EMCrit 278 – Labors of Trauma – Blunt Edition (Part 1)

After reviewing many recordings of major trauma resuscitations, I have come to the conclusion that we are not training our learners on how to perform as a Trauma Team Leader (TTL). They are forced to extrapolate from ATLS, a course never designed for a team at a Level I trauma center. Trauma resuscitations as opposed to medical are a bounded reality. Both the time in the bay and the menu of options are limited--the complete list could be delineated and therefore available for novice TTLs. For a few weeks, I set out to do exactly that. I then sent it out to Chris Hicks (@humanfact0rz) for peer review. His feedback was so good, that I asked him to co-author this project with me. If the response to this project is positive, we will work on the penetrating edition as well.

Blue=cognitive tasks for the TTL

Red=TTL must assign to a subteam (operational)

Solid=always happens in every trauma

Dotted=May happen based on patient injuries or severity

* Zero Point Survey

* Team Leadership with Cliff Reid

* EMCrit #230 - Resuscitation Communication

* COMM CHECK: More On Resuscitation Communication

* Rapid Infusion Catheter

Revised Assessment of Bleeding and Transfusion (RABT)

* Penetrating Trauma

* Shock Index > 1.0

* Pelvic Fracture

* Positive Abdominal FAST

>=2 had sensitivity of 84% and a specificity of 77%

World J Surg 2018;42:3560

5 Sites of Bleeding

* Chest

* Intra-Peritoneal

* Retro-Peritoneal/Pelvis

* Thigh

* Street

* Hemostatic Resuscitation by Richard Dutton, MD

* EMCrit Podcast 30 Hemorrhagic Shock Resuscitation

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