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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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The Third Law Of Trauma

The Trauma Pro

They occasionally crash when we think everything is going so well. Like go to CT, do some more stuff in the ED because that BP cuff just has to be wrong, or call interventional radiology and wait for 45 minutes. Neither can playing around in the resuscitation room, unless the bleeding is spraying you in the face.

Radiology 201
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ToxCard: Iron

EMDocs

Aggressive fluid resuscitation as patients may be severely hypovolemic from GI symptoms. 5 Severe metabolic acidosis persists Multi-system organ failure The endpoints of deferoxamine are less well defined but it can be weaned off as the patient is clinically improving, the anion gap resolves, and down-trending serum iron concentration.

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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.

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

RebelEM

4F-PCC contains factors II, VII, IX, X as well as Proteins S and C. Clinical Take Home Point: In adult patients with trauma at risk of massive transfusion, receiving standard trauma resuscitation management, the addition of 4F-PCC did not result in a decrease in blood product consumption over 24 hours compared to placebo.

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Preperitoneal Packing Vs Angioembolization: Part 2

The Trauma Pro

In the next post, I’ll look at a brand new paper that includes a cost analysis as well. Angioembolization requires the presence of a special interventional radiology team and a reasonably stable patient. The resuscitation equipment is not on par with the OR, and one never knows exactly how long the procedure will last.

Radiology 113
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emDOCs Revamp: Esophageal Perforation

EMDocs

ECG – May show tachycardia or rate related ST depressions Laboratory evaluation: CBC w/ differential – may reveal leukocytosis with left shift CMP, Lipase – can reveal alternative intra-abdominal diagnoses as well as show findings of end-organ hypoperfusion (elevated serum creatinine, transaminitis, etc.)