https://statstitch.etsy.com

STAT Stitch clothing is now here. The wait is over. We finally made shirts and sweatshirts for us.

Not covered in flowers. Not wrapped in hearts. Not pretending the Emergency Department is a soft, quiet place.

These are shirts for ER nurses, trauma junkies, night shifters, fast-track warriors, and yes—Murses.

This episode marks the official launch of our apparel line built from the same culture this podcast lives in: controlled chaos, dark humor, competence under pressure, and the unspoken bond that forms when you’ve held the line at 0300 with no chair, no breaks, and no margin for error.

These aren’t novelty shirts you wear once and forget. They’re conversation-starter shirts. The kind that get a nod from another nurse in the elevator. The kind that make an attending smirk. The kind a medic reads and says, “Yeah… that tracks.”

Some designs are clean and professional—shirts you can wear under a jacket, to class, or into the hospital without looking like a walking meme. Others lean into the humor of ER life: the rapid pace, the gallows laughs, the “kept them alive till shift change” energy that only people in emergency medicine truly understand.

This drop is about reclaiming ER nursing culture. About wearing something that actually reflects what we do. About finally having gear that doesn’t pretend we’re delicate—but still respects the professionalism of the job.

And just as important: every shirt supports the podcast. This show exists to teach, educate, and talk honestly about emergency medicine—from real clinical lessons to the stuff nobody puts in textbooks. If you’ve learned something here, laughed here, or felt seen here, this is one way to keep it going.

So whether you’re a new grad trying to find your footing, a seasoned trauma nurse who’s seen everything, or a Murse who’s tired of shopping the “women’s tee” section—this one’s for you.

Grab your stuff. Report’s been given. We’ve got work to do.

Shirts and sweatshirts are live now.

And go checkout DudeRNCreations on Etsy to shop his products mentioned in the episode like the SYRINGE SOCKET

Developed by the American College of Surgeons Committee on Trauma following a 1976 plane crash that highlighted deficiencies in trauma care, the course is now a global standard used in over 60 countries. The core philosophy involves treating the greatest threat to life first, not allowing a lack of definitive diagnosis to delay treatment, and recognizing that a detailed history is not essential to begin evaluation.

Initial Assessment and Primary Survey The hallmark of ATLS is the primary survey, structured around the ABCDE mnemonic:

• Airway: Assessment of patency while strictly maintaining cervical spine motion restriction. A definitive airway (cuffed tube in the trachea) is required for patients with airway compromise or a Glasgow Coma Scale (GCS) score of 8 or lower.

• Breathing: Identification and immediate management of life-threatening thoracic injuries, such as tension pneumothorax, open pneumothorax, and massive hemothorax.

• Circulation: Recognition of shock, predominately hemorrhagic in trauma. Management focuses on stopping the bleeding and restoring volume. Hypotension is considered hypovolemic until proven otherwise. Fluid resuscitation begins with isotonic crystalloids, moving to blood products for transient or non-responders.

• Disability: A rapid neurologic evaluation using GCS and pupillary response to establish a baseline.

• Exposure: Complete removal of clothing to identify all injuries while preventing hypothermia.

Secondary Survey and Specific Injuries Following the stabilization of vital functions, a detailed head-to-toe secondary survey is performed.

• Head and Spine: The primary goal in traumatic brain injury is preventing secondary brain injury caused by hypotension and hypoxia. Spinal motion is restricted until injury is excluded via clinical rules (NEXUS, Canadian C-Spine) or imaging.

• Abdomen and Pelvis: Unrecognized hemorrhage is a major cause of preventable death. Diagnostic adjuncts include Focused Assessment with Sonography for Trauma (FAST), Diagnostic Peritoneal Lavage (DPL), and CT scans. Unstable pelvic fractures require mechanical stabilization, such as a pelvic binder, to limit hemorrhage.

• Musculoskeletal: Limb-threatening injuries, such as vascular compromise, compartment syndrome, and open fractures, must be identified early. Compartment syndrome is a clinical diagnosis requiring immediate surgical intervention.

• Thermal Injuries: Management involves stopping the burning process and fluid resuscitation. The Parkland formula has been updated to a consensus formula starting at 2 mL/kg/%TBSA for adults to prevent over-resuscitation.

Special Populations and Logistics

• Pediatric: Children have unique anatomical characteristics and physiological reserves. A length-based resuscitation tape (Broselow) helps determine weight-based equipment sizes and drug doses.

• Geriatric: Comorbidities and medications, such as anticoagulants and beta-blockers, alter the physiological response to injury, often masking shock.

• Pregnancy: Treatment involves two patients; optimal fetal outcome depends on aggressive maternal resuscitation. The uterus should be displaced to the left to relieve vena cava compression..

Epidemiology and Unique Characteristics Injury is the leading cause of death and disability in children, surpassing all major diseases. While management priorities (ABCDEs) mirror those of adults, pediatric care requires adjustments for unique anatomy and physiology. Children have a smaller body mass, meaning impact forces are applied per smaller unit of body area, often damaging multiple organs. Their skeletons are incompletely calcified and pliable; consequently, internal organ damage, such as pulmonary contusion, can occur without overlying bone fractures. Additionally, a child's disproportionately large head increases the frequency of blunt brain injuries. The high ratio of body surface area to mass makes children highly susceptible to hypothermia, which can complicate resuscitation.

Airway and Breathing Anatomical differences dictate airway management. The large occiput causes passive flexion of the cervical spine, potentially buckling the airway; therefore, the midface must be maintained parallel to the spine board (neutral position) rather than the "sniffing" position used in adults. Because the infant trachea is short (approx. 5 cm), tube dislodgment and right mainstem intubation are significant risks. Clinicians should use the mnemonic "Don't be a DOPE" (Dislodgment, Obstruction, Pneumothorax, Equipment failure) to troubleshoot deterioration in intubated patients. In breathing assessment, the mobility of mediastinal structures makes children particularly prone to tension pneumothorax.

Circulation and Shock Recognizing shock in children is challenging due to their increased physiologic reserve. A child can maintain a normal systolic blood pressure despite losing up to 30% of their circulating blood volume. Hypotension is a late, ominous sign of decompensated shock involving >45% volume loss. Early signs of hypovolemia include tachycardia, skin mottling, and weakened peripheral pulses rather than blood pressure drops.

Fluid resuscitation is weight-based. If weight is unknown, a length-based resuscitation tape (e.g., Broselow) is essential for estimating medication doses and equipment sizes. Venous access can be difficult; if peripheral attempts fail, intraosseous (IO) infusion is the preferred alternative. Current protocols suggest an initial bolus of 20 mL/kg of warmed isotonic crystalloid. However, strategies are shifting toward "damage control resuscitation" using balanced blood products early for those with severe hemorrhagic shock.

Head, Spine, and Abdomen Children are susceptible to secondary brain injury caused by hypovolemia and hypoxia. However, because of the long-term cancer risks associated with ionizing radiation, CT scans should be used selectively, guided by clinical decision rules like PECARN, rather than routinely. Regarding the spine, "SCIWORA" (Spinal Cord Injury Without Radiographic Abnormalities) is common; a normal x-ray does not rule out spinal cord injury. In abdominal trauma, gastric decompression is critical as swallowed air can mimic distension. Most hemodynamically normal children with solid organ injuries are managed non-operatively.

Maltreatment Non-accidental trauma is a leading cause of infant homicide. Clinicians must identify red flags, such as history inconsistent with the injury, delays in seeking care, retinal hemorrhages, or fractures in children too young to walk.

Analogy: Think of a child's cardiovascular system like a modern lithium-ion battery, while an adult's is like an old flashlight battery. An old flashlight battery dims gradually as it loses power (adults show dropping blood pressure as they lose blood). A lithium battery provides consistent, strong output until it is nearly empty, then shuts down abruptly and completely.