Remove 2015 Remove Fractures Remove Shock
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Preperitoneal Packing Vs Angioembolization: Part 1

The Trauma Pro

In this series, I will review the two major techniques for addressing troublesome bleeding from pelvic fractures. A multi-center trial published in 2015 showed an astounding 32% mortality rate for patients with shock from pelvic fracture. As I continue to preach, going anywhere but the OR is dangerous for the patient.

Fractures 147
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IVC Distensibility Index vs Collapsibility Index: Using the Correct Index

RebelEM

13 That is to say nothing of the effect that the type and response to shock has on the individual patients involved in these studies. just be careful with pelvic fractures or any femoral arterial punctures/ devices. Jan 2015; PMID: 25559473 Airapetian N, et al. Nov 2015; PMID: 26563768 Yartsev, Alex. Echocardiogr.

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Trauma Resuscitation Updates

RebelEM

I recently gave a talk on the initial management of trauma patients with hemorrhagic shock. Clinical Take Home Point: In patients with TBI and hypovolemic shock, target a SBP or MAP ≥90mmHg, but know this is based on limited evidence. vs SBP target <90mmHg which resulted in a mortality of 33.4%

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Publication Bias and Therapeutic Fashion

Sensible Medicine

CAST shocked the world of cardiology because suppression of rhythm disturbances after MI had been an accepted practice. Some things will surely hold up: PCI for MI, fixing displaced fractures, antibiotics for bacterial infection, and of course, caring and empathy. Anti-arrhythmic drugs killed 1 patient for every 29 we treated.

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Don’t Forget About the IO in the Critically Ill Patient

RebelEM

In these situations, the American Heart Association (AHA) and the European Resuscitation Council (ERC) of 2015 recommend the intraosseous (IO) route after the peripheral route and before the central venous route ( 1). 2015 PMID: 25768683 8 Leidel BA. This can often lead to significant delays in proper resuscitation. Trauma 1996.

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London HEMS pre-hospital REBOA video

ETM Course

Resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct for hemorrhagic shock. Intra-Aortic Balloon Occlusion to Salvage Patients with Life-Threatening Hemorrhagic Shocks from Pelvic Fractures J Trauma 2010; 68(4): 942–8 (full article free text) 3. J Trauma Acute Care Surg 2015 Apr;78(4):721-8 4.

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Tranq dope (fentanyl-xylazine combination): A new horizon in opioid withdrawal treatment

ALiEM

A trans-esophageal echocardiogram showed a normal ejection fracture, normal right ventricular function, and no vegetations. 2015 Apr 28;313(16):1636-44. Evaluation for nephrotic syndrome due to viral hepatitis, endocarditis, venous thromboembolism or other cause of chronic lymphedema is reasonable.