Prehospital and Retrieval Medicine – THE PHARM dedicated to the memory of Dr John Hinds

Blessed the emergency systems who train their professionals with simulation

Blessed the emergency professionals who challenge themselfs day by day in simulation

Facing their fears to win their weakness

Improving the quality of their work for the good of all patients

They are the future of emergency medicine

Shame on emergency systems who don’t train with simulation

Shame on emergency professionals who don’t have the umility to challenge themselfs

Running from their fears and weakness

Compromising the quality of their work and the health of the patients

They will disappear from emergency medicine panorama

Inspiring discussion on Twitter (Minh Le Cong@rfdsdoc, Karim Brohi @karimbrohi and Peter Sherren@PBSherren)

The topic:

Your hypotensive blunt/penetrating trauma patient with associated severe TBI needs a vent. How do you set it and how you achive your physiological goals?

Is it possible to mantain eucapnia, avoiding hypercapnic insult to the brain, using low minute ventilation strategy and not depressing stroke volume with high intrathoracic pressure?

“Permissive hypoventilation” in a swine model of hemorrhagic shock.

Conclusions: Although permissive hypoventilation leads to respiratory acidosis, it results in less hemodynamic suppression and better perfusion of vital organs. In severely injured penetrating trauma patients, consideration should be given to immediate transportation without PPV.

But what if we have concomitant severe TBI? How can we avoid respiratory acidosis and hypercapnia (due to hypoventilation) and conseguent insult to the brain?

Is PEEP…