Emergency medicine clinics of North America
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Procedures such as central access and tube thoracostomy are integral in the care of the injured patient. However, both increasing life span and patient complexity of comorbidities can hinder procedural success. ⋯ From anatomy to pain control to postprocedural management, this article will be the building block for technical success. Understanding what you are doing and careful planning ahead are now more than ever crucial to patient care.
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Emerg. Med. Clin. North Am. · Feb 2023
ReviewProtect That Neck! Management of Blunt and Penetrating Neck Trauma.
Blunt and penetrating vascular injuries to the neck represent a significant burden of mortality and disability among trauma patients. Blunt cerebrovascular injury can present with signs of stroke either immediately or in a delayed fashion. ⋯ In contrast, for patients presenting with penetrating neck injuries, assessment for hard signs of vascular and aerodigestive injury should be done and prompt emergent surgical consultation if present. Overall management priorities for penetrating neck injuries focus on airway management, hemorrhage control, and damage control resuscitation before definitive surgical repair.
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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.