Take Home Points
- Don’t rush to the airway. In most situations, you have some time so resuscitate before you intubate. Give blood products and get the BP up a bit to give yourself a little better physiologic situation in which to intubate.
- Start your massive transfusion immediately if the patient is shocked. There’s always a delay in getting products but the earlier you start, the shorter the delay.
- Include US in your primary survey. Your E-FAST should start with the cardiac window, then go to the lungs and then, finally, the abdomen. This order focuses on finding pathology you can fix immediately.
- If the patient is shocked and peri-arrest or recently lost vitals, open the chest and look for a fixable injury. Start with opening the pericardium to relieve tamponade, identify and repair cardiac wounds and cross clamp the aorta.
Larry Mellick: Open Thoracotomy Video
EMCrit: Podcast 081 – An Interview on Severe Trauma with Karim Brohi
LITFL: Penetrating Chest Trauma
EM:RAP: How to Crack the Chest
EM: RAP: Stabbed in the Chest