So we've talked about damage control resuscitation, we've talked about intubation, vascular access,

and hemostasis. Now let's turn our attention to head-toe pearls and pitfalls and controversies.

What we're going to do is we're going to present some quick cases and talk about head, neck, spine,

chest, abdo pelvis, and extremity trauma, and just try and get some take-home points

from each of those. So the first case is a 55-year-old man who presents to your emergency

department from the local hockey arena where he was knocked unconscious after being boarded.

Now, for those non-Canadian listeners, getting boarded is something that actually happened to me when I was a kid and come to think of it.

Maybe that's why I can never remember where my car keys are.

Anyhow, what happens is you get body checked from behind without warning.

And usually it's by some Goliath-looking monster on skates and your head slams into the boards at a million

miles an hour. And so this patient who got boarded comes in with normal vital signs, but a GCS

of seven. Now, head-injured patients in particular require a whole other set of considerations

compared to the non-head injured trauma patient.

Let's talk a little bit about how we can minimize increased ICP, anticonvulsant prophylaxis,

therapeutic hypothermia. So first, we talked a little bit about intubating trauma patients at the beginning,

but we didn't talk about using lydicane and fentanyl for pre-treatment for head injured patients.

What's your take on lydicane and fentanyl as pre-treatment before RSI and head injured patients?

I don't know that the literature is all that supportive of giving lydocaine. I mean, I think we do it because, again, it's relatively benign. I think if you look at the original studies, it was patients in the ICU with intracranial pressure monitors in place, and they basically went around and gave them lytocaine or not and jiggled their ET tubes and saw the response in the

ICP. So I'm not sure it's exactly the same population that we're dealing with, but do I give it?

Probably half the time I do. If I've got a couple minutes before I'm actually going to intubate

the patient, I might consider giving the lytocaine. Neurprotective agents such as fentanyl or benzodiazepines for that matter,

or propopal if you want. I'm not sure, again, about the literature, but I certainly do try to

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