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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% NEJM 1994. [2]

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Imported Malaria

Pediatric EM Morsels

This allowed US hospitals to stock the drug to ensure quick treatment of suspected severe cases, rather than having to ship it from the CDC under the prior expanded-access protocol (Thomas 2023). Higher Rates of Misdiagnosis in Pediatric Patients versus Adults Hospitalized with Imported Malaria. June 28, 2023. J Travel Med.

Seizures 281
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ToxCard: Iron

EMDocs

Stage 3 (timing variable) Shock 1 : Can occur within hours for massive ingestion, but may occur over a longer time course. 6 Severe toxicity and shock are typically seen with serum iron concentrations above 500 g/dL and serum iron concentrations above 1000 g/dL are associated with significant mortality. Manoguerra, A. Erdman, A.

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Trick of Trade: Dual Foley catheter to control massive epistaxis

ALiEM

If left untreated, it can lead to significant blood loss, shock, airway obstruction, and even death. Because he presumably had uremia-induced thrombasthenia (weak platelets), he received blood transfusions and IV TXA. Unfortunately, the bleeding still continued. And still — he continued bleeding heavily.

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Are we on the right TRACT? 

Don't Forget the Bubbles

Let’s take the humble blood transfusion – used in emergency departments across the globe and playing a key role in critical care. Severe anaemia is a common and life-threatening cause of hospital admission in children in sub-Saharan Africa. 8% die in hospital, with a further 12% dying in the six months following discharge.

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Episode 16: “Blood”

PHEM Cast

Prehospital Blood Product Resuscitation for Trauma. Shorter times to packed red blood cell transfusion are associated with decreased risk of death in traumatically injured patients. Prehospital transfusion of plasma and red blood cells in trauma patients. Lots to think about! 2016 Jul;46(1):3–16.

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Episode 21- Updates and Controversies in the Early Management of Sepsis and Septic Shock

EB Medicine

This month, we’ll be talking Updates and Controversies in the Early Management of Sepsis and Septic Shock. For those listening, my hospital probably looks a little bit like yours. Roughly half of in-hospital mortality is associated with septic in some fashion. At our hospital in northern Manhattan they like to breath around 18.

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