Emergency Medicine Cases - By Hanton Helman
"Take Home Points for Trauma – The First and Last 15 Minutes Part 1
- Prepare your team, your gear and yourself prior to patient arrival with 4 discussion points, assigning specific gear preparation to specific team members and mental preparation
- Resequence the trauma resuscitation by managing massive external hemorrhage and active/dynamic airway first, then concentrating on hemodynamic optimization before definitive airway management in those patients without active/dynamic airways
- Identify occult shock using shock index >1, delta shock index ≥0.1, the lowest BP recorded, FAST/IVC, a fluid challenge and clinical exam
- Consider the patient’s age, blood pressure medications and baseline blood pressure in assessing for occult shock, interpreting the shock index and in deciding to activate massive transfusion protocol
- Early actions to consider include control of massive external hemorrhage, bilateral finger thoracostomies, pelvic binder, tranexamic acid, activation of massive transfusion protocol and call for help
- Two large bore IVs are the preferred initial access in most trauma patients
- Avoid transferring a patient long distances with IO access only
- Large volumes of crystalloid may lead to the “triangle of death”; your goal should be no crystalloid
- Controlled resuscitation to a target SBP of ≥70 is reasonable in most young, otherwise healthy trauma patients presumed to be in hemorrhagic shock
- Use clinical judgement, mechanism of injury, pitfall conditions, shock index and resuscitation intensity to help in decisions to activate massive transfusion protocol"