Tamingthesru
A Crack in the Ice? An In-Depth Breakdown of the TTM Trial
Like many other Emergency Medicine residencies, we took the time in our last Journal Club to break down the Targeted Temperature Management Article. There is tons out there in the #FOAMed space about this trial. And, one of our 4th year residents, Dr. Trent Wray, took some extra time to break down the article in gory detail and put it into the context of the previously published literature.
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.
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