REBOA: The Next Stop on the Road to Trauma Management?

The management of major trauma has a long history of failures found along a road of good intention. From Military Anti-Shock Trousers (MAST) to aggressive crystalloid administration, we’ve seen management strategies come and go over the years, after the reality of the practice didn’t measure up to the expectation of improved outcomes. Today, we have several novel concepts being implemented across the world to try to move the needle for trauma resuscitation. Tranexamic acid (TXA), blood product administration, and simple (finger) thoracostomy are a few of the advances that seem to be gaining interest in EMS. Although these developments are still “state of the art” practice in EMS, many are wondering what the next stop is on the road to trauma management. The next stop may be resuscitative endovascular balloon occlusion of the aorta (REBOA) for hemorrhagic shock with uncontrolled abdominal, pelvic, or lower extremity bleeding. What Is REBOA?
Source: JEMS Patient Care - Category: Emergency Medicine Authors: Tags: Trauma Columns Source Type: news

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This report describes a case in which emergency placement of a tube thoracostomy, in a patient with type 2 respiratory failure due to left tension pneumothorax and receiving the anticoagulant rivaroxaban, in the pharmacokinetics phase with greater anticoagulant effect, did not result in bleeding greater than that typically encountered during such interventions. The procedure ended successfully with no acute complications. PMID: 32548992 [PubMed - in process]
Source: Monaldi Archives for Chest Disease - Category: Respiratory Medicine Tags: Monaldi Arch Chest Dis Source Type: research
ConclusionThis case suggests that even if great vessel injury is not detected on contrast CT at admission, it should always be considered especially in a hemothorax case with multiple rib fractures.
Source: International Journal of Surgery Case Reports - Category: Surgery Source Type: research
Conclusions: The therapeutic efficacy of rFVIIa is dependent on the adequacy of hemostatic resuscitation; restoration of normal serum fibrinogen, INR, and platelet counts>100 K/mL may provide an adequate substrate for rFVIIa to be effective in managing refractory postoperative cardiac surgical bleeding. PMID: 31621674 [PubMed - in process]
Source: Annals of Cardiac Anaesthesia - Category: Anesthesiology Authors: Tags: Ann Card Anaesth Source Type: research
This report also highlights the use of above mentioned novel therapeutic methods for successful management of these complications in these frail patients.
Source: Annals of Thoracic Medicine - Category: Respiratory Medicine Authors: Source Type: research
‚ÄčThe value and importance of our specialty branching out into tactical emergency medicine are not widely discussed, but it can be rewarding to work with law enforcement. Tactical emergency medicine has expanded rapidly over the past two decades. The American College of Emergency Physicians even has an active tactical emergency medicine section. (http://bit.ly/2Dt1spl.) Its goal is to provide a forum for emergency physicians with interest or expertise in tactical medicine and to share information with the college and other organizations. Fellowships in tactical emergency medicine have been developed as part of academ...
Source: M2E Too! Mellick's Multimedia EduBlog - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Purpose of review Hemorrhage is the major cause of early death in severely injured patients. In civilian emergency medical services, the majority of life-threatening bleedings are found in noncompressible body regions (e.g. abdomen and pelvis). Resuscitative endovascular balloon occlusion of the aorta (REBOA) has therefore been discussed in recent years as a possible lifesaving procedure and numerous studies, meta-analyses and guidelines have been published. In this review, the data situation of REBOA in the management of bleeding trauma patients is discussed and practical implementation is depicted. Recent findings T...
Source: Current Opinion in Anaesthesiology - Category: Anesthesiology Tags: TRAUMA AND TRANSFUSION: Edited by Corey Scher Source Type: research
Background: Intrapleural fibrinolytic using the combination of tPA and DNAse can be an alternative to surgery for pleural infection cases who fail antibiotics and tube thoracostomy. To our knowledge, this is the first study on the use of tPA/DNAse in Asia.Aim: To study the use and outcomes of patients treated with tPA/DNase in our centre.Methods: Medical records of all patients who received intrapleural tPA/DNase for pleural infection from 1/12/2016 to 30/11/2017 were reviewed for demographics, treatment details, survival outcomes and complications.Results: Sixteen patients received intrapleural tPA/DNAse. Median (interqua...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Respiratory infections Source Type: research
ConclusionsMinor mechanisms of blunt trauma can cause rib fractures and massive hemothorax. Traumatic diaphragm injury should be considered a differential diagnosis if hemodynamic instability persists after transcatheter arterial embolization in patients with lower level rib fractures.
Source: Journal of Medical Case Reports - Category: General Medicine Source Type: research
The management of major trauma has a long history of failures found along a road of good intention. From Military Anti-Shock Trousers (MAST) to aggressive crystalloid administration, we’ve seen management strategies come and go over the years, after the reality of the practice didn’t measure up to the expectation of improved outcomes. Today, we have several novel concepts being implemented across the world to try to move the needle for trauma resuscitation. Tranexamic acid (TXA), blood product administration, and simple (finger) thoracostomy are a few of the advances that seem to be gaining interest in EMS. Alt...
Source: JEMS Special Topics - Category: Emergency Medicine Authors: Tags: Trauma Exclusive Articles Columns Source Type: news
Massive intrathoracic bleeding caused by rupture of a benign schwannoma is extremely rare. A 73-year-old man was admitted to our emergency department because of chest pain and dyspnea. Computed tomography revealed massive pleural effusion and a posterior mediastinal tumor. Chest tube thoracostomy was performed, and the initial blood drainage was 1700 mL. Magnetic resonance imaging revealed that the tumor at the 8th costal level measured 46 x 60 mm. The tumor, located beside the 8th vertebra, had ruptured and caused the bleeding. It was successfully excised by thoracoscopic surgery and diagnosed as a benign schwannoma.
Source: Asian Cardiovascular and Thoracic Annals - Category: Cardiology Authors: Tags: Thoracic Source Type: research
More News: Bleeding | Emergency Medicine | Thoracostomy