Cite this post as:
Scott Weingart, MD FCCM. Podcat 081 – An Interview on Severe Trauma with Karim Brohi. EMCrit Blog. Published on September 2, 2012. Accessed on June 5th 2023. Available at [https://emcrit.org/emcrit/severe-trauma-karim-brohi/ ].
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.
Original Release: September 2, 2012
Date of Most Recent Review: Jan 1, 2022
Termination Date: Jan 1, 2025
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Another excellent podcast covering some of the major issues were faced with when dealing with the severe trauma patient.
Keep em coming!
Dr. Brohi. Excellent presentation of the topic. I work in British Columbia where the transport times are often significant (hours) to delivering definitive investigation of and control of active hemorrhage. Our rural sites transfer to two Tertiary/Level 2 Trauma centres from a wide geographic area.
You suggest a MAP of 50-65mmHg in the order of 20-30 minutes and emphasis on emergent bleeding control. If the rural patient will wait hours for hemorrhage control, can you suggest a MAP target during transport?
Alan Vukusic, CCFP(EM)
Clinical Trauma Director
Royal Inland Hospital
Well….. what about prehospital treatment of traumatic cardiac arrest? Opening the chest is usually not an option…
PHTLS says either call the code, or do external chest compressions.
I think prehospital compressions are fine if bilateral finger thoracostomies have already been tried and they are not delaying for one instant transport to a trauma center.
Hi Karim & Scott, First off great podcast and discussion. Thanks for puuting a huge area into a clear and concise presentation. Great to hear that in all likelihood it is probably fair to manage penetrating and blunt haemorragic shock the same way in terms of fluids and targets. Karim, in your Trauma Masters presentation, you highlight evidence that shows the detrimental effect of both high volume crystalloid and possible pleiotropic effects of the crystalloid. I work at motorsports events where storing blood products (including albumen) is impractical, so not an option, and transport distances can be significant (similar issues… Read more »
As always very provocative and enlightening interview. It seems there was a lot of emphasis on the limited role that closed chest compressions have in traumatic ( hemorraghic ) arrest. I was always under the assumption that the only situation in which a thoracotomy helps was for release of tamponade. Dr Brohi felt that your case of an exsanguination from neck bleed needed a thoracotomy. To be clear , is it felt that open chest massage is THE way to go for an empty hemorrhaged heart? If this is true, then shouldnt it follow for the medical patient who arrests… Read more »
Scott and Karim, Just catching up on my EMCrit podcasts and wanted your opinion on the mixed head and abdominal trauma patient. Where I work I do both tertiary care emergency medicine and rotary wing transport. I recently had that was brought to a smaller ER approximately 1 hour flight from our centre. On arrival she had CT confirmed facial fractures, SAH, and likely DAI. She also had a positive abdominal FAST for free fluid. Her initial blood pressure was 60/40 when I arrived. En route back to our hospital we transfused her 4u pRBC but she still had a… Read more »
To my mind, you made a good decision in a circumstance without much evidence. MAP of 60 is very reasonable and is unlikely to pop the clot, while giving some degree of cerebral perfusion. of course we would do it differently if we had all the products at our disposal, but you don’t so i don’t think it is a bad call. i don’t think you made the spleen bleed more. what norepi can do however is decrease tissue perfusion and make coagulopathy worse. probably better to give some calcium next time and see if you can maintain bp. other… Read more »
Thanks for the feedback.
My take is that the majority of evidence for minimal fluid resuscitation occurs in trauma networks where transport times are relatively short. To try to extrapolate this to rural and remote situations would be dubious. It concerns me when we immediately try to generalise observations from a quaternary centre with a well organised retrieval system. We need more research.
Prof Karim whispers and blurts out during talk making it difficult to follow ,I hope he maintains the tempo of talk next time.sound quality is also bad for such a great and important Topic