Trauma

The First and Last 15 Minutes Part 1

emDocs - October 4, 2019 By Helman A

Originally published at EM Cases – Visit to listen to accompanying podcast

"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"

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The First and Last 15 Minutes Part 2

emDocs - October 11, 2019 - By Helman A

Originally published at EM Cases – Visit to listen to accompanying podcast

"In this podcast we answer questions such as: What should your resuscitation targets be in the first 15 minutes for trauma patients with hemorrhagic shock, neurogenic shock, severe head injury? When is a pelvic binder indicated? Is a bedsheet good enough? What are the most common pitfalls in binding the pelvis? What are the best ways to maintain team situational awareness during a trauma resuscitation? Should we rethink patient positioning for the trauma patient? What are the indications for transport to a trauma center? What is the minimal data set required before transfer? Which patients require a pelvic x-ray prior to transfer to a trauma center? What are the key elements of a transport checklist? What does the future hold for trauma care and many more…"