Ep 118 Trauma – The First and Last 15 Minutes Part 1

The first and last 15 minutes of trauma management are critical in giving your patient the best chance of functional survival. In this podcast we gain perspectives from both academic trauma team leaders Dr. Chris Hicks and Dr. Andrew Petrosoniak and community trauma expert Dr. Kylie Booth in these critical moments. In this part 1 we answer questions on trauma resuscitation such as: how should we best prepare our team, our gear and ourselves for the trauma patient? How does resequencing the initial trauma resuscitation save lives? How can we most readily identify occult shock, the silent killer in trauma? What are 7 actions to consider in the first 15 minutes of resuscitation? How can the concepts of "controlled resuscitation" and "resuscitation intensity" help us decide resuscitation targets and when to activate a massive transfusion protocol? and many more... Podcast production, sound design & editing by Anton Helman. Voice editing by Sucheta Sinha. Written Summary and blog post by Shaun Mehta & Anton Helman, December, 2018 Cite this podcast as: Helman, A, Booth, K, Hicks, C, Petrosoniak, A. Trauma - The First  and Last 15 Minutes Part 1. Emergency Medicine Cases. December, 2018. https://emergencymedicinecases.com/trauma-first-last-15-minutes-part-1/. Accessed [date]. Go to part 2 of this 2-part podcast on trauma Prepare the team, your gear and yourself for trauma resuscitation Preparing the team for trauma Prepare your team in the few minutes prior to the patient arriving in your ED based on the little information you have garnered from the EMS call, so that this complex logistical co-ordination can occur as an efficient flow [1]. Team-Based Preparation: 4 Discussion Points * What do we know? The stem that you receive from the EMS call * What do we expect to see/What are the possibilities? Run through the most likely immediate life-threatening issues/injuries * What do we do? And discuss contingencies if those actions fail. What is your response if the initial plan fails or does not produce expected results? * Role assignment. Assign logistical tasks to team members. Learn more about team preparation with Dr. Hicks in Episode 83 Preparing the gear for trauma resuscitation Ensure that your ED has a well thought out trauma cart that clearly contains the gear that you may require, including a pelvic binder, thoracostomy kit, cricothyrotomy kit etc. When assigning roles, assign gear preparation with each role. Learn more about trauma preparation with Dr. Hicks and Dr. Petrosoniak in Setting up Your Trauma Bay Preparing yourself for trauma resuscitation Mental preparation, including visualization of complex tasks, deep breathing exercises, and positive self-talk to help focus. See Weingart's ‘Beat the Stress Fool‘ technique. Consider calling for help early (anesthesia, surgery, orthopaedics, paediatrics etc) if you work in a center that does not have a dedicated trauma team. Tie up loose ends with other patients in your ED if time permits before the trauma patient arrives, so that after you’re done managing the trauma patient, your ED is not a disaster zone. Resequencing the trauma resuscitation Intubation causes an increase in intrathoracic pressure, resulting in a decrease in right atrial pressure which negatively impacts both ...