2018 Trauma Care Update PRESIDENT ELECT

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Presentation transcript:

2018 Trauma Care Update PRESIDENT ELECT Prof. Lisa Moreno-Walton, MD, MS, MSCR, FAAEM, FACEP PROFESSOR of Emergency Medicine Director of: Research, Diversity, Viral Testing Section of Emergency Medicine Director of Latino Scholars Program Louisiana State University Health Sciences Center- New Orleans PRESIDENT ELECT AMERICAN ACADEMY OF EMERGENCY MEDICINE

Disclosures Dr. Moreno receives research funding from Gilead Sciences, Inc. There will be no discussion of any Gilead products, however there will be discussion of peer reviewed articles on HIV infection. Disclosures: I do receive research funding, directly or indirectly, from several government agencies NIH- NIAA CDC LSUHSC Dean’s Research Program LSUHSC Translational Research Fund Alpha Omega Alpha Honor Society I am a National Institutes of Health PRIDE Research Scholar I may in future receive royalties from Springer Publishing Company for the sales of my book “Diversity and Inclusion in Quality Patient Care”

Objectives To cover the new evidence based updates in trauma care as recommended by the American College of Surgeons Committee on Trauma Advanced Trauma Life Support Course.

Initial Assessment One liter of crystalloid only (not 1-2) Move to blood quickly for non-responders Tranexamic Acid

Shock Give 1:1:1 blood products as part of the massive transfusion protocol New standards for signs and sx of hemorrhage Emphasis on base deficit

Thorax Use US to identify PTX New site for needle decompression is the 5th intercostal space in adults New recommended chest tube size is 28-32 F, which replaces 36-40 F

Traumatic Cardiac Arrest Algorithm BRAND NEW!

Pelvis High riding prostate is NOT reliable to determine urethral injury Consider pre-peritoneal packing in ED to control bleeding.

Head Trauma Anti-coagulation reversal guidance Recommendations for protamine, vitamin K, platelets, etc which are standard recommendations put into a chart Clarification but no change in GCS scores

Spine and Spinal Cord Diagram for key dermatomes and myotomes included Backboard awareness (> 2 hours results in ulcers) Endorsement of NEXUS and Canadian C-spine rules Neuro deficit Etoh or other intoxication X-treme distracting injury Unable to provide history (AMS) Spinal tenderness in the midline Spinal motion restriction as opposed to immobilization

Musculoskeletal Resurgence of the tourniquet

Transfer No CT at transferring hospital Do not do any studies that will not change care at transferring hospital ABC- SBAR Airway Breathing Circulation Situation- pt ID, reason for transfer, IV access, tx so far Background- Event hx, AMPLE, blood products, interventions, response Assessment- VS, PE, response to tx Recommendations- type of transfer, type of tx

BETTER CARE THROUGH USE OF EVIDENCE! SAVING LIVES IN 2018