Thanks to Dr. Andrew Lohoar and Sue Benjamin for leading the discussions this month
Major points of interest:
A) Managing airway in severely head injured patient
Intubate GCS < 5 prior to CT scan or after? Good discussion ensued. The bottom line – with a well-placed i-gel LMA and spontaneous respirations with O2 sats of 99%, obtaining CT to rule out potentially correctable brain injury is the priority. Intubation on return to ED from DI should be done using appropriate techniques and medications to minimize surge in ICP – SEE THIS PODCAST
B) He is on Riveroxaban? That’s just great..
Trauma patient on NOAC/DOAC can be a challenge. Only medication with true reversal agent is dabigatran (Praxbind 5G IV). Consider Octaplex until true reversal agents for the Xa inhibitors become available. Remember TXA!
C) Trauma transfers from other centers
Expectation is trauma activation for all major trauma transfers, even if “direct” for a consultant.
D) Post intubation analgesia and sedation – “Is he hungry?”
No he isn’t! – biting the ET tube means it is time to crank up the meds. Infusions are superior to push dosing. Analgesia is often given in inadequate doses or not at all. Also consider the need for larger doses of opioids in patients on methadone.
E) Disposition from Emergency Department
NB Trauma Program Policy 2.4-010, which has long been approved by LMAC – commit this to memory!
“The TTL, in consultation with other inpatient services, shall determine the most appropriate service and level of care for admission, transfer or discharge.”
