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Trauma Top 10
2014-15
@EMManchester
@EMManchester
10
Yes or No?
9
Gp 1. 0.3mg/Kg Etomidate + 1.5mg/Kg Suxamethonium
Gp2a. 3mcg/Kg Fentanyl + 2mg/Kg Ketamine + 1mg/Kg Rocuronium
Gp2b. 1mcg/Kg Fentanyl + 1mg/Kg Ketamine + 1mg/Kg Rocuronium
Screenshot 2015-04-18 10.04.48
8
http://www.sciencedirect.com/science/article/pii/S0020138314006731
10 Trauma Centres
Patients surviving >30 mins and who received blood
966 patients included
23% received major transfusion
Sensitivity 65.6%
Specificity 63.8%
7
http://www.nejm.org/doi/full/10.1056/NEJMoa1404304
http://www.nejm.org/doi/full/10.1056/NEJMoa1404304
Moderate and severe brain injury
GCS 4-12
Within 4 hours of injury
Infusion of progesterone for 96 hours
6
5
4
http://prehospitalmed.com/2015/03/24/a-response-to-the-hirt-trial/
Method
Protocols
Time
Reproducibility
3
http://emj.bmj.com/content/early/2014/11/09/emermed-2014-204260.full.pdf+html
e
Case courtesy of Dr Frank Gaillard, radiopaedia.org
66.6%
6.6%
Case courtesy of Dr Frank Gaillard, radiopaedia.org
29.7%
54.3%
2
2010-2012*
385 patients on ICU
160 ‘shock’ patients (65% given TXA)
254 ‘non shock’ patients (30% given TXA)
1
http://jama.jamanetwork.com/article.aspx?articleid=2107789
http://jama.jamanetwork.com/article.aspx?articleid=2107789
http://www.wessexics.com/The_Bottom_Line/Review/index.php?id=7495881379650332408
http://www.wessexics.com/The_Bottom_Line/Review/index.php?id=7495881379650332408
Be (very) selective in blunt thoracotomy
Use Ket/Roc/Fent for trauma RSI
You’re rubbish at determining need for MHPs
Don’t make head injuries sexy
DSI you’re combative hypoxic patients
REBOA may not be all that it seems
RCTs in pre-hospital care are tricky
Don’t give up on the dilated head injury
TXA benefits the sickest patients
Use 1:1:1 blood, plasma, platelets in trauma
Top 10 trauma 2014 15
Top 10 trauma 2014 15

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Top 10 trauma 2014 15

Editor's Notes

  1. selection process
  2. follow on twitter/social media
  3. Kaplan-Meier Failure Curves for Mortality at 24 Hours and 30 Days The colored areas indicate 95% confidence bands, which were calculated using the Hall-Wellner method. The Hall-Wellner bands extend to the last event (death) in each group. For 24-hour mortality, the Cox proportional hazards regression model, adjusted for site as a random effect, produced a hazard ratio (HR) of 0.72 (95% CI, 0.49-1.07). There were no patients lost to follow-up during the first 24 hours from randomization. For 30-day mortality, the Cox proportional hazards regression model, adjusted for site as a random effect, produced an HR of 0.83 (95% CI, 0.61-1.12). Between 24 hours and 30 days, 4 patients were lost to follow-up and were censored when they withdrew consent or were last known to be alive (3 in the 1:1:1 group and 1 in the 1:1:2 group).
  4. Kaplan-Meier Failure Curves for Mortality at 24 Hours and 30 Days The colored areas indicate 95% confidence bands, which were calculated using the Hall-Wellner method. The Hall-Wellner bands extend to the last event (death) in each group. For 24-hour mortality, the Cox proportional hazards regression model, adjusted for site as a random effect, produced a hazard ratio (HR) of 0.72 (95% CI, 0.49-1.07). There were no patients lost to follow-up during the first 24 hours from randomization. For 30-day mortality, the Cox proportional hazards regression model, adjusted for site as a random effect, produced an HR of 0.83 (95% CI, 0.61-1.12). Between 24 hours and 30 days, 4 patients were lost to follow-up and were censored when they withdrew consent or were last known to be alive (3 in the 1:1:1 group and 1 in the 1:1:2 group).