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Sorry for snapping. It's actually a really widespread confusion. I think it's because people want to titrate analgesia according to the patient's appearance, and the scale sorta looks like it's meant for that. Again, there actually are tools for that, such as with intubated patients -- but...

The widespread misunderstanding of the FACES scale continues to blow my mind. The visual analog scale is meant to help PATIENTS indicate their pain level (particularly when they're not great with numbers). The little faces are not for comparing to patient faces, like in Scrubs. Non-subjective...

Most folks who are working to breath probably benefit from a little extra inspiratory support. Just bear their disease process in mind to help remind you whether they need mostly IPAP or mostly EPAP.

That'll happen. Some folks won't get a pulse back unless you can stick in a finger or something to occlude their bleeder.

No, but they still might.

Although hard to say over the internet, this sounds like a zone 1 injury. Can try to pack (no delaying!) but it may be tricky.

If they seem to be inappropriately bradycardic, fair bet it's either neurogenic or they're decompensating and headed for arrest. I'd say a trial of an inotrope is totally reasonable, IF you don't delay transport and if you give just enough (i.e. don't push up their pressure too far, just...

It's not much different from penetrating trauma to the abdomen that's crashing in front of you. For whatever reason people sometimes want to do everything but surgery. Must be neurogenic, or inflammatory, or the cuff is wrong... it's like the guy in the horror movie who says "it's just the...

This is definitely a case where the BP is a big whoop. Doesn't matter at all at at this juncture. Get 'em to the hospital. IVs if you can.

Sure, but unless they respond spectacularly to that management, this is an unequivocal emergent surgical case. Delaying for any other efforts at stabilization or exploration of the differential would not be acceptable.

You really gotta assume these people are exsanguinating, though. You can do the aforementioned, but I would not delay transport for one moment, and he should probably have a thoracotomy ASAP upon arrival (in ED if truly crashing). Assuming "it's just neurogenic" is how folks bleed to death...

A lot of potential for a (non-compressible) large vessel arterial injury. Would transport ASAP for surgical hemostasis.

No starch in the blood please.

I guess what you consider "part of it" is semantics. Neuronal cell bodies in the hypothalamus connect to and regulate the sympathetic chain. At least as far as I can remember. FFS you're really bringing me back here.

Sounds a bit like the high spinal injury was causing sympathetic denervation (neurogenic shock) and respiratory compromise. Innervation of the diaphragm as well as sympathetic tone to the cardiovascular system run through the cervical spine. Not sure about the posturing without seeing it...

(Anesthesia's secret is that it's always lunch)

We're usually real excited to do a tube exchange in someone who was a difficult enough airway to need a fiberoptic intubation...

Oy. These give us grief in the ICU sometimes. We run out of room to advance 'em in long patients... or the adaptor (as discussed) gets all weird.

Can you shed some light on this mysterious practice? Last I checked bronchoscopes are longer than endotracheal tubes.

Definitely has a role. But some people do need real PEEP.