Trio of Trauma - Journal Club Recap

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Trio of Trauma - Journal Club Recap

The care of trauma patients is constantly evolving. From the time of injury to OR or ICU, there are dozens of management decisions that can improve the care and outcome for your patients. In our most recent journal club we took a look at 3 articles that looked at the management of trauma patients in the ED and ICU. Should we be adding vasopressin to our massive transfusion protocols? Is DL dead for trauma patients? Should we move to use IO’s early in traumatic arrests?

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Is a Bag Enough?

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Is a Bag Enough?

Trauma scene flights are often the first thing people think of when they think of Helicopter EMS. Although we know that HEMS and Critical Care Transport involves much more than just scene flights, they are still a critical part of most HEMS programs’ mission and capabilities. In addition, many flights are “modified scenes” or “scene intercepts,” meaning the HEMS crew meets the EMS crew at an outlying hospital helipad, or arrives shortly after the patient’s arrival to an under-resourced ED. Many of these patients are critically ill, and a subset will require intubation and ventilation. Once intubated is bag valve ventilation enough? Or should all these patient’s be placed on a mechanical ventilator?

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Air Care Series: Ideal Resuscitation Pressure in Polytrauma with TBI

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Air Care Series: Ideal Resuscitation Pressure in Polytrauma with TBI

Damage Control Resuscitation, Permissive Hypotension, Fluid Restrictive Resuscitation… Regardless of name, with all the enthusiasm surrounding permissive hypotension in the actively bleeding trauma patient, what do we do when they have a TBI? Take a dive into the literature surrounding ideal perfusion pressures of patients suffering from TBIs and traumatic injury to find out if we know what pressure is really the best.

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Air Care Orientation Case #1

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Air Care Orientation Case #1

This is Case #1 of our Air Care Orientation Curriculum!  This curriculum is designed to help prepare our rising R2's for their new responsibility as flight physicians.  These cases are discussed amongst our training flight docs and this is the resultant learning points.  In this case, we discuss a sick trauma patient that needs multiple interventions.  But what interventions need to be done?  In what order?  And who should do them?  Read on to find out!

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Pre-Hospital Trauma Care – Lessons Learned From the Front

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Pre-Hospital Trauma Care – Lessons Learned From the Front

The UC Division of EMS has recorded a series of podcasts to celebrate EMS Week 2016.  We are honored to be able to engage EMS Providers throughout the world with this forum.  If you practice pre-hospital medicine, we would like to say thank you and that we appreciate everything you do to provide a high level of care to ill and injured patients in a wide variety of austere environments.  For this podcast, we were joined by Dr. Jay Johannigman, Chief of the Division of Trauma and Critical Care at the University of Cincinnati.  Dr. Johannigman has over thirty years of military experience which includes 6 deployments to Iraq and Afghanistan.  Dr. Johannigman joined us to discuss how the military experience has changed civilian trauma care in the United States.    

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Lessons in Transport - Hypotensive Resuscitation

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Lessons in Transport - Hypotensive Resuscitation

Permissive Hypotensionis also known as hypotensive resuscitation or low volume resuscitation

What is it?

A resuscitation strategy in the critically ill trauma patient (primarily applicable to penetrating trauma but also adapted to blunt trauma) where we allow the systolic BP to remain as low as necessary to avoid exsanguination while still maintaining critical end organ perfusion. (typically defined as appropriate mental status & or the presence of a radial pulse)

The Thought Process:"Don't pop the clot"...

By allowing lower blood pressures we avoid the potential disruption of an unstable fresh clot and thus worsening bleeding caused by higher BP's. 

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Lessons in Transport - The Lethal Triad

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Lessons in Transport - The Lethal Triad

To successfully resuscitate the critically ill trauma patient we must have an understanding of and a respect for the LETHAL TRIAD of TRAUMA...

Bleeding causes acidosis, coagulopathy, and hypothermia... 

Acidosis and hypothermia causes more coagulopathy which causes more bleeding... and so begins a deadly cycle

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Lessons in Transport - TXA has Arrived!!

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Lessons in Transport - TXA has Arrived!!

To successfully resuscitate the critically ill trauma patient we must have an understanding of and a respect for the LETHAL TRIAD of TRAUMA...

Bleeding causes acidosis, coagulopathy, and hypothermia... 

Acidosis and hypothermia causes more coagulopathy which causes more bleeding... and so begins a deadly cycle

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