Shock in Trauma; Roadside to Resus

So as promised, and following on from our previous shock episode, this time we've covered the topic of shock in Trauma. It's a massive topic and one that we all, yet again, can make a huge difference for our patients' outcomes. 

There is some crossover as you'd expect from the concepts and assessment that we covered in our Shock episode, so we'd recommend taking a listen to that one first. Make sure you have a comfy seat and plenty of refreshments to keep you going for this one as we cover the following;

• Definition
• Aetiology
• Hypovolaemic shock
• Neurogenic shock
• Obstructive shock
• Cardiogenic shock
• Physiology; Traumatic coagulopathy
• Other diagnostics
• Controlling external haemorrhage
• Pelvic binders
• REBOA
• Avoiding coagulopathy
• BP targets & permissive hypotension
• Fluid choices & supporting evidence
• TEG/ROTEM
• Calcium
• TXA
• Vasopressors
• Preventing hypothermia
• Relieving obstruction
• Interventional radiology
• Damage control surgery

As always we’d love to hear any thoughts or comments you have on the website and via twitter, and make sure you take a look at the references and guidelines linked below to draw your own conclusions.

Enjoy!

Simon, Rob & James

References

Shock;The Resus Room podcast

REBOA;The Resus Room podcast

External Haemorrhage;The Resus Room podcast

Blood;PHEMCAST

TEG & ROTEM;FOAMcast

Major Trauma guideline;NICE

Resuscitative endovascular balloon occlusion of the aorta (REBOA):a population based gap analysis of trauma patients in England and Wales

Nationwide Analysis of Resuscitative Endovascular Balloon Occlusion of the Aorta in Civilian Trauma. Joseph B. JAMA Surg. 2019

The Pre-hospital Management of Pelvic Fractures: Initial Consensus Statement. I Scott. FPHC. 2012

RePHILL;Birmingham University Trials

Assessment and Treatment of Spinal Cord Injuries and Neurogenic Shock;Fox A. JEMS

Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. Holcomb JB. JAMA. 2015

Risks and benefitsof hypotensive resuscitation in patients with traumatic hemorrhagic shock: a meta-analysis. Owattanapanich N. Scand J Trauma Resusc Emerg Med. 2018

The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients.Roberts I. Health Technol Assess. 2013

TEG and ROTEM for diagnosing trauma‑induced coagulopathy (disorder of the clotting system) in adult trauma patients with bleeding;Cochrane Review. 2015 

Optimal Dose, Timing and Ratio of Blood Products in Massive Transfusion: Results from a Systematic Review.McQuilten ZK. Transfus Med Rev. 2018

Prehospital Plasma during Air Medical Transport in Trauma Patients at Risk for Hemorrhagic Shock.Sperry JL. N Engl J Med. 2018