Shock in Trauma; Roadside to Resus
The Resus Room
Simon Laing
4.8 • 678 Ratings
🗓️ 16 September 2019
⏱️ 77 minutes
🧾️ Download transcript
Summary
So as promised, and following on from our previous shock episode, this time we've covered the topic of shock in Trauma. It's a massive topic and one that we all, yet again, can make a huge difference for our patients' outcomes.
There is some crossover as you'd expect from the concepts and assessment that we covered in our Shock episode, so we'd recommend taking a listen to that one first. Make sure you have a comfy seat and plenty of refreshments to keep you going for this one as we cover the following;
- Definition
- Aetiology
- Hypovolaemic shock
- Neurogenic shock
- Obstructive shock
- Cardiogenic shock
- Physiology; Traumatic coagulopathy
- Other diagnostics
- Controlling external haemorrhage
- Pelvic binders
- REBOA
- Avoiding coagulopathy
- BP targets & permissive hypotension
- Fluid choices & supporting evidence
- TEG/ROTEM
- Calcium
- TXA
- Vasopressors
- Preventing hypothermia
- Relieving obstruction
- Interventional radiology
- Damage control surgery
As always we’d love to hear any thoughts or comments you have on the website and via twitter, and make sure you take a look at the references and guidelines linked below to draw your own conclusions.
Enjoy!
Simon, Rob & James
References
Shock;The Resus Room podcast
REBOA;The Resus Room podcast
External Haemorrhage;The Resus Room podcast
Blood;PHEMCAST
TEG & ROTEM;FOAMcast
Major Trauma guideline;NICE
Resuscitative endovascular balloon occlusion of the aorta (REBOA):a population based gap analysis of trauma patients in England and Wales
Nationwide Analysis of Resuscitative Endovascular Balloon Occlusion of the Aorta in Civilian Trauma. Joseph B. JAMA Surg. 2019
The Pre-hospital Management of Pelvic Fractures: Initial Consensus Statement. I Scott. FPHC. 2012
RePHILL;Birmingham University Trials
Assessment and Treatment of Spinal Cord Injuries and Neurogenic Shock;Fox A. JEMS
Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. Holcomb JB. JAMA. 2015
Risks and benefitsof hypotensive resuscitation in patients with traumatic hemorrhagic shock: a meta-analysis. Owattanapanich N. Scand J Trauma Resusc Emerg Med. 2018
The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients.Roberts I. Health Technol Assess. 2013
TEG and ROTEM for diagnosing trauma‑induced coagulopathy (disorder of the clotting system) in adult trauma patients with bleeding;Cochrane Review. 2015
Optimal Dose, Timing and Ratio of Blood Products in Massive Transfusion: Results from a Systematic Review.McQuilten ZK. Transfus Med Rev. 2018
Prehospital Plasma during Air Medical Transport in Trauma Patients at Risk for Hemorrhagic Shock.Sperry JL. N Engl J Med. 2018
Transcript
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| 0:00.0 | So hi, and welcome back to the recent program. |
| 0:15.4 | I'm Simon Lang. |
| 0:16.7 | I'm Rob Fenwick. |
| 0:17.8 | And I'm James Yates. |
| 0:18.9 | And we're back following on from our previous podcast on shock with shock in trauma |
| 0:24.9 | and as always we have got a massive amount to cover and we've bitten off way more than we can chew so we're going to try and keep it as succinct and digestible as possible at least that's the plan anyway |
| 0:36.5 | well I don't know what you talk about Rob it. It's a pretty simple topic, isn't it? |
| 0:39.8 | Well, it's pretty simple when you look at it that there's not a huge amount of evidence for |
| 0:43.4 | most of it. But anyway, yeah, there's lots of controversy around what we should be doing. |
| 0:47.6 | That's going to be the nuanced discussion, which we're of course famous for. You might be in your own household, mate, but I don't think outside of those four walls. Of course I jest. So before we get into the podcast, a big thanks to |
| 1:00.7 | SJTrem, the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. They're an online |
| 1:06.5 | journal with all of their articles, open access. They cover exactly the sort of topics that we do |
| 1:11.6 | here on the podcast. The hyperlinks on our websites again have a look at that and they are our |
| 1:15.7 | partners in this podcast and make this all possible. So without further ado, let's get on with the |
| 1:21.2 | topic. So the reason that we've separated this off from shock is that traumatic shock has a number of specific parts to it that are different to your standard approach to a patient with shock. |
| 1:36.2 | We'd really highly recommend, not just for our download numbers, that you go and have a listen to our shock episode before you have a listen to this. |
| 1:43.1 | And then we'll be covering |
| 1:44.4 | the bits that you'd expect so a bit about the definition a bit about the etiology and most importantly |
| 1:50.2 | the bit about the management because we can make a huge difference to these patients who are in |
| 1:55.9 | traumatic shock and really try and ensure that they've got the best outcomes as possible. So James, do you want to |
| 2:02.4 | start off with a definition? Yeah, absolutely. And you set the scene really nicely there, Simon, |
| 2:07.8 | in that trauma shock is a different sort of an entity to medical shock. However, the definition |
... |
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