Trauma Rounds (Dr. Campbell):
- Consider using the Ambu-scope to evaluate integrity of airway (with an ETT loaded on top in case patient requires intubation) for penetrating neck injuries
- Always be prepared with a cricothyroidotomy set-up for patients
- For further reading on penetrating neck injuries, check out our full post here
- T-Pods or pelvic binders will limit your access to the femoral vessels (for cordis placement, a-line placement or REBOA)
- Do not forget medical management in trauma patients- always obtain EKG/FS to evaluate reason for fall that caused the trauma in the first place
Pre-Hospital Termination of Resuscitation (Dr. Baciak):
- Many ethical and legal considerations
- Exists to more effectively utilize hospital resources, reduce hazards to EMS (light and siren transport), financial expense to families, decrease emotional distress to families, and increase EMS availability/transport for other patients
- Research has shown certain predictors of very poor outcome: no prehospital ROSC, unshockable initial rhythm, and unwitnessed by bystanders
Medico-Legal Advice (Dr. Meyer):
- First and foremost, treat your patients as if they were your family members (ones that you like)!
- Always advocate for your patients (especially important if you do not agree with a consultant’s plan)
- Documentation is important- do it well and in real time
- If it is a patient’s repeat visit, either re-think the patient’s work-up from the beginning or escalate care!
- Even if your patient is leaving AMA, you should do what you can to treat them (ex: if he/she has a PNA and is leaving AMA, prescribe him/her antibiotics)
- Further reading from ALIEM on AMA documentation
M&M (Dr. Fontana):
- Sodium Bicarbonate used primarily to combat acidosis
- Mixes with lactic acid (forms in low perfusion states and inadequate oxygenation states) and excess acid –> H2CO3 –> CO2 and H20 –> excess CO2 expelled through lungs during ventilation
- Ensure adequate ventilation to eliminate the CO2 produced
- Bicarb infusions can increase lactate concentrations (increase gut lactate production and decreased hepatic lactate extraction)
- Bicarb infusions can lead to hypernatremia
- All intubated ED patients being transported outside the ED should be monitored with a cardiac monitor and end-tidal CO2 monitors
- Consider venous pH as a 5th Vital Sign, especially when transporting critically ill patients so consultants involved are aware of the patient’s status