EMCrit Podcast 34 – 2010 ACLS Guidelines

The brand new ACLS & BCLS guidelines were published last week. Not huge changes, but some good stuff! The free full text is available at the Circulation website. It takes hours to make your way through all of it. I boiled it down to just the facts and posted a summary on the Crashing Patient Site.

ACLS 2010 Guidelines Summary

In this EMCrit Podcast I discuss some of the highlights that I think are particularly important.

There have also been many questions about the head impulse testing discussed in episode 33. I have an easier method; check out this post.


EMCrit Podcast 30 – Hemorrhagic Shock Resuscitation

This week we discuss the resuscitation of the hemorrhagic shock patient with Dr. Richard Dutton, MD.

Rick was director of trauma anesthesia at the Shock Trauma Center when I trained there. He is an incredible teacher, clinician, and researcher.

Here are the take home points:

  • Induction agent choice does not matter in these patients; what matters is DOSE! Reduce dose to 1/10 of full intubating dose.
  • Blood products need to be available in the trauma bay for when these patients arrive. If you need to give crystalloid while awaiting the products, give only small amounts just to keep the patients heart beating.
  • A systolic of 80 with good perfusion and normal sized vessels is very different than that same SBP in a patient who is clamped down. The former is a resuscitated state, the latter =spiral of death.
  • The resuscitation fluid for trauma is equal parts PRBC and FFP.

To read more of Dr. Dutton’s thoughts, go to this article:

ITACCS Damage Control Anesthesia

Update: This article is even better (Br J Anaes 2012;109(s1):139)

photo from trauma.org