. Distention. So if you want to put a nasogastric tube in. Or an orogastric tube, you click on that. It takes you to the procedure itself, so you can go down here to nasogastric tube insertion. It tells you the indication. Well, I'm putting this in here because the patient's got abdominal distention, so you click on that. The next thing is you gotta prepare the patient, so this is where your, your nursing teams and you have to make sure you wanna know the right size of the nasogastric tube. You click on that, it gives you the answer. So the the issue here is you don't have a lot of guessing to do. Then let's go back one more. And you can see here abdominal preparation, abdominal assessment, so it tells you exactly in the algorithm where you are. OK, let's, uh, let's go back here. I wanna go down here to the femur fracture. And what I'm gonna do is it, first thing it says is you got a femur fracture, you wanna check the neurovascular status. And what it does is now I'm gonna go and check the neurovascular status, and I've clicked this off. I'm gonna click up here to show you where we are. OK, so we're just into the femur fracture. And I'm gonna go down here and it's ask you all this pain, paresthesia, pressure. You get down here to the bottom. And it says, confirm the absence of compartment syndrome. I guarantee you, most people have never seen a compartment syndrome. So the reason, so we solved that problem. Good morning, good afternoon, and good evening. Greetings from the Norman M. Rich Department of Surgery at the uniformed Service. So this goes through the compartment syndrome and how to take care of a child and how to do the procedure. Compartment is common. Then the next thing you have is you actually, as a surgeon, it tells you how to do, it tells you how to do the, the 2 compartments, 2 incisions, 4 compartment decompression. To completely open, is that the best thing you've ever seen? I mean, I, I think that's fantastic because it's the kind of thing. Thank you. What's that? It's fantastic. It is wonderful. You always have it handy and you can watch it. And it is, it is great. I think it's great because we have here, excuse me, we have here Iona who is a chief surgeon in pediatric hospital in Odessa, and by the way, Odessa was bombed today. Um, unfortunately, but how, how are you today? Thank you for, uh, signing on. I appreciate it very much. I just want you to know we're here to help you in any way we can. Uh, and I'm just trying to show you, uh, something that we can share with you, uh, to make sure that you have the information that you need. Um, and I'm sort of a minimalist. I, I'm, I'm, my, my thing about general surgery is that you're taught to be, be very versatile and innovative, and so I think this app will help you do that. So what I just did, I'm just gonna go back here for a second. I'm gonna go, uh, what I did was I went down here and I'm gonna go to resources. I'm gonna click on the resources. And you can see up here, this is the diagnosis. You have to have a diagnosis, so it's telling you to select a diagnosis. I'm gonna select a diagnosis, and then I'm gonna come down here to skin. I'm gonna hit skin, I'm gonna pick burn. Now, there are 78. Resources in here on Burns. So, what I'm gonna do. You can either go directly to it. I'm gonna just show you here the normal skin anatomy. Uh, you can bring that up to see if you, you want that, or it tells you how to decide on the depth of the burn wound. You can see here, the follicles are critical in making this decision. You got, that's where the healing comes from, is from these follicles, and the also the vasculature. So you can see it's very superficial, and then if you go down, it's going down a little further. This is the scar. Uh, you get down here is a deep, uh, partial thickness burn. These, these need to be debrided, I think, and grafted cause they don't look good at the end of the day. And then down here is a full thickness burn. Most people never seen a burn. They don't feel comfortable. I'm talking about doctors and nurses. They don't feel comfortable taking care of a burn. And then the other thing that's really slick is that we've, slick is an an American word. By the way, I, I was born in Brazil, so I, I speak Portuguese fluently like you speak Ukrainian. So, I've had to pick up some of these words and slick means really good. Uh, so when I use that term. So the idea here is this is a partial thickness burn, and this is the way it looked when the patient came in the first day. The 2nd day, this is after the er form has been lifted off of it, you can see that it looks nice and clean, it's pink, and if you look up real close to it. You can see the hair follicles. You can see the hair follicles in here, so that means that you've got plenty of room to actually heal. So, now that you Here we go. Now that you know that, you can take, you follow this patient through, so that when you take the zero form off, if it's, if it's stuck, you leave it, because it'll heal underneath that. So don't take it all the way off. Only take those things that are really easy to come off. And then it shows you how this progresses, so you can see this wound here is at 10 days, this one appears at 7, you can see the difference in the wound. And then it tells you, here's one at 11 days, and I'm just gonna go through this, and this is the way it looks at 6 weeks. So, the point is that we've tried to make it so that it's available to you. The other thing that's, that's really interesting about this is if it says filter by tag. So you got 78 of these things, so if you wanna go on that. What it does now, it tells you. Shows you like mechanism of injury, all the, all the, the resources that have to do with pain, uh, how to take care of the wound, and then you've got images. So, what it does is it breaks it out real quick for you, so that you have access to the information that you need right now. So, this app allows you to do a couple of things. Uh, what's going on here? Let's go back to the Back to the beginning, so that you can see that the procedures that we've done, oh I, oh, I know what I wanted to do. I'm sorry. Let's go back here. Let's go back to the profile. So remember, we, we clicked on this patient here, and when you go click on that, it may be that you've got a question that you wanna ask without going through this algorithm. You can do that by just hitting the, the, the resources that we were just in, and you can go back to the diagnosis, change the diagnosis, let's say to pneumothorax. And so everything that has to do with pneumothorax comes up. So the way this is set up is that, it tells you when you go into it, it tells you what the problem is that you're trying to solve. It tells you the preparation for whatever procedure you wanna do. And if we go back now, let's go back to uh Let's go back here. All right, so you can see here, we just looked at operations. I'm gonna just click on here to show you if you just, you just want to look up a procedure. I'm gonna, this is the patient that I'm working on. And here's the patient. So what happens now is that all the procedures that you need to do are on here. If you wanted to do, let's just pull, let's just put the chest tube removal. You click on that, it tells you the indication the patient had a pneumothorax, and then it tells you the preparation. And then it tells you how to do the procedure, step by step. So What, what we've tried to show you here is the fact that the triage system is set up to be user-friendly. And we've got about, we've got about 30 diagnoses that are on here now. And over the next 5 years, we're gonna add those, we're gonna have more diagnoses on there. I showed you a lot of trauma stuff here, uh, but we also have, if you look at it, let's go back to look at diagnosis. I'm gonna go up here with the diagnosis. And I'm going back into here. Let's go down to uh thorax. You can see we have asthma, bronchiolitis, uh, you go up here to ENT, you've got acute otitis, chronic otitis, um, existing tracheostomy, cause there are a lot of chronic kids that you're taking care of and difficulty. So the point is, this is not just a trauma app, it just happens to be that there's information on here that we think would be very useful to you. Um.
Click "Show Transcript" to view the full transcription (16438 characters)
Comments