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:
- This article is even better (Br J Anaes 2012;109(s1):139)
- You can see a full lecture by Rick from the EMCrit Conference
- Great Article from STC on choice of Anesthetics (Curr Anesthiol Rep 2014;4:225)
- COVID19 – Awake Pronation (aka the Pig Roast) A guest write-up by David Gordon, MD - April 6, 2020
- EMCrit Wee – Webinar I Gave to Pulm/Crit Care Fellows on Avoiding Intubation and Initial Ventilation of COVID19 Patients - April 4, 2020
- EMCrit 269 – Rationing of Critical Care and Ventilators in COVID19 with Reub Strayer - March 31, 2020