Tuesday, June 11, 2019

Intubation in Trauma

R.E.B.E.L.EM - By Zaf Qasim - June 10, 2019
... Bring in the New Order!
If anything good has come out of the recent military conflicts, it is our approach to trauma care. We have learnt the benefit of tourniquets and whole blood, and are applying or studying them in civilian practice.
Another important takeaway should be the re-ordering of our approach to resuscitation. Patients who are truly exsanguinating will likely arrest if you attempt to intubate them first. One of the prototypical wartime injuries was the traumatic amputation leading to massive exsanguination. Over time, their management changed and these patients would always have an extremity tourniquet applied before definitive airway management.
This logically leads to the reordering of resuscitation by shifting the initial focus from airway to managing a major insult like this. The ABC mnemonic can be changed to either (C)CAB (Catastrophic hemorrhage; Circulation; Airway; Breathing) or MARCH (Massive hemorrhage; Airway; Respiration; Circulation; Head/Hypothermia)..."