The Surge: Surgery. Trauma. Critical Care

Just a brief review of the literature. 

Key Questions. 

What populations?

What are the risks?

Heparin ? 

#trauma #ECMO #surgery #CRITICALcare #ICU #MEDED #FOAMED #Emergencymedicine #ECLS

Second part of our review on communication during high stress, time sensitive codes. Focus is on Training the team and team dynamics as well as how to build a resus simulator for 140 dollars!!!!!! 

 

The last time we accepted the fact that every now and then your ability to communicate during a code will be tested and that by definition if you work in an acute care environment ..... chaos is part of the game. 

 

 

#simulation #FOAMED #TRAUMA #ICU #CRITICALCARE #EMERGENCYMEDICINE #codeblue #CPR #communication #EMT #Nursing

This Episode addresses what you can do to communicate better during noisy and chaotic code blues, resuscitations and trauma codes where things just aren't going right. 

Ever wondered how to set up for an intubation in low light?

or in a car crash.?

Maybe on an ambulance where you have to be seated ?

This is todays topic.

Intubation on the field.

#Airway #intubation #icu #ems #fieldtransport #medic #criticalcare #emergency airtrainsport #emergencymedicine

How good are you at rounding?

How could you making it better?

Whats in your ICU rounding checklist?

My own checklist.

Selected References:

The JAMA paper.

The Attitudes at Rounds paper.

The exploirative discriptive paper.

The two Cochrane Reviews:

https://www.ncbi.nlm.nih.gov/pubmed/10796485

https://www.ncbi.nlm.nih.gov/pubmed/19588316

The Diffusion of Evidence Based Practice statewide paper. 

The checklist paper. 

The computer bsed decision making algorithim paper. 

What is Massive Transfusion?

What's in an MTP?

When to Trigger? 

What's in the box?

New trends and controversies. 

When to halt your MTP. 

 

Selected References:

Early high ratio platelet transfusion in trauma resuscitation and its outcomes.

Trauma resuscitation requiring massive transfusion: a descriptive analysis of the role of ratio and time.

Ten-year analysis of transfusion in Operation Iraqi Freedom and Operation Enduring Freedom: increased plasma and platelet use correlates with improved survival.

Massive transfusion protocols: the role of aggressive resuscitation versus product ratio in mortality reduction.

Improvement of Treatment Outcomes after Implementation of a Massive Transfusion Protocol: A Level I Trauma Center Experience.

Massive transfusion policies at trauma centers participating in the American College of Surgeons Trauma Quality Improvement Program.

Use of prothrombin complex concentrate as an adjunct to fresh frozen plasma shortens time to craniotomy in traumatic brain injury patients.

Plus the PROMTT and PROPPR Trials ofcourse. 

THERE IS NO SUCH THING AS AN ED STERNOTOMY! 

BUT There are emergent sternotomies. 

and they are exteremly fulfilling. 

Just a short commentary on a cool video ! 

Chapter Mentioned. 

Pictures Referenced. 

Dr Tongmeesee

How many lumens do you actually need in the real world? 

Is a single lumen enough?

How much more flow can I get from a pressure bag?

What's the optimal way to set up line access?

 

Copy of the powerpoint.

Selected readings:

An In Vitro Assessment of the Efficacy of Various

IV Cannulas for the Rapid IV Fluid Administration

Mineto Kamata, MD1; Hina Walia, MBBS2; Mumin Hakim, MBBS2; Dmitry Tumin, PhD2;

Joseph D. Tobias, MD

Double-barrelled resuscitation: A feasibility and simulation study of dual-intraosseous needles into a single humerus Matthew J. Douma a,1,*, Gurpaul S. Bara b,1, Domhnall O’Dochartaigh c,1, Peter G. Brindley d,1 a Trauma and Emergency Services, Royal Alexandra Hospital, 10240 Kingsway Avenue NW, Edmonton, AB, Canada T5H3V9 b Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada c Shock Trauma Air Rescue Society, Edmonton, Canada d Neurosciences Intensive Care, Alberta, Canada

 

 

What are vasoelastic assays?

How do I read them?

What do I do?

Is it ready for primetime?

TEG VS ROTEM - the format wars. 

Whats the future like? 

Selected references: 

Effect of thromboelastography (TEG®) and rotational thromboelastometry (ROTEM®) on diagnosis of coagulopathy, transfusion guidance and mortality in trauma: descriptive systematic review

An assessment of clinical interchangeability of TEG and RoTEM thromboelastographic variables in cardiac surgical patients.

TEG and ROTEM: technology and clinical applications.

The use of viscoelastic haemostatic assays in goal-directing treatment with allogeneic blood products – A systematic review and meta-analysis

Point-of-Care Coagulation Tests Monitoring of Direct Oral Anticoagulants and Their Reversal Therapy: State of the Art.

What factor within the Japanese Association for Acute Medicine (JAAM) disseminated intravascular coagulation (DIC) criteria is most strongly correlated with trauma induced DIC? A retrospective study using thromboelastometry in a single center in Japan.

Hypercoagulability after distal pancreatectomy: Just meaningless alterations?

Traumatic Abdominal Solid Organ Injury Patients Might Benefit From Thromboelastography-Guided Blood Component Therapy

All the bang without the bucks: Defining essential point-of-care testing for traumatic coagulopathy.

Last but not least REBEL reviews.

 

Copy of the slides can be found here.

A play by play video of a scalpel finger bougie cric. 

 

As much as I'd like to take credit, original video was filmed by Reuben Strayer with patients consent. 

 

Simply mind blowing how much cognitive work goes into a surgical airway and the video is just an amazing example. Another good example can be found here by Dr Rhee which shows a more traditional surgical approach although a prefer the scalpel finger bougie similar to Scott Wiengart, although I've had favourable experiences with the lifestat recently (seperate episode) .

Other References: 

The formulation and introduction of a 'can't intubate, can't ventilate' algorithm into clinical practice.

Emergency surgical cricothyroidotomy: 24 successful cases leading to a simple ‘scalpel–finger–tube’ method