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Whole-body computed tomography (CT) for blunt trauma patients is common. Chest CT (CCT) identifies “occult” pneumo- (PTX) and hemothorax (HTX) not seen on chest radiograph (CXR), one-third of whom get chest tubes, while CXR identifies “non-occult” PTX/HTX. To assess chest tube value for occult injury vs. expectant management, we compared output, duration, and length of stay (LOS) for chest tubes placed for occult vs. non-occult (CXR-visible) injury. We compared chest tube output and duration, and patient length of stay for occult vs. non-occult PTX/HTX. This was a retrospective analysis of 5451 consecutive Level I blunt trauma patients, from 2010 to 2013. Of these blunt trauma patients, 402 patients (7.4%) had PTX, HTX or both, and both CXR and CCT. One third (n = 136, 33.8%) had chest tubes placed in 163 hemithoraces (27 bilateral). Non-occult chest tube output for all patients was 1558 ± 1919 cc (n = 54), similar to occult at 1123 ± 1076 cc (n = 109, p = 0.126). Outputs were similar for HTX-only patients, with non-occult (n = 34) at 1917 ± 2130 cc, vs. occult (n = 54) at 1449 ± 1131 cc (p = 0.24). Chest tube duration for all patients was 6.3 ± 4.9 days for non-occult vs. 5.0 ± 3.3 for occult (p = 0.096). LOS was similar between all occult injury patients (n = 46) and non-occult (n = 90, 17.0 ± 15.8 vs. 13.7 ± 11.9 days, p = 0.23). Mature clinical judgment may dictate which patients need chest tubes and explain the similarity between groups.

Whole-body computed tomography (CT) for blunt trauma patients is common. Chest CT (CCT) identifies "occult" pneumo- (PTX) and hemothorax (HTX) not seen on chest radiograph (CXR), one-third of whom get chest tubes, while CXR identifies "non-occult" PTX/HTX. To assess chest tube value for occult injury vs. expectant management, we compared output, duration, and length of stay (LOS) for chest tubes placed for occult vs. non-occult (CXR-visible) injury.We compared chest tube output and duration, and patient length of stay for occult vs. non-occult PTX/HTX. This was a retrospective analysis of 5451 consecutive Level I blunt trauma patients, from 2010 to 2013.Of these blunt trauma patients, 402 patients (7.4%) had PTX, HTX or both, and both CXR and CCT. One third (n = 136, 33.8%) had chest tubes placed in 163 hemithoraces (27 bilateral). Non-occult chest tube output for all patients was 1558 ± 1919 cc (n = 54), similar to occult at 1123 ± 1076 cc (n = 109, p = 0.126). Outputs were similar for HTX-only patients, with non-occult (n = 34) at 1917 ± 2130 cc, vs. occult (n = 54) at 1449 ± 1131 cc (p = 0.24). Chest tube duration for all patients was 6.3 ± 4.9 days for non-occult vs. 5.0 ± 3.3 for occult (p = 0.096). LOS was similar between all occult injury patients (n = 46) and non-occult (n = 90, 17.0 ± 15.8 vs. 13.7 ± 11.9 days, p = 0.23).Mature clinical judgment may dictate which patients need chest tubes and explain the similarity between groups.

History of present illness: A 15-year-old male was transported to the emergency department via ambulance as a trauma activation after being struck by an automobile while jogging. Patient was alert and oriented, with no focal neurological deficits and no loss of consciousness. The patient complained of right eye foreign body sensation. Significant findings: Physical exam was significant for multiple broken teeth, multiple minor abrasions on the face, and fine shards of shattered glass on his face and hair. His right eye had conjunctival injection, with no signs of subconjunctival hemorrhage or ocular penetration. Vision, extraocular movement, and pupillary exam were grossly intact. Fluorescein staining with slit lamp exam with cobalt blue filter examination of the right eye revealed superficial bulbar conjunctival uptake of fluorescein dye staining an area of the conjunctiva inferior to the limbus 5 mm vertical by 2 mm horizontal (estimation by photo provided). No foreign bodies were visualized in the inferior fornix. These findings were consistent with superficial conjunctival abrasion. The exam noted sparing of the corneal epithelium. Discussion: The conjunctiva is a thin, transparent membrane covering the ocular surface from the corneal limbus to the posterior eyelid margin.1 When damaged, the patient will classically have a “foreign body” sensation. It is important to identify the extent of the injury as not extending over the cornea, and also to search for lodged foreign bodies that damage the conjunctiva further with each blink. Classically retained foreign bodies will form a linear and vertical pattern of staining with fluorescein.2,3 Fluorescein stains expose basement membrane and fluoresces bright green under ultraviolet light, thus indicating areas of damage in contrast to its surrounding tissue.4,5 In the setting of acute trauma, urgent Ophthalmologic consultation is indicated if there is anterior chamber hemorrhage, a ruptured or perforated globe, or conjunctival laceration greater than 1cm.6 Most minor mechanical traumas to the conjunctiva have an excellent prognosis and can be handled in the emergency department with outpatient treatment with antibiotic drops or ointment.

Introduction: Bystander CPR is uncommonly performed in out-of-hospital cardiac arrest patients transported to our ED. Previous studies suggest adults without formal CPR training can retain compression-only CPR skills with a single viewing of a 60 second, AHA training video. We sought to determine the impact of viewing this video on the willingness of ED patients and their companions to perform compression-only CPR. Hypothesis: Watching a 60 second AHA CPR training video is associated with a 10% increase in willingness to perform CPR. Methods: A convenience sample of adults age 18-70 from two urban, academic EDs with socioeconomically diverse patient populations was recruited. Patients in hallways and non-english speakers were excluded. Subjects were asked to complete a pre-video survey to assess baseline knowledge and willingness to perform CPR on a stranger and on family/friends, watch a 60 second, previously validated AHA CPR instructional video, and then complete a post-training CPR survey. Willingness was scored as 1 (not at all likely) to 5 (extremely likely). An answer of 4 or 5 was considered “willing to perform CPR”. A sample size of 110 subjects from each hospital was determined necessary to detect at 10% absolute difference assuming 0.80 power and one-sided alpha level of 0.05. Sign and McNemar's tests were used to compare pre and post video measurements. Results: Between 1/1/15 to 6/7/15, 281 patients and their companions were approached about study participation, of which 229 (82%) consented; complete data were available for 216 subjects. Subjects were mean age 47, 66% female, 68% black, and 69% college educated. After watching the video, willingness to perform CPR on a stranger increased by 29%, from 57% to 86% (p< 0.001). Willingness to perform CPR on family/friends increased by 19%, from 75% to 94% (p Conclusion: In adult patients and their companions in two diverse, academic EDs, watching a 60 second CPR training video was associated with a significant absolute increase in willingness to perform compression-only CPR on a stranger (29%) and on family/friends (19%).

Introduction: Bystander CPR is uncommonly performed in out of hospital cardiac arrest patients transported to our Emergency Department (ED). ED visits are brief and complex, but represent a valuable opportunity to teach CPR to members of our community. Our objective was to determine what percentage of ED patients and their companions are willing to learn compression-only CPR. Hypothesis: The majority of ED patients and their companions are willing to learn compression-only CPR. Methods: A convenience sample of clinically stable adults age 18-70 from two urban, academic EDs with socioeconomically diverse patient populations was recruited. Patients in hallways and non-english speakers were excluded. Subjects were asked to complete a pre-video survey to assess baseline knowledge and willingness to perform CPR, watch a 60-second previously validated CPR instructional video, and then complete a post-training CPR survey. Consenting patients were asked if they thought their ED visit was related to their heart. All study subjects were categorized as: 1. patient or companion, and 2. cardiovascular or non-cardiovascular complaint. Subjects who did not consent were asked to share reasons for not participating. Data were entered into a REDCap database. Results: Between 1/1/15 to 6/7/15, 281 patients and their companions were approached about study participation. Mean age was 47, 66% female, 68% African American, and 69% had a college education. 73 believed their visit was related to their heart. 70% were patients, and the remainder were their companions. Overall, 229 (82%) were willing to learn compression-only CPR. 51 of 52 shared reasons for not participating. Reasons included: not feeling well (29%), already CPR trained (16%), and not interested (16%). Patients who thought their ED visit was related to their heart and their companions were equally likely to participate than those who did not (80% vs 83%). Conclusion: In two diverse, academic EDs, 82% of medically stable adult patients and their companions were willing to learn compression-only CPR.