Thanks to Stacey Turner for a fantastic talk!
Collar off and Manual In-Line Stabilisation
Ramping – improve position + view, optimise ventilation and reduce regurgitation
Consider neutral position with head elevated
SHOCKED TRAUMA PATIENT
Pretreatment – PREVENT ANY HYPOTENSION
Reduce haemorrhage – splint long bones + pelvis
Treat other causes of traumatic shock – eg: tension pneumothorax
Pressors: Adrenaline dilute 1:10,000 to 10ml and give 1ml (10mcg) boluses
Drugs – consider NO induction agent in peri-arrest as ALL will drop BP
GO LOW with induction agents:
Ketamine: 25-50% standard dose = 0.5mg/kg
Propofol: 10% standard dose
GO HIGH with paralysing agents:
Prevent secondary brain injury due to raised ICP as as a result of hypertension BUT any episode of HYPOTENSION is associated with increased mortality….
collar off to improve venous drainage
gentle intubation – video laryngoscopy
- Antiemetic – ondansetron
- Analgesia – eg: fentanyl
- Antihypertensive – eg: esmolol
- High dose fentanyl – 3-5mcg/kg
- Propofol or ketmine
- Rocuronium – no fasciculations which may elevate ICP
- Propofol + Fentanyl – don’t forget analgesia!
- Morphine + Midazolam
Excellent music selection!
Gastroenteritis in EOU – Dr Jason Kollios
Only 2 out of 40 patients had altered assessment, but unsure if more patients’ diagnosis altered as may be changed on EDIS
Consider definition of GASTROENTERITIS – diarrhoea, vomiting…if these not present MUST consider an alternative diagnosis
We need to improve education of patients regarding reducing transmission on discharge.
Pulmonary Embolism – Dr Ali Alobaidy
Criteria for thrombolysis in Massive PE:
- systolic BP <90mmHg for >15 min
- high pretest probability of PE and RV dysfunction on bedside echo