Emergency medicine clinics of North America
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Shock is a life-threatening condition of circulatory failure leading to inadequate organ perfusion and tissue oxygenation. In a trauma patient, shock may be due to hypovolemia, cardiogenic, obstructive or distributive causes individually or in combination. The physiological response to major hemorrhage is dependent on a variety of autonomic reflexes, mechanism of injury, bleeding source, and baseline physiology of the patient. This article discusses the common causes of shock and the accompanying physiology, how clinical assessment can support the diagnosis and effective treatment of shock, and the common pitfalls in trauma patients.
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Emerg. Med. Clin. North Am. · Feb 2023
ReviewMassive Hemorrhage Protocol: A Practical Approach to the Bleeding Trauma Patient.
Damage-control resuscitation is the standard of care for the hemorrhaging trauma patient. This approach combines rapid hemostasis and early-ratio-based blood product administration. ⋯ Emerging evidence supports that this includes more than blood product administration alone but rather a comprehensive suite of treatments. In this article, we review the existing evidence and provide a pragmatic framework, the 7 Ts of massive hemorrhage protocol, to guide the care of patients with life-threatening traumatic hemorrhage.
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Emerg. Med. Clin. North Am. · Feb 2023
ReviewResuscitative Endovascular Balloon Occlusion of the Aorta: A Practical Review.
Hemorrhage, in particular, noncompressible torso hemorrhage, remains a significant contributor to mortality in trauma cases. Despite many advances in resuscitation, noncompressible sites of bleeding have presented a particular challenge. ⋯ Although the technique is relatively straight-forward, it carries significant risk, in particular, from ischemia due to aortic occlusion. This article describes the role and considerations for the use of REBOA in the critically injured patient.
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Emerg. Med. Clin. North Am. · Feb 2023
ReviewTrauma in the Aging Population: Geriatric Trauma Pearls.
The relative proportion of trauma patients who are older adults continues to rise as the population ages. Older adults who experience trauma have unique needs compared with their younger counterparts. ⋯ This article reviews the most important aspects of geriatric trauma care. We focus on presentation and initial resuscitation, triage guidelines and the issue of undertriage, the importance of multidisciplinary and specialized geriatric care, and common injuries and their management.
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Emerg. Med. Clin. North Am. · Feb 2023
ReviewProtect That Neck! Management of Blunt and Penetrating Neck Trauma.
Blunt and penetrating vascular injuries to the neck represent a significant burden of mortality and disability among trauma patients. Blunt cerebrovascular injury can present with signs of stroke either immediately or in a delayed fashion. ⋯ In contrast, for patients presenting with penetrating neck injuries, assessment for hard signs of vascular and aerodigestive injury should be done and prompt emergent surgical consultation if present. Overall management priorities for penetrating neck injuries focus on airway management, hemorrhage control, and damage control resuscitation before definitive surgical repair.