Emergency medicine clinics of North America
-
Shock is a life-threatening condition of circulatory failure leading to inadequate organ perfusion and tissue oxygenation. In a trauma patient, shock may be due to hypovolemia, cardiogenic, obstructive or distributive causes individually or in combination. The physiological response to major hemorrhage is dependent on a variety of autonomic reflexes, mechanism of injury, bleeding source, and baseline physiology of the patient. This article discusses the common causes of shock and the accompanying physiology, how clinical assessment can support the diagnosis and effective treatment of shock, and the common pitfalls in trauma patients.
-
Emerg. Med. Clin. North Am. · Feb 2023
ReviewResuscitative Endovascular Balloon Occlusion of the Aorta: A Practical Review.
Hemorrhage, in particular, noncompressible torso hemorrhage, remains a significant contributor to mortality in trauma cases. Despite many advances in resuscitation, noncompressible sites of bleeding have presented a particular challenge. ⋯ Although the technique is relatively straight-forward, it carries significant risk, in particular, from ischemia due to aortic occlusion. This article describes the role and considerations for the use of REBOA in the critically injured patient.
-
Traumatic brain injury (TBI) continues to be a leading cause of morbidity and mortality worldwide with older adults having the highest rate of hospitalizations and deaths. Management in the acute phase is focused on preventing secondary neurologic injury from hypoxia, hypocapnia, hypotension, and elevated intracranial pressure. Recent studies on tranexamic acid and continuous hypertonic saline infusion have not found any difference in neurologic outcomes. Care must be taken in prognosticating TBI outcomes, as recovery of consciousness and orientation has been observed up to 12 months after injury.
-
The utilization of extracorporeal membrane oxygenation (ECMO) in trauma mirrors wider trends toward increased utilization of ECMO throughout various forms of critical illness. ECMO can safely be performed on trauma patients with or without anticoagulation. ⋯ A sound understanding of the ECMO circuit components can help troubleshoot system malfunctions. Emerging technologies may combine extracorporeal circulatory support with endovascular hemorrhage control to prolong the viable survival of exsanguinating patients.
-
Emerg. Med. Clin. North Am. · Feb 2023
ReviewTrauma in the Aging Population: Geriatric Trauma Pearls.
The relative proportion of trauma patients who are older adults continues to rise as the population ages. Older adults who experience trauma have unique needs compared with their younger counterparts. ⋯ This article reviews the most important aspects of geriatric trauma care. We focus on presentation and initial resuscitation, triage guidelines and the issue of undertriage, the importance of multidisciplinary and specialized geriatric care, and common injuries and their management.