MCC of death for trauma patients in 1st hour → hemorrhagic shock

MCC of death for trauma patients reaching hospital → TBI

M&M s/p trauma - age >65 have worst outcomes, h/o MI (1 pt), dementia (0.25 pt), cane use (0.5 pt)

Anterior pelvic fracture → Venous bleed

Posterior pelvic fracture → Arterial bleed

Above the knee popliteal access → posterolateral Sartorius

Below the knee popliteal access → posterolateral gastrocnemius (medial head)

DPL make the incision above umbilicus.

Positive with:

100,000 RBC

10 cc of blood, or

500 WBC

Elevated fluid amylase

Enteric contents or bacteria

If negative + HD unstable → resuscitate with blood

Evaluate for chest, RP, or thigh/femur for sources of bleeding

ED thoracotomy – SBP <60 or loss of pulse

• Blunt trauma - best when experiencing witnessed cardiac arrest and has <10 min of pre-hospital CPR

MC will do CPR for 20-25 min before pronouncing patient deceased

Lactate (<2.5) is the best measure of resuscitation in trauma patients, not UOP

Failure of non-op trauma treatment increases 2x in pts > 55 yo

• Frailty
• Approach for specific injuries
• Emergent Airway
• Pregnant Trauma Patient
• Penetrating abdominal injury
• Hemorrhage
• Hypothermia
• Retroperitoneal hematoma management