Management of the crashing trauma patient can be hectic and challenging. The primary role of the traumatologist is to create a calm environment in the trauma bay in order to effectively designate roles and provide cohesive, structured care. Preparing the trauma team prior to arrival can be helpful in order to obtain appropriate equipment, including an airway cart, RSI drugs, tube thoracostomy, ED thoracotomy tray, or a Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) catheter. Managing the room and all members of the trauma team can be difficult, but can often make a sloppy and potentially unsuccessful resuscitation more organized. As the Boy Scouts of America motto states,…
So what do we do in that first hour?
Dr. Dave MacKinnon and Dr. Mike Brzozowski go through key management strategies and controversies surrounding head, neck, chest, abdominal, pelvic and extremity trauma, followed by a discussion on how best to prepare the trauma patient for transfer to a trauma centre. They end the Trauma Pearls & Pitfalls podcast with a great rant about ‘pan-scanning’ the multi-trauma patient.
Sadly, the senseless death of a young man is a familiar story, another entry in the ledger of senseless deaths and tragedies that make up the ambient reality of work in a trauma center.
TXA has been widely adopted as an effective drug for improving outcomes of patients who are bleeding from a variety of sources, even though many of the trials’ conclusions are contentious.
BCI can be excluded in a patient without EKG abnormalities and a negative troponin.
Bruised and broken hearts: diagnosis and management of blunt cardiac injury...
Archives for various trauma presentations
This emDocs series will provide you with regular tips and must-know items for EM boards and inservice. Each post will feature several key takeaways on a specific organ system.
Barbara Haas, Bourke Tillmann, Camilla Wong and Anton discussed the problem of under-triaging geriatric trauma patients, resuscitation and airway considerations, common injury patterns in the geriatric trauma patient, lab work, head and c-spine imaging, clearing the c-spine in geriatric trauma patients and resuming anticoagulation after minor head injury in the geriatric trauma patient.
Reduce and splint immediately if neurovascular compromise is present,
Assess for compartment syndrome (present in 9% of open fractures) by looking for severe pain, decreased sensation, pain with passive stretch of fingers or toes.
As with all critical patients, the first step is airway management. Care should be taken and best practices should be followed to allow for first pass success including preoxygenation if possible to avoid desaturation. Resuscitation before intubation if possible is important. The appropriate induction agent is of vital importance. Ketamine is associated with the most neutral hemodynamic properties, and it is also the ideal agent for head injured patients. By maintaining hemodynamic stability and its dissociative properties, it is useful to blunt the response to laryngoscopy. Fentanyl is another option as well at doses 3-5 mcg/kg IV.
Blood pressure may not be your best indicator! Look at Cap Refill!
Trauma is the most common cause of non-obstetrical maternal death in the United States, and is estimated to complicate 1 in 12 pregnancies. Blunt trauma is most common, with motor-vehicle accidents, assaults – often a result of intimate partner violence – and falls being the most common mechanisms.
Abdominal-pelvic trauma remains the leading cause of morbidity and mortality in both children and adults aged 15-44 in the western world. Hemorrhagic shock must be assumed in patients presenting with hemodynamic instability after trauma until proven otherwise. A focused and expeditious workup must take place to identify the source of hemorrhage to provide definitive management.
Unfortunately, in the melee of an emergency, the people responsible for patient care tend to focus on obvious injury and lose sight of the big picture. It is important to have a systematic way to approach trauma patients, to ensure that nothing is missed.
Physicians often rely on more advanced imaging to evaluate for dangerous injuries in trauma, such as CT. This test is sensitive and rapid for detecting injuries. CT use has increased in trauma, and use of whole-body CT (WBCT) is commonly used to assess for traumatic injuries.
Falls come in all shapes and sizes, especially with trauma. This post will cover falls in special populations, including the elderly, intoxicated patients, and falls from extreme height.
Most commonly the right ventricle or right atrium are involved. Sternal fracture alone does not predict BCI.
Your trauma patient from Trauma Tribulation 013 has arrived… A trauma call was activated and the team assembled. The patient was transferred onto a bed in the trauma bay, and removed from a spinal board used fro transfer. Handover and vital signs are being obtained as the trauma team get to work.
As the Trauma Team Leader, you’re going to need to know your stuff to be able to coordinate the team’s initial assessment and management of this trauma patient.
Management of the crashing trauma patient can be hectic and challenging. ..
In this episode we review the "lethal 6" and "hidden 6" chest injuries that comprise the deadly dozen of thoracic trauma. Mechanism of injury together with vital signs and findings from the physical exam should provide us with the data needed to identify life-threatening thoracic injuries on our primary survey. For hidden injuries, the diagnostic adjuncts required to identify these injuries are also discussed.
Peer-reviewed simulation cases for Emergency Medicine programs available in FOAMed spirit.
The journal gives particular emphasis to papers that integrate the findings of academic research into realities of clinical practice in the following areas:
JETS encourages research, education and dissemination of knowledge in the fields of Emergency Medicine, Traumatolgy and Shock Resuscitation thus promoting translational research by striking a synergy between basic science, clinical medicine and global health.
Place a pelvic binder on the stretcher before the patient arrives and and secure it on the patient ASAP, before imaging, if they are hemodynamically unstable without an obvious cause; but don’t forget to shoot a pelvic x-ray soon thereafter in case the binder has not fully reduced the fracture.
To secure a chest tube to the chest wall quickly and easily, use the ETT holder as a temporary measure.