Remove Blood Transfusions Remove Resuscitation Remove Wellness
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Jehovah’s Witnesses And Blood Transfusion Demystified

The Trauma Pro

Pack well, close and re-establish normal physiology before doing all the final repairs. Use direct pressure or direct suture ligation for external bleeding. Splint to reduce fracture bleeding. Aggressively use damage control surgery. Don’t go for a definitive laparotomy which may take hours. Always watch the temperature. Keep the OR hot.

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EM@3AM: Amniotic Fluid Embolism

EMDocs

The newborn is doing well, but the mother is complaining of shortness of breath and chest pain. A 37-year-old G5P4 at 33 weeks presents to the ED after being brought in by ambulance. She had a precipitous delivery while the ambulance was pulling in. Triage vital signs (VS) include BP 88/45, HR 121, T 97.1, RR 28, SpO2 89% on 6L NC.

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Best Of AAST #7: How Do You Like Your Platelets – Warm Or Cold?

The Trauma Pro

Until the last few years, massive transfusion in trauma consisted of component therapy, an admixture of packed red cells, plasma, and platelets. Whole blood transfusion is making inroads again, but it is used in a minority of centers. Reference: An analysis of the use of cold-stored platelets in combat trauma.

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The Latest in Critical Care, 11/6/23 (Issue #19)

PulmCCM

Intuitively, plasma seemed even less likely to help the very sickest of the sick— those mechanically ventilated with ARDS from Covid-19, whose mortality rate was well over 50% at many centers. This can interrupt massive blood loss and buy time for potentially life-saving damage control surgery. Only it turns out, it did help.

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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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emDOCs Podcast – Episode 84: Capnography

EMDocs

2019 American Heart Association Focused Update on Advanced Cardiovascular Life Support: Use of Advanced Airways, Vasopressors, and Extracorporeal Cardiopulmonary Resuscitation During Cardiac Arrest: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation.

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A Beginner’s Guide to Vasoactive Drug use in Children with Septic Shock

Don't Forget the Bubbles

Four-year-old Ed is being resuscitated for presumed Invasive Group A Streptococcal Sepsis from tonsilitis. Obviously, one also needs to address the cause of the shock, or any efforts in resuscitation will only bring a temporary improvement. This works well for a while, but eventually, the heart beats too fast to fill adequately.

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