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Whole Blood - More than the Sum of Its Components?
Q: For a patient in hemorrhagic shock from acute blood loss, what is the best resuscitative fluid?
A: If they've lost blood, give them blood.
It's never quite that simple though right? For a generation now, we have practiced primarily by transfusing patient's with acute blood loss varying ratios of blood product components. Thanks to the PROPPR trial, we most recently arrived on a generally accepted ratio of 1:1:1 for Plasma, Platelets, and Red Blood Cells for severely injured bleeding trauma patients. Recent military literature however, suggests that there may be another strategy (which is in and of itself a bit of a throwback) that could offer additional benefits over a component transfusion strategy. If were are trying to recreate a whole blood with a 1:1:1 plasma:platetel:PRBC ratio, why not just give whole blood?
A Pain in the Neck
There are some areas in our practice where the literature grants us a somewhat sure path forward in the evaluation of our patients. The decision whether or not to pursue cervical spine imaging studies following a traumatic mechanism of injury is one of these areas. The NEXUS criteria and Canadian C-Spine Rule are useful guides for the evaluation of these patients. What comes after the imaging can be a bit more challenging. What do we do with patients who have persistent pain but negative imaging? To what extent do we pursue the possibility of a ligamentous injury? Must we wait for all patients to be sober so that we can "clinically clear" them in addition to our radiographic clearance. The 3 articles below seek to answer some of these challenging questions. Take a listen to the podcast and read the summaries to familiarize yourself with some of the latest literature addressing these challenging patient care scenarios.
The Future of Airway Management?
What is the future of airway management in the ED? How can we make our practice more effective and more efficient? In this journal club recap, we focus on 2 topics emerging in the literature - flush rate O2 for pre-oxygenation and head of bed elevation during intubation.