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Discussion

Trauma

We're not a trauma hospital but we got a GSW that was DOA basically. I asked if we can give blood products theough the IO but it was said no. We waited several minutes for the doc to get the femoral line.

Should we have given blood through the IO?

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    Whoever told you blood cannot go through an IO was misinformed. Blood can absolutely be given through an IO.

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    Not only can you give blood through an IO, it probably would have had a faster flow rate anyway. A 20 cm 14 gauge CVC lumen has approximately the same flow rate as an IO or 20-22 gauge angio when placed under pressure. Smaller CVC lumens are going to have slower flow rates, and after you get one IO and start infusing you can go ahead and start another. An IO is far from my preferred access in a trauma but you work with what you have.

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    And to add: if that IO is placed in the humerus, you get even better flow rates than the typical proximal tibia site placement. Anything that goes through an IV can go IO.

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    Yea that is what I figured! I will surely remember that and tell everyone that was there. Thank you!!!!!!!

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    Also, can I ask how many units of blood are at your fingertips for a GSW? We put in a chest tube and out came 4L, so I know what our doc ordered was not right either.

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    • Moderator
    Also, can I ask how many units of blood are at your fingertips for a GSW? We put in a chest tube and out came 4L, so I know what our doc ordered was not right either.

    4L? Was your patient alive? That is almost the average circulating volume in a typical patient. You pretty much need a massive transfusion at that point, geez! We have three units of uncrossmatched brought to every trauma activation, and initiating a massive transfusions brings additional packs that include 4 units of PRBCs and 4 units of FFP with either cryo or platelets (those alternate with each pack). Your patient needed to be in the OR, immediately. Statty stat stat.

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    He was dead on arrival, shot in the heart. That was my first real trauma ... pretty much worse thing ever. and I definitely want to learn from what was going on. I think we could have done the thoracotomy sooner and gotten more blood to him sooner. He was 17 so I'd like to come out thinking we did everything perfect and he still died. We didnt do it perfectly. Our hospital's location is closer to the violence that happens with guns and stabbings, the trauma hospital is farther and in the upscale neighborhood... seems backwards like we should have a trauma team also.

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    He was dead on arrival, shot in the heart. That was my first real trauma ... pretty much worse thing ever. and I definitely want to learn from what was going on. I think we could have done the thoracotomy sooner and gotten more blood to him sooner. He was 17 so I'd like to come out thinking we did everything perfect and he still died. We didnt do it perfectly. Our hospital's location is closer to the violence that happens with guns and stabbings, the trauma hospital is farther and in the upscale neighborhood... seems backwards like we should have a trauma team also.

    If you didn't witness the cessation of vitals or it had been more than 15 minutes without measurable vitals, then a thoracotomy wasn't indicated (considered futile). Don't beat yourself up. Those are really tough traumas to deal with, especially with younger patients. Unfortunately we cannot save them all, though we certainly try. Have you taken TNCC?

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    He was dead on arrival, shot in the heart.

    Statistically speaking, traumas that arrest prior to medical personnel arrival (EMS or ED) have near as make no difference zero chance of survival. Standard practice is to stop external bleeds, intubate, place bilateral chest tubes (or bilateral finger thoracostomies), have given one round of ACLS drugs, and call it if there is no progress in rhythm. If those measures do not save them their injuries are to profound to survive. This has been studied in trauma centers for decades, and nobody has yet to find a better solution.

    Thoracotomy, clam shells, and sternotomy have very little benefit in the ED, and are almost always a futile effort (there are some very rare times that they do help, but are not likely to help if they are not going directly to the OR anyway).

    I thing that TNCC is a great idea, it's a great beginners class for trauma.

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