Skip to content

PHARM Podcast 153 Prehospital traumatic arrest in Special Forces operation

9b4b1-top-secret

Hi folks

on todays episode I describe a case report from US Special Operations of traumatic arrest and full recovery as result of application of evidence based trauma care.

Heres the article link:

A Case of Prehospital Traumatic Arrest in a US Special Operations Soldier: Care From Point of Injury to Full Recovery

Podcast ( available here and on iTunes)

Right Click and Choose Save-as to Download the Podcast.

8 Comments Post a comment
  1. Grant Jonsson, MSc, CC-paramedic #

    Doctors…Much of what was done for this soldier in the field could be done for a trauma patient in the civilian setting. In our service area we are 30-40 minutes away from a Level 1 Trauma Center by ground ambulance. We are right on the cusp of utilizing HEMS, which would likely take very close to 30-40 minutes to arrive on scene, and then, of course, would have to load and transport, so add at least 15-20 additional minutes. We DO NOT have blood products. In the podcast the presenter spoke about the obvious superiority of blood products over crystalloid fluids. I get that. But, in the absence of blood products, would we pack and pray, or use crystalloids to achieve an acceptable permissive hypotension mark? Obviously, we cannot simply allow blood pressure to drop to the point where the patient is going to die on our cot, but do we use crystalloids to attempt to stay at a MAP of perhaps 65, or do we just apply diesel therapy and try to make that 30-40 minutes perhaps a few minutes less? I know this is a topic that has proponents on both sides of the argument, but I would appreciate any insight. It is unfortunate that none of the blood substitute products to date have proven to be the miracle we had hoped for.

    October 26, 2016
    • Saline is death

      October 26, 2016
      • Grant Jonsson, MSc, CC-paramedic #

        Dr. Le Cong…Thank you for your response. I would hope that you might add a bit more, however. Saline is obviously not death, or it wouldn’t be the most commonly (I think) used crystalloid in the world (I think again, that’s two thoughts in one sentence). But I get what you are saying. However, it does not quite answer my question. Since I do NOT have blood product, do I, or do I not, judiciously give saline in order to keep at least some minimally acceptable blood pressure for a trauma patient? I believe I would be in deep trouble if I showed up at the trauma center doors with a dead patient to whom I gave no fluids because I had no blood products. I am not being the least bit sarcastic. I really want to know what you and others think. If I did not I would not follow your site on a daily basis. “Saline is death” is just not enough. Respectfully, Grant Jonsson, MSc, CC-paramedic

        October 26, 2016
      • hi Grant. apologies for the quip but it was taken from an actual talk on trauma resus last year. I think we need to seriously reconsider our approach that we have been doing in the past. Its not illegal to give saline, of course,but the question is it really a good idea. What are we treating? the Blood pressure or the bleeding? if we truly think treating the bleeding is ideal then giving salty water is not only illogical but has no proven benefit for anything other than treating dehydration. Its a harsh reality but we do need to consider what is in fact best for the patient not just what looks good on handover or on the chart. The Israelis do use crystalloid resus in prehospital setting in their protocols but admit this is a grey area of care that no one knows the true answer but there is a clear signal that the point of benefit vs harm for crystalloid resus in bleeding shocked patients is quickly reached and we just have no idea how to judge that in prehospital setting. Therefore giving no salty water is a reasonable strategy as long as you have a plan to stop bleeding or give blood ASAP. Replace blood with like, not salty water.

        October 26, 2016
      • I used to think giving some saline/crystalloid was a good idea for the bleeding trauma pt but I do not think so any longer. And as you know in Philadelphia, they are running a study to just prove this theory https://medicine.temple.edu/departments-centers/clinical-departments/surgery/research-programs/philadelphia-immediate-transport

        October 26, 2016
    • check out this podcast to discuss the issue further. I support its opinion http://etmcourse.com/etm-podcast-episode-10-bruce-paix-andrew-perry-haemorrhage-control-in-trauma/

      October 26, 2016
      • Grant Jonsson, MSc, CC-paramedic #

        Doctor…Oh, my God. I feel like crying. On one hand I almost wish Dr. Paix was just plain wrong, because then I could feel better about what we are doing to trauma patients routinely. On the other hand, of course, I don’t think he is wrong. Interestingly, the interviewer was posing the questions that were/are on my mind, almost verbatim. As a matter of fact the interviewer was rather insistent that there just HAD TO BE a point where crystalloids (or better, blood) simply HAD to be used to keep blood pressure at SOME level, and yet Dr. Paix was pretty adamant that we needed to let nature’s physician do what was best, and that was to leave things alone if there was no way to actively control bleeding. It will be very interesting, to say the least, the first time I go into the Trauma resuscitation bay with no fluids running and my fist compressing the abdominal aorta. As they suspend my license I will at least play this podcast at my hearing. But, that’s OK. I’m old and having been in EMS since 1969 I can finally ride off into the sunset. It would be especially gratifying if the patient actually lived! It’s as though someone has given me one of the secrets of life. Now, when will we see studies that support Dr. Paix’s practice? Before I die, hopefully of old age with all my faculties, I’d like to be able to say that “yes, I used to be a paramedic before they took away my license, but I was ultimately shown to have done the right thing”. Because, guess what. Almost every time something like this comes out there is the proviso that you should “Follow local protocols”, and I don’t know of any EMS system, at least in the US, where this would be the local protocol. Perhaps I’m wrong. I hope I’m wrong. Thank you VERY MUCH for taking the time to follow up with additional responses when I asked for something more than “Saline is death”. I haven’t read all your responses. I certainly will, I’ve just been busy running shifts. I just finished the podcast minutes ago. You know, the advances in medicine are the only reason I still do what I do. I’m 68 old and very comfortable financially. It’s all simply too damned interesting to quit.

        October 28, 2016
    • the ideal strategy in the bleeding patient in shock is to stop the bleeding. if you cant do that then really you shouldnt waste time and need to get them to somewhere their bleeding can be stopped or blood replaced with blood.

      October 26, 2016

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: