Login
Site Search
Trauma-List Subscription

Subscribe

Would you like to receive list emails batched into one daily digest?
No Yes
Modify Your Subscription

Modify

Home > List Archives

crushing case

Ian Seppelt seppelt at med.usyd.edu.au
Sun Apr 15 21:13:38 BST 2012


I can't access AfJEM - is it possible to post the paper?

Ian

Sent from my iPhone

On 15/04/2012, at 15:56, "Dr and Mrs T Hardcastle" <dr.tchardcastle at absamail.co.za> wrote:

> Short answer - now we know it does not help: Study by Brown et al from
> California in J Trauma and one from Cape Town (AfJEM 2011) showed no
> difference in need for RRT or mortality.
> 
> Tim Hardcastle
> 
>> This raises a question from a field provider.  As a paramedic, should
>> sodium bicarb play any role in the resuscitation of this individual?
>> Assuming a longer transport time to an ER.
>> 
>> Bicarb has always been discussed (to my knowledge) in this type of
>> resuscitation, given the (presumed) acidotic state that led to the arrest.
>> 
>> Is this correct or incorrect logic?
>> 
>> Sahaj Khalsa
>> 
>> On Sat, Apr 14, 2012 at 5:09 PM, Scott Bricker
>> <scottbricker at verizon.net>wrote:
>> 
>>> On arrival, do pericardial ultrasound. If there is cardiac motion, do
>>> resuscitative thoracotomy. If there is no cardiac motion, pronounce the
>>> patient dead.
>>> 
>>> Scott Bricker, MD
>>> Harbor-UCLA Medical Center
>>> 
>>> Connected by DROID on Verizon Wireless
>>> 
>>> -----Original message-----
>>> From: Errington Thompson
>>> <errington at erringtonthompson.**com<errington at erringtonthompson.com>
>>>> 
>>> To: trauma-list at trauma.org
>>> Cc: trauma-list at trauma.org
>>> Sent: Sat, Apr 14, 2012 22:52:10 GMT+00:00
>>> Subject: Re: crushing case
>>> 
>>> I have not followed this thread. But it appears from the presentation u
>>> have PEA. Need to go thru the drill. Bilateral chest tubes. Pericardial
>>> tap. Fluids.
>>> Errington C. Thompson, MD
>>> Trauma/Critical Care
>>> Sent from my Verizon Wireless 4GLTE Phone
>>> 
>>> -----Original message-----
>>> From: Jan <jwduijff at gmail.com>
>>> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
>>> Cc: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
>>> Sent: Sat, Apr 14, 2012 22:13:07 GMT+00:00
>>> Subject: Re: crushing case
>>> 
>>> Case very interesting, just a bit over my head so I thought better to
>>> read
>>> posted suggestions in awe..
>>> 
>>> Kind regards,
>>> 
>>> Jan Duijff
>>> Trauma fellow
>>> 
>>> Op 14 apr. 2012 om 18:23 heeft Caesar Ursic <cmursic at gmail.com> het
>>> volgende geschreven:
>>> 
>>> Interesting lack of interest in this case.  I wonder if this listserve
>>>> membership is dwindling...
>>>> 
>>>>> On Wed, Apr 11, 2012 at 1:35 AM, Dr and Mrs T Hardcastle <
>>>>> 
>>>> dr.tchardcastle at absamail.co.za**> wrote:
>>>> 
>>>>> Caesar - my comments between your questions:
>>>>>> 
>>>>> Tim Hardcastle
>>>>> 
>>>>>> A case submitted for your consideration:
>>>>>> 
>>>>>>> 43 yo male construction worker suddenly had large amount of gravel,
>>>>>>>>> 
>>>>>>>> rocks
>>> 
>>>> and dirt fall on him, burying him up to his neck.  Co-workers dug him
>>>>>> 
>>>>> out
>>> 
>>>> with shovels (took them ten minutes) and he remained awake and alert
>>>>>> during
>>>>>> this time.  Finally freed of the rubble he collapsed and lost
>>>>>> consciousness.
>>>>>> 
>>>>>>> Paramedics arrive  two minutes after his collapse.  No bystander CPR
>>>>>>>>> 
>>>>>>>> is
>>> 
>>>> being performed.  He has no palpable pulses or spontaneous respiratory
>>>>>> efforts.  Pupils reported as 5 mm bilaterally and unresponsive. The
>>>>>> 
>>>>> medics
>>>>> 
>>>>>> begin closed chest compressions, place him on a spine board and load
>>>>>> him
>>>>>> into the ambulance.  They perform rapid sequence intubation
>>>>>> (successful
>>>>>> 
>>>>> on
>>>>> 
>>>>>> first try) and start two IVs en route to the hospital.  They give two
>>>>>> doses
>>>>>> (1 mg) of IV epinephrine en route to the hospital.  They do not feel
>>>>>> return
>>>>>> of palpable pulses.  Transport time is 16 minutes.
>>>>>> 
>>>>>>> On arrival to ER he is undergoing closed chest compressions.  He
>>>>>>>>> 
>>>>>>>> still
>>> 
>>>> has
>>>>> 
>>>>>> no palpable pulses at the carotid or the femoral arteries bilaterally
>>>>>> 
>>>>> but
>>> 
>>>> on ECG monitor his *heart rate is 140/min*.  The endotracheal tube
>>>> seems
>>>>>> to
>>>>>> be in the correct position on visual inspection with the laryngoscope
>>>>>> (i.e.
>>>>>> it is going through the vocal cords). He has bruising and abrasions
>>>>>> of
>>>>>> 
>>>>> the
>>>>> 
>>>>>> chest wall but no lacerations or external bleeding.  Rib fractures
>>>>>> are
>>>>>> palpable bilaterally. Breath sounds are equal bilaterally and he is
>>>>>> easy
>>>>>> to
>>>>>> ventilate using the bag-valve.  There are two 16 gauge antecubital IV
>>>>>> catheters already in place and one of the medics is squeezing in a
>>>>>> bag
>>>>>> 
>>>>> of
>>> 
>>>> 0.9 NS (they have given 300 ml so far).  Total pre-hospital CPR is
>>>>>> estimated at 20 minutes (includes time at scene and transport time to
>>>>>> 
>>>>> ER).
>>>>> 
>>>>>> What would you do at this point?
>>>>>>>>> Would you:
>>>>>>>>> A. pronounce him dead on arrival?
>>>>>>>>> 
>>>>>>>> No
>>>>> 
>>>>>> B. continue closed chest compressions, give more fluid (crystalloid?
>>>>>> blood
>>>>>> products?) and intravenous epineprhine or other vasopressor?
>>>>>> 
>>>>> Yes and check blood gas POTASSIUM and IONISED CALCIUM: this is an
>>>>> acute
>>>>> reperfusion - typically occurs about 10 minutes to one our after
>>>>> release.
>>>>> The underlying "tachy" PEA fits with hyperkalemia
>>>>> 
>>>>>> C. insert bilateral chest tubes?
>>>>>> 
>>>>> Not empirically
>>>>> 
>>>>>> D. perform ER thoracotomy?
>>>>>> 
>>>>> NO
>>>>> 
>>>>>> E. a combination of one or more of the above?
>>>>>> F. something else entirely?
>>>>>> 
>>>>>>> Thank you.
>>>>>>>>> C. Ursic, MD
>>>>>>>>> 
>>>>>>>> Honolulu
>>>>>> --
>>>>>> trauma-list : TRAUMA.ORG
>>>>>> To change your settings or unsubscribe visit:
>>>>>> http://www.trauma.org/index.**php?/community/<http://www.trauma.org/index.php?/community/>
>>>>>> 
>>>>>>> --
>>>>>>>>>>>> 
>>>>>>>>>>> trauma-list : TRAUMA.ORG
>>>>> To change your settings or unsubscribe visit:
>>>>> http://www.trauma.org/index.**php?/community/<http://www.trauma.org/index.php?/community/>
>>>>> 
>>>>>> --> 'Twas brillig, and the slithy toves
>>>>>>>>> 
>>>>>>>> Did gyre and gimble in the wabe:
>>>> All mimsy were the borogoves,
>>>> And the mome raths outgrabe.
>>>> --
>>>> trauma-list : TRAUMA.ORG
>>>> To change your settings or unsubscribe visit:
>>>> http://www.trauma.org/index.**php?/community/<http://www.trauma.org/index.php?/community/>
>>>> 
>>> --
>>> trauma-list : TRAUMA.ORG
>>> To change your settings or unsubscribe visit:
>>> http://www.trauma.org/index.**php?/community/<http://www.trauma.org/index.php?/community/>
>>> 
>>> --
>>> trauma-list : TRAUMA.ORG
>>> To change your settings or unsubscribe visit:
>>> http://www.trauma.org/index.**php?/community/<http://www.trauma.org/index.php?/community/>
>>> 
>>> --
>>> trauma-list : TRAUMA.ORG
>>> To change your settings or unsubscribe visit:
>>> http://www.trauma.org/index.**php?/community/<http://www.trauma.org/index.php?/community/>
>>> 
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>> 
> 
> 
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/


More information about the trauma-list mailing list