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An Evidence-Based Approach to Nonoperative Management of Traumatic Hemorrhagic Shock in the Emergency Department (Trauma CME) -
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An Evidence-Based Approach to Nonoperative Management of Traumatic Hemorrhagic Shock in the Emergency Department (Trauma CME)
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Publication Date: November 2020 (Volume 22, Number 11)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-A or 2-B CME credits. CME expires 11/01/2023.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma CME credits, subject to your state and institutional approval.

Author

Christopher Pitotti, MD, FACEP
Associate Program Director, University of Nevada-Las Vegas Emergency Medicine Residency, Las Vegas, NV; Assistant Professor of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
Jason David, MD
Department of Emergency Medicine, University of Nevada, Las Vegas, Las Vegas, NV

Peer Reviewers

Ryan M. Knight, MD
Assistant Professor of Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; Clinical Staff, University of Cincinnati, Cincinnati, OH
Leslie V. Simon, DO
Associate Professor, Mayo Clinic Alix School of Medicine; Chair, Department of Emergency Medicine, Mayo Clinic Florida, Jacksonville, FL

Abstract

The management of traumatic hemorrhagic shock has evolved, with increasing emphasis on damage control resuscitation principles. Despite these advances, hemorrhage is still the leading preventable cause of death in trauma. This issue provides evidence-based recommendations for the assessment and treatment of traumatic hemorrhagic shock. Hemostatic techniques as well as correction of hemorrhagic hypovolemia and traumatic coagulopathy are presented. The safety and efficacy of practices such as resuscitative endovascular balloon occlusion of the aorta (REBOA), viscoelastic clot testing, and whole blood resuscitation are also reviewed.

Excerpt From This Issue

Your first patient of the night is a 45-year-old man who was involved in a highway motorcycle crash. He is complaining of abdominal and pelvic pain and had a 30-minute helicopter transport time. On arrival, his vital signs are: heart rate, 130 beats/min; blood pressure, 100/60 mm Hg; respiratory rate, 26 breaths/min; temperature, 37°C; oxygen saturation, 96% on room air; and GCS, 14. You know this patient will need fluid resuscitation, but you are unsure whether you should start with crystalloid or blood…

While stabilizing the first patient, a second patient is dropped off in the ambulance bay with an inguinal gunshot wound. This 22-year-old man has a heart rate of 140 beats/min; blood pressure, 80/40 mm Hg; respiratory rate, 28 breaths/min; temperature, 36.8°C; and oxygen saturation, 98%. He has been applying his sweatshirt to the wound, which is soaked with blood. You attempt direct pressure as the team wheels him to the trauma bay and consider your options to stop this junctional bleeding...

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