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We have mentioned the Glasgow Coma Scale in multiple delicious morsels: Minor closed headinjuries in <3 month olds and in the rebaked morsel , Blunt cerebrovascular injury , Cerebral edema in DKA , Pediatric Trauma Pitfalls , and Carbon monoxide poisoning.
I recently gave a talk on the initial management of trauma patients with hemorrhagic shock. Ann Emerg Med 2017 [6] This was a retrospective database review of 7521 traumatic brain injury patients SBP target ≥90mmHg resulted in a mortality of 7.8% vs SBP target <90mmHg which resulted in a mortality of 33.4% NEJM 1994. [2]
In the context of a child with a headinjury- what was the best GCS/ GCS on arrival of the crew? E: Exposure and Environmental Control: Fully expose to check for other life-threatening injuries while maintaining normothermia. In addition, consider if there are any signs of injury with ENT, neurological or respiratory symptoms.
This work comes from the Shock Trauma Center in Baltimore and is a follow on to a paper published in the New England Journal of Medicine earlier this year. Our orthopedic surgery colleagues have been trying to use aspirin for venous thromboembolism (VTE) prophylaxis for decades.
Barbara Haas, Dr. Camilla Wong and Dr. Bourke Tillman answer questions such as: why are older patients under-triaged to trauma centers and how does that affect outcomes? What is the utility of the Shock Index in older patients? Which older patients do not require head or c-spine imaging after a ground level fall? and many more.
4] We also know that severe TBI is commonly associated with the development of intracranial hemorrhage where the presence and volume of blood are associated with increased mortality and poor outcomes.[5] Association between prehospital tranexamic acid administration and outcomes of severe traumatic brain injury. JAMA Neurol.
Military practice guidelines recommend REBOA for profound shock (SBP <90mmHg) 1 and ACEP along with the American College of surgeons recommend REBOA for traumatic life-threatening hemorrhage below the diaphragm in patients with hemorrhagic shock who are unresponsive or transiently responsive to resuscitation.
Whilst you were busy managing headinjuries and drownings, Ranulf had been out with a group of boys from school this evening. Ranulf went white with the shock. The primary outcome measure was chest drain failure, i.e., retained haemothorax requiring a secondary interventional procedure. J Pediatr Surg.
Be aware that later stages of malrotation may present as shock – they present in hypovolemic shock due to third-spacing from necrotic bowel and/or septic shock from translocation or perforation. Abusive headinjury is the most common cause of death from child abuse. Louwers et al. J Emerg Med. 2002; 141(6):793-7.
Flooding him with crystalloid is going to dilute his clotting factors, make him hypothermic and potentially worsen outcomes. Check his pupils – any signs of headinjury or subdural from flying debris? Our patient will need adequate pre-oxygenation with a bag-mask valve- be aware that not all bag-masks are the same!
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