Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · Feb 2023
ReviewMassive Hemorrhage Protocol: A Practical Approach to the Bleeding Trauma Patient.
Damage-control resuscitation is the standard of care for the hemorrhaging trauma patient. This approach combines rapid hemostasis and early-ratio-based blood product administration. ⋯ Emerging evidence supports that this includes more than blood product administration alone but rather a comprehensive suite of treatments. In this article, we review the existing evidence and provide a pragmatic framework, the 7 Ts of massive hemorrhage protocol, to guide the care of patients with life-threatening traumatic hemorrhage.
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Bedside ultrasound assessment has become a routine aspect of care in trauma resuscitation and the critical care setting. Although early research was focused on its role in blunt trauma, it has shown utility in the assessment of penetrating trauma by rapidly identifying hemopericardium and facilitating appropriate intraoperative management. ⋯ The Rapid Ultrasound in Shock and Hypotension and the Focused Rapid Echocardiographic Examination can diagnose etiologies of shock and guide resuscitation in the critically ill patient. Finally, the role of transesophageal echocardiography is expanding in the trauma setting as more research emerges.
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Emerg. Med. Clin. North Am. · Feb 2023
ReviewIntimate Partner Violence and Human Trafficking: Trauma We May Not Identify.
Intimate partner violence and human trafficking commonly affect patients presenting to the emergency department including the trauma bay. Although these forms of violence and exploitation are not always the underlying cause of that particular emergency department encounter, screening is important regardless of the presenting condition because this presentation may be the only opportunity to receive help and ultimately plants the seed for future access to help regardless of what a patient chooses to do following this first encounter. There are important medical care considerations in these patients beyond trauma bay procedures that can make the difference in saving a life.
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Airway injury, be that penetrating or blunt, is a high-stakes high-stress management challenge for any airway manager and their team. Penetrating and blunt airway injury vary in injury patterns requiring prepracticed skills and protocols coordinating care between specialties. Variables including patient cooperation, coexisting injuries, cardiorespiratory stability, care location (remote vs tertiary care center), and anticipated course of airway injury (eg, oxygenating well and comfortable vs increasing subcutaneous emphysema) all play a role in determining airway if and when airway management is required. Direct airway trauma is relatively infrequent, but its presence should be accompanied by in-person or virtual otolaryngology support.
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Although resuscitation in trauma requires a multidisciplinary and multifaceted approach, one of the Big Five procedures may need to be performed as lifesaving and improving intervention. Your patient's lives depend on understanding, timing, and techniques of these elusive and difficult-to-master procedures. ⋯ Prepare the team, system, and yourself when performing any of these procedures. It is important to be facile with your equipment and familiar with the steps to maximize success.