RCEM Learning June 2025
Jun 12, 2025
In this engaging discussion, guest Dave McCreary, an emergency medicine expert, delves into the intricacies of HALO procedures. He shares insights on the impact of pre-hospital resuscitative thoracotomy for traumatic cardiac arrest, revealing impressive survival outcomes linked to timely interventions. The conversation shifts to managing acute behavioral disturbances, emphasizing effective communication and de-escalation techniques for volatile patients. Additionally, Dave reviews the promising results of resuscitative hysterotomies, shedding light on maternal and neonatal outcomes in critical scenarios.
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Thoracotomy Timing and Survival
- Pre-hospital resuscitative thoracotomy improves survival mainly for traumatic cardiac arrest caused by tamponade.
- Survival drastically decreases after 5 minutes from arrest, especially for exsanguination cases.
Practice Boosts Thoracotomy Success
- London HEMS' experience shows frequent practice and robust training lead to quick thoracotomy decisions.
- Their median time to thoracotomy is 22 minutes post-call, contributing to better outcomes.
Pre-hospital Handover Essentials
- Always get clear pre-hospital handover on behavior, restraint, sedation, and mental capacity assessment for acute behavioural disturbance.
- This helps guide safe emergency department management and avoid further iatrogenic harm.