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Mon Jun 25 17:17:43 BST 2012

Huh. More evidence that everything I thought I used to know is either forgotten, wrong or out of date.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2657262/?tool=pubmed

Rob

Robert Smith, MD, MPH
Secretary War Dogs Making It Home
Chair, Div Pre-hospital Care and Prevention (ret)
Department of Trauma John H.Stroger Jr. Hospital of Cook County
http://wardogsmakingithome.org/
Tiny service dog heals Hampshire Marine - DailyHerald.com 

http://www.whereistheoutrage.net/wordpress/2012/03/20/interview-war-dogs-making-it-home/

On Jun 25, 2012, at 10:58 AM, Doc Holiday wrote:

> 
> From: edcritcare at gmail.com
>> One of my listeners can't convince her attendings that giving CPR and ACLS medications to a blunt traumatic arrest is not sound resuscitation
> 
> --> In order to "convince", one must be convincing. Sometimes there's just not enough evidence out there...
> 
> I know I was not convinced when I heard it initially... And later I became convinced... But read on...
> 
> The main problem I see with this whole theme is that "blunt traumatic arrest" is not a clinical condition in itself. It's quite a variety. "Blunt" is read as "non-penetrating", but it can be a fall, a decceleration, a baseball bat to skull, an explosive multiple amputation, etc... The mechanism can be something as "simple" as PEA due to, say, major pelvic fracture with bilateral femoral shaft fractures from an RTA with ensuing haemorrhage. But it can also be a fall from height with major head and spinal injuries along with cardiac contusion and let's throw in an aortic dissection at the same time - different animal.
> 
> "CPR and Drugs" is another broad term. Which drugs? How much CPR for how long while WHAT happens?
> 
> Having recently participated in resuscitation of a number of blunt trauma PEA arrests where good (closed) CPR along with VERY rapid infusion of blood brought patient out of PEA and bought time to stick the finger in the proverbial dyke (or something else specific), I can tell you she'd struggle hard to convince me now! And I used to be the one who, like her, tried to convince others of the futility of what I now know works.
> 
> As for "drugs" - for some of these people, vasopressors were included, but as a part of the whole - I have no formal evidence as to how much the drug made a difference, but overall we had some positive outcomes.
> 
> Trauma care has advanced a lot in recent years. We have developed very focused and resource-intensive solutions to some major killers. We CAN do good with certain conditions, but not with many others and the circumstances, timing and rapidly-deployable resource availability will make a difference. Time, in my opinion, to stop talking about "blunt traumatic arrest" and to deal with specific pathologies each in an appropriate and specific manner... And gradually, I think we'll develop some convincing evidence... 		 	   		  
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