Posts Tagged resuscitation
This week we talk about managing the intra-arrest period of cardiac arrest. My paradigm has changed dramatically over the past few years. In the past, I viewed the arrest as a period to teach my residents how to place a subclavian central line, how to intubate when the patient is moving, and how to cram as many drugs as possible into a patient in a short period of time.
Looking at how I manage an arrest today, so much has changed. LMAs instead of tubes, IOs instead of central lines, and so much more.
This week on the EMCrit Podcast, 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.