Trauma - Hot Off the Press by Diane Birnbaumer, MD
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Key Points and Recommendations
1. A prehospital program emphasizing avoidance of hyoxia, hypotension, and hyperventilation was associated with improved outcomes for severely injured patients and thus may be worth considering locally.
2. Tranexamic acid treatment for TBI is controversial; if it works it may help those with mild-moderate TBI.
3. Prophylactic hypothermia for severe TBI doesn’t work.
4. Age of red cells doesn’t matter when transfusing.
5. Arginine vasopressin for hemorrhagic shock is gaining traction, larger RCTs may be on the horizon, though it isn’t ready for prime time yet.
6. Hypotensive resuscitation, aiming for organ perfusion targets (SBP 70-90), appears to reduce mortality in hemorrhagic shock patients.
7. Plasma-first resuscitation is much discussed, and may reduce mortality—or not; this is an emerging conversation.
8. Consider a bougie-first ETI approach maybe for all, but certainly for difficult airways like trauma patients.
9. Occult rib fractures, seen only on CT, in elderly fall patients may not suggest risk for adverse outcomes.
10. eFAST for trauma helps to rule in abdominal and thoracic trauma injuries, not rule out.
11. FAST for children was not beneficial in the one rigorous RCT on the topic.
12. Clinical clearance of the c-spine, even among those with distracting injury, is possible and safe.
13. The PECARN decision aid for pediatric blunt abdominal trauma is highly sensitive for clinically important intra-abdominal injuries, and may obviate the need for CT imaging.
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