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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. NEJM 1994. [2] NEJM 1994. [2]

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Early Vs Delayed Thoracic Endovascular Repair

The Trauma Pro

At the time, there was a debate about whether the procedure should be done immediately versus waiting until the patient was well-resuscitated. The mortality trends do not appear to be related to injury grade, overall injury severity, or the presence of head injury.

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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. Establish IV access for potential fluid resuscitation. You feel the patient needs fluid resuscitation.

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Grand Rounds Recap 11.15.23

Taming the SRU

r4 case follow-up WITH DR. milligan CC: Found down The case: A young F was found down in a snow bank after a GSW to the head. She presented with a core temp of 30C and her CT scan did not show a devastating head injury as was expected. EMS had reported she had coded en route. She regained pulses with warming on arrival.

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REBEL Cast Ep122 – Delayed vs Rapid Sequence Intubation in Agitated Trauma Patients

RebelEM

The potential for soiled airways, cervical spine injuries, maxillofacial injuries and head injuries combined with agitation/delirium, altered mental status and hypoxemia can make securing a definitive airway both an anatomic and physiologic challenge. that would not be possible in an agitated/combative patient.

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UK-REBOA on Trial: Innovative or Over-Inflated?

RebelEM

Early expeditious definitive hemorrhage control is a major focus in trauma resuscitation. Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma Patients With Exsanguinating Hemorrhage: The UK-REBOA Randomized Clinical Trial [published online ahead of print, 2023 Oct 12].

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Penetrating chest trauma

Don't Forget the Bubbles

Whilst you were busy managing head injuries and drownings, Ranulf had been out with a group of boys from school this evening. In addition, a flimsy cannula is easily dislodged during ongoing resuscitation and easily clots off. Significantly more patients achieved haemostasis in the balanced ratio group ( 86% vs 78% p =.006),