Top 10 trauma 2014 15

Trauma Top 10 2014-15

@EMManchester

@EMManchester

10

Yes or No?

9

Gp 1. 0.3mg/Kg Etomidate + 1.5mg/Kg Suxamethonium

Gp2a. 3mcg/Kg Fentanyl + 2mg/Kg Ketamine + 1mg/Kg Rocuronium

Gp2b. 1mcg/Kg Fentanyl + 1mg/Kg Ketamine + 1mg/Kg Rocuronium

Screenshot 2015-04-18 10.04.48

8

http://www.sciencedirect.com/science/article/pii/S0020138314006731

10 Trauma Centres

Patients surviving >30 mins and who received blood

966 patients included

23% received major transfusion

Sensitivity 65.6%

Specificity 63.8%

7

http://www.nejm.org/doi/full/10.1056/NEJMoa1404304

http://www.nejm.org/doi/full/10.1056/NEJMoa1404304

Moderate and severe brain injury

GCS 4-12

Within 4 hours of injury

Infusion of progesterone for 96 hours

6

5

4

http://prehospitalmed.com/2015/03/24/a-response-to-the-hirt-trial/

Method

Protocols

Time

Reproducibility

3

http://emj.bmj.com/content/early/2014/11/09/emermed-2014-204260.full.pdf+html

e

Case courtesy of Dr Frank Gaillard, radiopaedia.org

66.6%

6.6%

Case courtesy of Dr Frank Gaillard, radiopaedia.org

29.7%

54.3%

2

2010-2012*

385 patients on ICU

160 ‘shock’ patients (65% given TXA)

254 ‘non shock’ patients (30% given TXA)

1

http://jama.jamanetwork.com/article.aspx?articleid=2107789

http://jama.jamanetwork.com/article.aspx?articleid=2107789

http://www.wessexics.com/The_Bottom_Line/Review/index.php?id=7495881379650332408

http://www.wessexics.com/The_Bottom_Line/Review/index.php?id=7495881379650332408

Be (very) selective in blunt thoracotomy

Use Ket/Roc/Fent for trauma RSI

You’re rubbish at determining need for MHPs

Don’t make head injuries sexy

DSI you’re combative hypoxic patients

REBOA may not be all that it seems

RCTs in pre-hospital care are tricky

Don’t give up on the dilated head injury

TXA benefits the sickest patients

Use 1:1:1 blood, plasma, platelets in trauma