Cite this post as:
Scott Weingart, MD FCCM. Podcast 110 – Exsanguinating Hemorrhage from Mid-Face Fractures. EMCrit Blog. Published on November 1, 2013. Accessed on January 28th 2023. Available at [https://emcrit.org/emcrit/exsanguinating-hemorrhage-mid-face-fractures/ ].
Financial Disclosures:
Dr. Scott Weingart, Course Director, reports no relevant financial relationships with ineligible companies.
This episode’s speaker(s), (listed above), report no relevant financial relationships with ineligible companies.
CME Review
Original Release: November 1, 2013
Date of Most Recent Review: Jan 1, 2022
Termination Date: Jan 1, 2025
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Pretty sure the Rapid Rhino should only be wet in water, not saline, or else the haemostatic agent is partially deactivated.
Brent, That is real time peer review–love it! Thanks, just made the correction above.
Scott, while you’ve never covered it, we’ve had success in using hemostatic gauze in the prehospital setting for oral bleeds if we can see the site of bleeding within the oral cavity. Z-Medica,(no conflicts..just a great product)make a 4×4 with hemostatic agents. Using those and long hemostat, or magills makes it easy to get bleeding to stop in the posterior oropharynx…
Love it Ryan-thanks
Don’t say we never taught you anything Scott!!
chubby bunny!!!!!! wash it down with some milky bag.
Ram
Can’t type, too many marshmallows in my mouth : )
Hi Scott
I hope you forgive a question that might be stupid, but why even bother with a regular tube? Why not just do the surgical airway right of the bat. I imagine in consequent surgeries and or interventions the endotracheal tube will only be disturbing in the field anyway.
b/c the surgical airway you offer, the cric, should only be in place for a day. Emergent trachs don’t usually work out as nicely. So if you get an ETT, then the surgeons will do a trach as the 1st part of their operation in the OR with good lighting and no emergency.
Thanks for clearing that:-)
Glad you have amended the rapid rhino in the show notes. It will still work but without the same haemostatic effect. Love the show.
Scott,
Maybe it has been mentioned before, but what is your take on doing a wire retrograde cric on a patient that is bleeding from the midface like this? It seems like one of your partners could be attempting this while you are trying to intubate. If you get the tube, they can stop and you haven’t done anything too invasive with the retrograde attempt. If you don’t get the tube, you should be seeing their wire any second to pass your tube over.
I was just wondering the same thing myself.
crash retrograde always seems like such a clever idea when speaking theoretically, but it doesn;t have a great track record in real life scenarios. Not saying it couldn’t work, just that it usually doesn’t and then you’ve burned a bunch of time.
much better move imho is to just do the cric, temporize with packing and then intubate from above with bougie or bronch and remove the cric while you are still in the ED
Hey Scott, Glad I listened to this post recently. While coordinating retrievals the other day I got called about a 85yo guy that hit the steering wheel with his face without a seatbelt. By the time the paramedics got to him many hours later, as he was on an isolated farm, he had BP 70, HR170 and a GCS 3 from the facial bleeding alone! GCS and haemodynamics improved after 2 L crystalloids but he was still hosing out when they rang me. I suggested the 2 foleys as you described and the bleeding subsided enough for them to be… Read more »
Thanks so much for sharing that case Peter!!
I have heard of soaking a rapid rhino in epinephrine to provide some vasoconstriction. Do you have any thoughts on this practice?
we soak in TXA