Trauma Reflections April 2021

Big thank you to our guest Dr Zlatko Pozeg and Sue Benjamin for her efforts in putting these reviews together.

Major points of interest:

A) Approach to airway management in peri-arrest patients

Shocked patients should have no more than 1/2 dose of induction agents during RSI.

Ketamine and etomidate are medications least likely to negatively affect hemodynamic status.

B) “The IV line is blown” – Now what?

Establishing vascular status quickly is a critically important step in the resuscitation of trauma patients – have a plan B (and C).

If a large bore peripheral IV catheter placement cannot be achieved, intraosseous access is likely the quickest alternative.

Also consider using ultrasound to identify other peripheral venous sites, direct cannulation of external jugular vein or saphenous vein at ankle or establish central venous access.

C) Reversible causes of traumatic cardiac arrest – Fix what you can fix, quickly

D) When was the last time I did an intubation in a trauma patient?

Probably a long time ago.

This underscores the importance of simulation for these high acuity low frequency events.


E) That patient is here for CT, just send them..

In this series of trauma patients transferred to the SJRH that were NOT evaluated by ED MD or RN on arrival, majority were admitted and ½ went to ICE. These are high risk patients that should be evaluated for stability prior to sending for imaging.

F) There are very few indications for ECMO in trauma in the ED

Consider in drowning and severe hypothermia.


G)ED Thoracotomy

See following podcast from EMCrit:

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