Trauma Reflections – August 2017

Thanks to Dr. Andrew Lohoar and Sue Benjamin for leading the discussions this month



Major points of interest:


A) Tranexamic acid administration

It should be given to patients “who have, or are at risk for, significant hemorrhage”. It has to be given within 3 hours of injury to be of benefit.
Free fluid on POCUS? Discussing trauma transfer from peripheral facility? “Trauma bloods” have been ordered? – Think TXA.

Isolated head injury patients may be candidates for CRASH 3 study.

“I don’t ask myself if I should give it, I ask myself why I shouldn’t give it!” – Dr Jay Mekwan, airway guru and trauma enthusiast

B) Injured patients self-presenting to department

Trauma patients that “walk-in” to department may have significant injuries. Be vigilant with this group, especially if a significant MOI is described.

C) Disposition

Patients with significant injuries, but not needing immediate surgical intervention, should be admitted/observed in ICU x 24 hrs. TTLs have a duty/right in policy to effect appropriate disposition setting. Department head and/or chief of staff are available to assist if needed.

D) Time to CT

Results of CT scan are often critical to determining next steps in treatment. CT should be ordered early. If more than one patient is waiting for CT, prioritize and communicate with staff as to which patient should go first.


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