Things that Might Change Your Trauma Practice in 2017 JR Taylor III, - - PDF document

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Things that Might Change Your Trauma Practice in 2017

JR Taylor III, MD Assistant Professor of Surgery University of Arkansas for Medical Sciences

No Disclosure PREHOSPITAL 1

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CONCLUSION

• In civilians sustaining major limb trauma,

prehospital and in‐hospital personnel are capable of applying tourniquets appropriately

• No complications due to tourniquet use 

Safe to use in civilians with major upper or lower limb trauma via blunt or penetrating mechanisms

PREHOSPITAL 2 CONCLUSION

• For individuals with penetrating injuries in

urban trauma systems, private vehicle transport to a Level 1 or Level 2 trauma center is associated with significantly lower mortality when compared with similarly injured individuals who are transported by ground EMS

PREHOSPITAL 3

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CONCLUSION

• Blood product transfusion within minutes of

injury or prehospital was associated with greater 24‐hour and 30‐day survival than with delayed transfusion or no transfusion

RESUSCITATION 1

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RESUSCITATION 2

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CONCLUSION

• 30 day survival for patients who received

REBOA for severe traumatic hemorrhage 59%

• 24 hour survival for patients in traumatic

arrest who received REBOA 10%

• REBOA is a safe alternative to ED thoracotomy

in patients who present in traumatic arrest

RESUSCITATION 3

• INR > 1.5  2 U FFP
• Fibrinogen < 150 mg/dl  10‐pack CRYO
• PLT < 100,000  1 U apheresis of PLT
• D‐diner > 0.5 mcg/ml  TXA given

Admission TEG

• ACT > 140s  2 FFP, 10‐pack CRYO, 1 U apheresis of PLT
• 111 < ACT < 139  2 FFP

Subsequent TEG

• ACT > 110  2 FFP, angle < 63  10‐pack CRYO,
• MA < 55  1 U apheresis PLT, LY30 > 3.0%  1g TXA

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CONCLUSION

• Goal‐directed, TEG‐guided MTP improves

survival after injury and promotes appropriate use of hemostatic blood products

INTERVENTION 1

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CONCLUSION

• At 6 months, decompressive craniectomy for

severe and refractory intracranial hypertension after TBI resulted in mortality that was 22% lower than that with medical management

• Surgery also associated with higher rates of

vegetative states, lower severe disability, and upper severe disability than medical management

• Rates of moderate disability and good recovery

with surgery were similar to medical management

INTERVENTION 2

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FIBRINOLYSIS PHENOTYPES CONCLUSION

• Persistent fibrinolysis shutdown is associated

with increased late mortality after trauma

• Not much is known about the impact of TXA
• n patients with persistent shutdown