Critical Care Topic of the Month

TXmed

Forum Captain
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Correct. Our kits are 7fr and 64cm in length, with two ports, one for balloon occlusion and the other for transducing an arterial waveform.
So in theory a critical/unstable trauma patient should just have this thrown in regardless of if you use the balloon occlusion or not, more of just a safe thing to have correct?
 

CANMAN

Forum Asst. Chief
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So in theory a critical/unstable trauma patient should just have this thrown in regardless of if you use the balloon occlusion or not, more of just a safe thing to have correct?
Idk if I would say all of that. I think the decision for REBOA with our Trauma Surgeon's is very assessment & provider based prior to placement and I don't think, or at least haven't seen them arbitrarily just placing them for a just in case scenario. If the patient is a candidate then the decision to REBOA would be a quick one and would look something like this when patient arrives: Decision to intubate/not intubate, bilateral manual blood pressures with declaration of shock/no shock, rapid trauma assessment. If mechanism or assessment findings are suggestive of waist down trauma then patient gets a portable pelvis x-ray in the bay, and if time allows/stable enough they will shoot a quick chest. If abdomen is a concern we are likely looking at doing a DPL. If patient has been declared hypotensive and in shock, TXA and 2 units is given, and pelvic x-ray shows considerable fractures/trauma then REBOA would be the next line if not going to be something we can control with pelvic binder. Regardless if patient gets a binder or REBOA, if they continue with hypotension they will go straight to the OR to get opened up within 15 minutes or less of hitting the door. Depending on who is doing the REBOA I have seen start to finish in about 5-8 minutes total time spent in bay, I have also seen the REBOA procedure take 8 minutes in and of itself for someone who isn't the most familiar with the kit...

That answer your question?
 
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Remi

Forum Deputy Chief
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Idk if I would say all of that. I think the decision for REBOA with our Trauma Surgeon's is very assessment & provider based prior to placement and I don't think, or at least haven't seen them arbitrarily just placing them for a just in case scenario. If the patient is a candidate then the decision to REBOA would be a quick one and would look something like this when patient arrives: Decision to intubate/not intubate, bilateral manual blood pressures with declaration of shock/no shock, rapid trauma assessment. If mechanism or assessment findings are suggestive of waist down trauma then patient gets a portable pelvis x-ray in the bay, and if time allows/stable enough they will shoot a quick chest. If abdomen is a concern we are likely looking at doing a DPL. If patient has been declared hypotensive and in shock, TXA and 2 units is given, and pelvic x-ray shows considerable fractures/trauma then REBOA would be the next line if not going to be something we can control with pelvic binder. Regardless if patient gets a binder or REBOA, if they continue with hypotension they will go straight to the OR to get opened up within 15 minutes or less of hitting the door. Depending on who is doing the REBOA I have seen start to finish in about 5-8 minutes total time spent in bay, I have also seen the REBOA procedure take 8 minutes in and of itself for someone who isn't the most familiar with the kit...

That answer your question?
DPL? Really? Lol
 

E tank

Caution: Paralyzing Agent
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Aortic occlusion balloons are pretty useful for ruptured AAA's. But with these, they have to be put in under fluoro because of the risk of trans migration of the wire/sheath through the damaged aorta.

Never used one in trauma...is fluoro used in that situation or is it a blind placement?
 

CANMAN

Forum Asst. Chief
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Aortic occlusion balloons are pretty useful for ruptured AAA's. But with these, they have to be put in under fluoro because of the risk of trans migration of the wire/sheath through the damaged aorta.

Never used one in trauma...is fluoro used in that situation or is it a blind placement?
Blind no fluro
 

Brandon O

Puzzled by facies
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Aortic occlusion balloons are pretty useful for ruptured AAA's. But with these, they have to be put in under fluoro because of the risk of trans migration of the wire/sheath through the damaged aorta.

Never used one in trauma...is fluoro used in that situation or is it a blind placement?
Just measured based on anatomy. They try to hit various "zones" based upon the site of injury.
 

VFlutter

Flight Nurse
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Bump. HEMS/Critical Care section has been lagging lately. Anyone have requests on topics? Devices to cover? Interesting flights?
 

VentMonkey

Ajaw
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Bump. HEMS/Critical Care section has been lagging lately. Anyone have requests on topics? Devices to cover? Interesting flights?
//shrugs// had a good MVA polytrauma v. STEMI “chicken or the egg” a few weeks ago.

Bought a tube, got good care on our end, and watched the trauma center work the pt., drop a cortis and do their best a few weeks back.
 

GMCmedic

Forum Asst. Chief
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One of our crews had a recent Head on MVA, one driver intoxicated and dead on impact, the driver they flew had a hole in his right ventricle (you could fit 3 fingers in it)

About the most interesting thing Ive heard or seen recently. He is still alive.
 

VentMonkey

Ajaw
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GMCmedic

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Has anyone heard of/ gone over the EPIC Trial? I breezed through the article and found it interesting on a broad provider scale.

Full disclosure, I did not read the study but I listened to Dr. Jarvis do a breakdown on the lighthouse podcast. I would have better luck understanding a bible written in Japanese.

I didnt find the study to be very informative as far as current practice that im used too, I could see several services local that could learn something. I thought overall the way they conducted the study and used the imformation was impressive.
 

StCEMT

Forum Deputy Chief
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One thing I haven't learned much about are the impella devices. I could read up on it myself, but some first-hand knowledge and pearls would be good as well to supplement that with.
 

GMCmedic

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One thing I haven't learned much about are the impella devices. I could read up on it myself, but some first-hand knowledge and pearls would be good as well to supplement that with.
biomed has some impella courses online that are free. I think there are 5 of them.
 

VFlutter

Flight Nurse
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One thing I haven't learned much about are the impella devices. I could read up on it myself, but some first-hand knowledge and pearls would be good as well to supplement that with.
Any specific questions? Probably deserves a write up. Lots to talk about with them. Just had a tandem (CP and RP) a few weeks ago
 

StCEMT

Forum Deputy Chief
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Any specific questions? Probably deserves a write up. Lots to talk about with them. Just had a tandem (CP and RP) a few weeks ago
I understand the very basic idea of what it does, but I think this is a case of not knowing what I don't know. Off the top of my head IABP vs Impella (when and why specifically), any unique complications to be aware of and how to fix them, and how your treatments of patients varies between the two (different approach with pressors for example). Otherwise....whatever is particularly relevant and useful knowledge.
 
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