Thoughts from the Control Tower

careflightcollective's avatarThe Collective

This is the first of what we hope will be a series of posts from Dr Paul Bailey who works as a Medical Director for CareFlight International Air Ambulance. Paul will try to provide insights into the challenges of managing retrievals across oceans. Here’s the starter. 

In his real life, Paul Bailey is an Emergency Physician based in Perth, Western Australia who dabbles in the Greyhound racing industry (having owned 10 dogs and never been to the track).  He can often be found in the outer at an Aussie Rules football oval, most commonly critiquing the performance of the umpires in an entirely constructive manner.  Past lives include a molecular biology PhD – in Jellyfish venom – don’t ask – and being a glassy in various drinking establishments in Western Australia. 

 Paul has previously undertaken international retrievals, helicopter work supporting Australian Army exercises and time with Queensland Rescue at…

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The Bind When It Comes to a Binder (Part 3)

careflightcollective's avatarThe Collective

There’s been a lot of stimulating discussion after parts 1 and 2 of this series from Dr Alan Garner (you can check those here and here). Here’s part 3. 

Thanks for sticking with the discussion so far. In part 2 we had a look at AP compression injuries and lateral compression injuries. Short summary is binders make sense and there is some observational evidence of benefit in AP compression injuries. However in lateral compression, binders make no biomechanical sense and there is definite evidence they increase fracture displacement both in cadavers and real live trauma patients.

The final group that we have not yet considered in the Young and Burgess classification is the vertical shear group. These patients are complex because the injuries are both horizontally and vertically unstable. You will see what I mean if you have a look at this Xray:

Pelvic Xray copy

Is putting a binder around the…

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Fluid resuscitation in bleeding trauma patient: are you aware of wich is the right fluid and the right strategy?

medest118's avatarMEDEST

DCR copy

The fluids of choice in prehospital field are, in most cases, cristalloids (Norma Saline or Lactate Ringer).

But what is the physiological impact of saline solutions when administered in large amounts (as the latest ATLS guidelines indicates) to hypotensive trauma patients?

Is aggressive Fluid resuscitation the right strategy to be pursued?

The triad of post-trauma lethal evolution is:

  • Hypotermia
  • Acidosis
  • Coagulopathy

Aggressive fluid resuscitation with cristalloids, and saline solutions in particular, can be detrimental in many ways:

  1. Cristalloids tend to displace the already formed clots and improves bleeding
  2. Normal Saline produce hypercloremic acidosis worsening coagulation and precipitating renal and immune dysfunction
  3. Cristalloids diluts the coagulation factors and precipitate the coagulation system (dilution coagulopathy)
  4. Cristalloids rapidilly shift in intercellular space worsening SIRS process and interstitial edema (brain edema, bowel wall edema) with consequent compartment hypertension

So wich is the perfect fluid to infuse in trauma?

The perfect fluid doesn’t exists.

Balanced saline…

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