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Trauma Resuscitation Updates

RebelEM

CRYSTALLOIDS Too much crystalloid resuscitation in traumatic hemorrhagic shock can increase dilutional coagulopathy, as well as increase morbidity and mortality Bickell WH et al. I recently gave a talk on the initial management of trauma patients with hemorrhagic shock. vs SBP target <90mmHg which resulted in a mortality of 33.4%

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First10EM Journal Club: November 2024

Broome Docs

Early intramuscular adrenaline administration is associated with improved survival from out-of-hospital cardiac arrest. Resuscitation. However, it might be new to your radiology group, so if they are still using oral contrast (with all of its many problems) it might be worth starting a conversation. Resuscitation.

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emDOCs Podcast – Episode 116: Massive Hemoptysis

EMDocs

Resuscitate prior to intubation. TXA administration should not delay other interventions. Bronchoscopy (Pulmonology/critical care): Used in intubated patients, those too unstable for CT despite resuscitation, or if the source of bleeding is not clear despite other imaging (CT). Journal of Vascular and Interventional Radiology.

COPD 81
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ToxCard: Iron

EMDocs

In 1997, the Food and Drug Administration (FDA) mandated unit-dose packaging for all iron-containing products with more than 30 milligrams of elemental iron. Aggressive fluid resuscitation as patients may be severely hypovolemic from GI symptoms. Radiology in the management of acute iron poisoning. Antiemetics as needed.

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REBEL Cast Ep 118: The PROCOAG Trial – 4F-PCC for Trauma Patients?

RebelEM

Interventions such as early application of hemorrhage control, tranexamic acid, reduction of crystalloid fluid administration and balanced ratio blood product transfusion have improved many patients’ outcomes. However, mortality still remains high due to trauma-induced coagulopathy. Severe acute traumatic coagulopathy = PT >1.5

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Major Trauma – Injuries by Assault

Don't Forget the Bubbles

This should include early identification of life-threatening injuries, targeted fluid resuscitation using blood products, pain management, then eventual safeguarding and psychological support. E.g. burns, neurosurgery, interventional radiology. Establish IV access for potential fluid resuscitation. Administer O2 if necessary.

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The Electronic Trauma Flow Sheet: What Does(n’t) Work – Part 1

The Trauma Pro

This stream of information continues after the patient leaves the trauma bay for CT, imaging, interventional radiology, operating room, ICU, or floor bed. Once this occurs, the entire record is suspect and will not represent the true flow of the resuscitation. All of these occur during a relatively brief period of time.