Carolinas Case Conference - Dr. Beverly

Trauma Resuscitation: Not ACLS

• Trauma resuscitation should focus on treating the underlying cause.
  • Trauma patients need intubation, resuscitation with blood products and bilateral thoracotomies when in extremis
• ACLS in trauma is not indicated.
  • Chest compressions and epinephrine are the cornerstone of medical resuscitation, not trauma.
  • In traumatic arrest, chest compressions are not attempted until underlying causes have been appropriately addressed including hypoxia, hypovolemia, tension pneumothorax and cardiac tamponade
• REBOA now being explored and in place for patients with suspected or diagnosed intra-abdominal hemorrhage secondary to penetrating torso injuries, blunt trauma patients with suspected pelvic fracture and isolated pelvic hemorrhage and patients with penetrating injury to the pelvis or groin area with life-threatening hemorrhage. 

 
It's Not Always Sepsis!

• Multiple physiologic processes can elevate lactate.
  
• Be careful with premature closure in patients. It is not always sepsis. 
  
• Reviewing old EKG’s in comparison to new EKG’s is invaluable. If you order it, make sure you review it. 
  
• New EKG changes even in the absence of symptoms in the altered patients should always prompt further investigation 

​

---