EMCrit Podcast EMCrit 353 - Massive Hemorrhage Protocol, the Trauma Anesthesiologist's Perspective with Roman Dudaryk
Jul 13, 2023
Roman Dudaryk, The Trauma Anesthesiologist, discusses optimizing trauma resuscitation strategies, the logistics of massive transfusion in trauma anesthesia, and managing hyperkalemia in trauma patients. Topics include subclavian access, central line placement, tranexamic acid use, and risks of MTP-induced cardioplegia.
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Watch EtCO2 And Pulse-Pressure Variation
- Use end-tidal CO2 and pulse-pressure variation rather than MAP alone to decide when to escalate blood product delivery.
- If EtCO2 drops <20 or PPV rises dramatically, prepare for aggressive transfusion and possible arrest interventions.
Place Arterial Lines Early
- Place arterial lines early for MTP patients to monitor ABGs, electrolytes, and hemodynamics; low threshold in OR and resuscitation bay.
- Use ultrasound-guided radial lines to reduce sticks and enable frequent point-of-care testing.
Use Ketamine For Hypotensive Induction
- Use ketamine for induction in hypotensive trauma to preserve endogenous catecholamines and maintain hemodynamics.
- Add small midazolam and judicious fentanyl depending on shock severity and risk of coughing on induction.