Hypothermia Part 2: Prognostication and Protocols

Here we present part two on our series on hypothermia. For more on the assessment, resuscitation, and management of the hypothermic patient, see part one. Prognostication of cardiac arrest in hypothermia Indicators of cardiac arrest before cooling (Brown 2012) Major trauma Witnessed normothermic arrest Avalanche burial <35 min Patients with primary hypothermia and cardiac stability who have been treated with […]

Hypothermia: Keeping your cool when it gets cold

Hypothermia results in slightly over one hundred deaths per year in Canada; typically as a result of primary hypothermia, frostbite and other cold exposure injuries (Toronto Public Health, 2014). In the United States, this is estimated at 1500 deaths annually (Baumgartner 2008). Both are likely underestimates of the scope of illness, as it only represents patients brought to a hospital, […]

Effect of Low-Dose Supplementation of Arginine Vasopressin on Need for Blood Product Transfusions in Patients With Trauma and Hemorrhagic Shock: A Randomized Clinical Trial

Methodology: 4/5 Usefulness: 2/5 Sims CA, et al. JAMA Surg. 2019 Aug 28. Question and Methods: Single-centre, double-blind, randomized control trial to determine whether low-dose vasopressin decreases the need for blood product transfusion in trauma patients with hemorrhagic shock. Findings: A total of 100 adult trauma patients were enrolled. Vasopressin significantly decreased the volume of blood products given in the […]

Effect of Early Sustained Prophylactic Hypothermia on Neurologic Outcomes Among Patients With Severe Traumatic Brain Injury: The POLAR Randomized Clinical Trial.

Methodology Score: 3/5 Usefulness Score: 3/5 Cooper DJ, et al. JAMA. 2018;320(21):2211-2220. doi:10.1001/jama.2018.17075 Question/Methods: This study was done to determine the effectiveness of early prophylactic hypothermia compared with normothermic management of patients after severe traumatic brain injury (TBI). Findings:  No statistically significant difference in favorable neurologic outcomes at 6 months was found between the hypothermic and normothermic groups (48.8% vs 49.1%, […]

Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomized, placebo-controlled trial

Methodology: 3.5/5 Usefulness: 3.5/5 The CRASH-3 trial collaborators. The Lancet. 2019 Oct 14. Online First Editorial: CRASH-3: a win for patients with traumatic brain injury Question and Methods: Multi-centre, randomized, placebo-controlled trial looking at whether TXA (1g over 10 minutes followed by infusion over 8 hours) reduces mortality in patients with ICH. Findings: No difference in mortality in TXA vs. […]

Three week versus six week immobilisation for stable Weber B type ankle fractures: randomised, multicentre, non-inferiority clinical trial

Methodology: 4/5 Usefulness: 3.5/5 Kortekangas T, et al. BMJ. 2019 Jan 23;364:k5432 Question and Methods: This is a pragmatic, randomized, controlled trial to determine if 3 weeks of immobilization (in cast or orthosis) is non-inferior to usual treatment (6 weeks cast immobilization) for stable Weber B ankle fractures Findings: Immobilization for 3 weeks with a cast or orthotic is NOT […]

Extreme Ownership: How to Own the Trauma Bay and Lead High-Stakes Resuscitations

In this post, we’re going to do something a little different. Instead of reviewing a specific Emergency Medicine topic, we’re going to discuss Leadership – How to lead your team and make things happen during a high-stakes resuscitation. As the Leadership principles are transferable between medical and trauma resuscitations, for brevity, we will refer in this article to trauma team […]

Minor Blunt Thoracic Trauma in the Emergency Department: Sensitivity and Specificity of Chest Ultralow-Dose Computed Tomography Compared With Conventional Radiography

Methodology: 2/5 Usefulness: 2.5/5 Macri F, Greffier J, Khasanova E, Claret PG, Bastide S, Larbi A, Bobbia X, Pereira FR, de la Coussaye JE, Beregi JP. Ann Emerg Med. 2019 Jun;73(6):665-670.  Question and Methods: This 160-patient pilot study prospectively compared ultra-low dose CT chest and CXR to routine CT chest in minor blunt thoracic trauma patients. Findings: ULD-CT chest was 100% sensitive and specific, […]

Abdominal Stab Wounds: A Decision Algorithm

If you work at a trauma center, then you’re bound to see your fair share of abdominal stab wounds. Though civilian penetrating trauma has declined over recent decades and is less common than blunt trauma, penetrating trauma represents ~10% of all trauma evaluations in the U.S. and of those, ~50% are caused by stab wounds. In  2018, the Western Trauma […]