Podcasts about reboa

Welcome back to the St. Emlyn's podcast. This episode covers some of the most important developments in emergency medicine and critical care from July 2024. Whether you're practicing on the frontlines or keeping up with the latest research, this episode has something for you. From coronary risk scoring tools to cutting-edge AI in ECG interpretation, and the management of non-fatal strangulation, it's packed with insightful updates. Here's a breakdown of the key topics: The Manchester Acute Coronary Score (MACS Rule) is a valuable tool for risk-stratifying patients presenting with chest pain in the emergency department (ED). MACS uses both clinical characteristics and biomarkers like troponin to assess a patient's likelihood of experiencing an acute coronary event. A recent systematic review found that the T-MACS model (which uses troponin) has a sensitivity of 96%, making it highly effective at ruling out serious coronary events. Though the specificity is lower, MACS's real strength lies in its ability to drive clinical decisions and patient referrals. This tool is already integrated into the Electronic Patient Record (EPR) in Manchester, where it helps streamline the decision-making process for patients with chest pain. If you're looking for a reliable method to quickly and accurately stratify risk, MACS could be the answer. Artificial intelligence (AI) is revolutionizing healthcare, and its application in ECG interpretation is particularly exciting for emergency medicine. In this episode, Steve Smith joins us to talk about how AI can enhance the detection of occlusive myocardial infarction (OMI)—a concept that might one day replace the traditional ST-elevation and non-ST-elevation classifications. By integrating AI into rapid assessment areas (like pit-stop zones in the ED), clinicians can benefit from real-time ECG analysis. This reduces the burden of interruptions and helps detect subtle abnormalities that might be missed in high-pressure environments. AI-driven ECG tools could dramatically improve patient outcomes, particularly in cases of high-risk cardiac events. Non-fatal strangulation (NFS) is an often underdiagnosed condition in emergency medicine, but it carries significant risks, including carotid artery dissection. A new guideline from the Faculty of Forensic and Legal Medicine emphasizes the importance of detecting these cases and suggests that clinicians use contrast angiography to rule out vascular injuries. Beyond the medical consequences, non-fatal strangulation is also a major indicator of future violence, including homicide. The guideline highlights the ethical challenges clinicians face when deciding whether to involve law enforcement, especially when patient consent is lacking. Safeguarding and appropriate referrals are essential for these high-risk patients. REBOA has been evolving in recent years, and now it's moving from the emergency department into the pre-hospital setting. In the latest advancements, partial REBOA—which allows for some blood flow below the balloon—is being used to resuscitate patients in traumatic cardiac arrest. This partial occlusion technique may be more effective in maintaining coronary perfusion, essentially resuscitating the heart in cases of extreme hemorrhage. Early data from a feasibility study shows promise, with an 18% survival rate in patients who otherwise would have had little chance of survival. REBOA could become a life-saving pre-hospital intervention for trauma patients in the near future. Paediatric eating disorders, particularly anorexia and diabulimia, remain under-recognized in emergency medicine. In this episode, we explore some of the red flags—such as rapid weight loss, bradycardia, and postural hypotension—and why emergency clinicians need to be more attuned to the signs of eating disorders. Of all mental health disorders, anorexia has the highest mortality rate, and in cases of diabulimia, patients intentionally stop taking insulin to induce ketosis and lose weight. Given the severity of these conditions, it's crucial that we recognize them early and respond appropriately, especially when young diabetic patients present with unusual symptoms. The advent of hybrid closed-loop insulin pumps is transforming the care of type 1 diabetes. These pumps act as an artificial pancreas, continuously monitoring blood glucose levels and adjusting insulin delivery automatically. The latest guidelines from NICE recommend these devices for all patients with type 1 diabetes in the UK. However, these pumps come with their own set of challenges, especially in the emergency department, where clinicians need to know how to troubleshoot common problems, such as cannula blockages or starvation ketosis. In this episode, Nicola Trevelyan walks us through the essential steps for managing patients who use these devices. Lidocaine patches have long been used as a low-risk intervention for managing pain in elderly patients with rib fractures, particularly when nerve blocks or NSAIDs aren't viable options. But how effective are they? A recent feasibility study compared lidocaine patches with standard care and found that while the pulmonary complication rate remains high, the patches may offer some benefit for pain relief. While more research is needed, lidocaine patches continue to be a low-harm option that might provide relief in certain patient populations, particularly where other pain management strategies are contraindicated. Button battery ingestion remains one of the most dangerous emergencies in pediatric medicine. Francesca Stedman, a pediatric surgeon, explains the dangers of battery-induced burns, which can occur within hours of ingestion. Time is of the essence in these cases, and quick identification through radiographic imaging followed by rapid removal is critical to prevent long-term damage. Even when batteries are lodged in places like the nose, they can cause significant tissue damage in a short time, making early intervention absolutely vital. That's a wrap for our July 2024 podcast update! From life-saving interventions like REBOA and AI in ECG analysis to the everyday challenges of managing pediatric emergencies and coronary risk, this month's highlights offer a wealth of knowledge for clinicians. Be sure to check out the full blog posts and podcasts for more in-depth discussions on each of these topics. Thanks for listening and stay tuned for more cutting-edge insights from St. Emlyn's!

[Ep26] REBOA is a minimally invasive technique that can be used to help control bleeding in certain trauma patients. On this episode, we talk with Andy Betz, MSN, BSN - aka the Trauma Program Manager within Mount Carmel Health System in Columbus, Ohio. He also functions as a CNP at our local Mount Carmel East campus, which is a Level II Trauma Center. Andy has helped develop programs to utilize REBOA for two different healthcare systems, and now he's sharing some of the insights from previewing the latest iteration of this technology (the Partial REBOA) - and more - on this episode of High-Fidelity Conversations!Listen in on our conversation to learn more about:What kind of patient is the Partial REBOA designed for?How does this technology work?What are the different variations of REBOA technology?Have there been any non-standard patient cases in which the Partial REBOA has been effective?What have been some of the challenges with implementing this technology in a trauma program?And more!Quick Links:REBOA used in OB hemorrhage d/t placenta accreta (Journal of Trauma and Acute Care Surgery)REBOA websiteCase studies (via Prytime website)Contact Info:Andy BetzTrauma Program ManagerMount Carmel East | Level II Trauma Centerandy.betz@mchs.comDo you have ideas for future guests or topics on this podcast? Maybe you have some thoughts on how to improve the show? If that sounds like you, take a moment to answer the 3 questions on our anonymous feedback survey!Podcast artwork was made with the awesome resources from CanvaMusic and Sound FX for the show obtained from Pixabay and Pond5Email the show at hfconversations@gmail.comClosed Captioning Resources:Podnews article (for Apple/Android phones and Google Chrome browsers)Microsoft Windows article (live captions for Windows users)Apple article (live captions for Mac users)

This is the second in the four-part series on anatomical trauma with some of the world's leading experts in specialist pre-hospital care. In this episode, we are examining pelvic trauma. In this discussion, I speak with Ash Vasireddy, a fellowship-trained Orthopaedic Trauma Surgeon at King's College Hospital, London, specialising in complex fractures. We explore the critical nature of pelvic trauma, covering topics such as pre-hospital prevalence, injury classification, and management strategies, including REBOA's potential in air ambulance services. In the conversation, Ash shares insights from his extensive experience, including training at major trauma centres in the UK and the US. We also discuss pre-hospital assessment, common issues in orthopaedic trauma, and lessons from practice, concluding with key take-home messages and a review of pelvic fracture classifications.  This podcast is sponsored by PAX. Whatever kind of challenge you have to face - with PAX backpacks you are well-prepared. Whether on water, on land or in the air - PAX's versatile, flexible backpacks are perfectly suitable for your requirements and can be used in the most demanding of environments. Equally, PAX bags are built for comfort and rapid access to deliver the right gear at the right time to the right patient. To see more of their innovative designed product range please click here: ⁠https://www.pax-bags.com/en/⁠

This week, Aebhric O'Kelly talks with Dr John Quinn and Eirik Holmstrøm, who all went to Ukraine to teach the Damage Control Resus Ukraine (DCRU) course. They discuss the curriculum, the use of clinical practice guidelines (CPGs), and the importance of access to blood in the pre-hospital setting. They highlight the collaboration with Tactical Medicine North and the professional partner forces in Ukraine. The hosts also mention the Defence Health Administration's (DHA) role and the resources on the DHA website and app. The conversation emphasises evidence-based practices and knowledge exchange's significance in improving military medicine. The conversation focuses on the challenges and solutions in Ukraine's implementation of damage control resuscitation (DCR). The speakers discuss the need for interoperability in large-scale combat operations (LSCO) and the importance of rethinking traditional medical practices. They highlight the limitations of blood transfusion in the field and the need for a logistic system to support the transportation of blood. The conversation also covers training Ukrainian combat medics in advanced skills such as resuscitative endovascular balloon occlusion of the aorta (REBOA) and ultrasound. The speakers emphasise the importance of continuous learning, adapting to failures, and the potential for DCR to increase combat effectiveness in Ukraine. Keywords Damage Control Resus Ukraine, DCRU, curriculum, clinical practice guidelines, CPGs, pre-hospital setting, blood access, Tactical Medicine North, partner forces, Defence Health Administration, DHA, evidence-based practices, military medicine, damage control resuscitation, interoperability, large-scale combat operations, blood transfusion, logistic system, training, combat medics, REBOA, ultrasound, continuous learning, combat effectiveness Takeaways The DCRU course in Ukraine focused on damage control resuscitation in the pre-hospital setting. The curriculum was based on clinical practice guidelines (CPGs) from the Defence Health Administration (DHA). Access to blood and blood components was highlighted as crucial in effective care. Collaboration with Tactical Medicine North and professional partner forces in Ukraine was instrumental in the course's success. The DHA website and app provided valuable resources for learning and reference in austere environments. The exchange of knowledge and lessons learned is essential for improving military medicine. Implementing damage control resuscitation in large-scale combat operations requires interoperability and a logistic system to support the transportation of blood. Traditional medical practices need to be rethought to align with the evolving nature of warfare. Training combat medics in advanced skills such as REBOA and ultrasound can improve patient care and increase patient transport confidence. Continuous learning and adapting to failures are essential in austere medicine. Damage control resuscitation has the potential to increase combat effectiveness in Ukraine. Chapters 00:00 Introduction to Dr John Quinn and Eirik Holmstrom 02:07 Adding Co-Authors and References 04:01 Introduction to the DCRU Course 08:09 Overview of the DCRU Curriculum 13:49 Importance of Access to Blood 16:40 Acknowledging the Defence Health Administration 18:56 Interoperability and Logistic Challenges 23:35 Rethinking Traditional Medical Practices 29:24 Training Combat Medics in Advanced Skills 38:34 Continuous Learning and Adapting to Failures 41:10 The Potential of Damage Control Resuscitation

The UK REBOA trial left many with doubts over its utility for trauma patients in ED. The time from injury to its use was around 90 minutes and the trial was stopped when it didn't reduce and maybe even increased mortality compared to standard care alone. But what effect does REBOA have when used prehospitally and how feasible is it? Our first paper, from London HEMS, looks at this and gives a fascinating insight into it's use and the physiological response seen with it. We've recently looked at dual sequential defibrillation for refractory VF with the DOSE-VF trial. Our second paper this month looks at how a double defibrillator strategy, in the context of cardioversion for AF, may affect restoration of sinus rhythm in obese patients. Finally we take a look at the use of video livestreaming from scene to EMS, in a feasibility RCT. How can it affect accurate dispatch of the most appropriate resources and what impact does it have on those that use it? Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon & Rob

Reference: Jansen et al. Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma Patients With Exsanguinating Hemorrhage: The UK-REBOA Randomized Clinical Trial. JAMA. 2023 Date: June 10, 2024 Guest Skeptic: Dr. Rob Leeper is an intensivist, trauma surgeon, and general surgeon at Western University where he also serves as the director of the […] The post SGEM#443: Don't Stop Me Now – REBOA for Hemorrhage Control in Trauma Patients? first appeared on The Skeptics Guide to Emergency Medicine.

In this month's EM Quick Hits podcast: Justin Morgenstern on the first RCT of high dose nitroglycerin in SCAPE, Andrew Neill on Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) indications and evidence, Brit Long on indications for CT in suspected diverticulitis, Tahara Bhate on Central Retinal Artery Occlusion (CRAO) and diagnostic error, Matthew McArthur on penicillin allergy labels, myths and penicillin challenges, and Susan Lu on how ED physician personality influences patient outcomes... The post EM Quick Hits 56 – Nitroglycerin in SCAPE, REBOA, Diverticulitis Imaging, CRAO, Penicillin Allergy, Physician Personality appeared first on Emergency Medicine Cases.

This time is always busy for our trainees with interview preparation so Leah took the opportunity to sit down with Dr Andrew Neill, consultant in Emergency and Intensive Care Medicine in the Mater Hospital to discuss the controversial topic of REBOA. They discuss the UK-REBOA trial and the evidence behind the technique and why we should be cautious about it's used in the Irish trauma system in particular. As always, don't forget to follow us on socials on ⁠⁠⁠instagram⁠⁠⁠, ⁠⁠⁠twitter ⁠⁠⁠and ⁠⁠⁠facebook ⁠⁠⁠to keep updated with all things TCR. Coffee in hand? Right then, let's get to it!

REBOA is one spicy meatball!   On this episode, Drs. Nina Clark and Patrick Georgoff discuss the landmark UK-REBOA trial with Dr. Karim Brohi.  This is the first randomized controlled trial studying REBOA and provides invaluable information about its potential indications.    Dr. Karim Brohi is a trauma and vascular surgeon at the Royal London Major Trauma Centre and director of the London Major Trauma System, which is the largest integrated urban trauma system in the world and manages over 33,000 injuries a year.  He studied at University College of London where he obtained degrees in both computer science and medicine.  Dr. Brohi went on to train in general surgery, vascular surgery, and anesthesia/critical care in the UK and trauma surgery in Cape Town and San Francisco.  He is a prolific researcher and has led multiple large clinical trials.  Link to UK-REBOA paper: https://jamanetwork.com/journals/jama/article-abstract/2810757 BIG T Trauma episode 290 covers potential indications, placement, and complications of REBOA: https://behindtheknife.org/podcast/big-t-trauma-series-ep-2-reboa/ ***TRAUMA SURGERY VIDEO ATLAS: https://app.behindtheknife.org/premium/trauma-surgery-video-atlas ***Fellowship Application - https://forms.gle/5fbYJ1JXv3ijpgCq9*** Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

   This podcast contains remarks from a JUN 23 presentation by Dr. Warren Dorlac to the Excelsior Surgical Society.     Prepare to be enlightened as we embark on an insightful journey into the world of combat casualty care with trauma surgeon and military veteran Dr. Warren Dorlac. With his firsthand experience from multiple deployments and active role in the American College of Surgeons, Dr. Dorlac offers an unparalleled perspective on the evolution of battlefield medicine over the past two decades. We explore impactful initiatives like the Ranger Regiment's life-saving mission to eliminate preventable deaths and the profound influence of Secretary Gates' mandate to expedite surgical care for combat patients. Prepare to delve into the complexities of paramedic involvement in the battlefield and the vital importance of continuous in-route care.    Dr. Dorlac puts the spotlight on extremity trauma management and the multitude of challenges it presents in military settings, from temporary vascular shunts to the alarming rise in osteomyelitis cases in long-term patient follow-ups. He focuses on the high re-operation rates in major lower extremity amputations and the game-changing role of initiatives like the Integrated Orthotic Rehabilitation Initiative in returning our brave service members to duty. He also reflects on the critical role of CCATT in military casualty care and how it's revolutionizing the field.    Wrapping up his discussion, Dr. Dorlac delves into the remarkable advancements in military trauma care from 1993 to 2012 and covers the courageous efforts of the Ukrainian military's tactical healthcare initiatives in their ongoing conflict with Russia. He highlights the indispensable role of education, collaboration, and technological innovations in this field, with a special mention of the groundbreaking REBOA catheter. From the pivotal development of the Acute Lung Rescue Team to the enriching insights brought by civilian surgeons through the Senior Visiting Surgeon Program, Dr. Dorlac leaves no stone unturned. This enlightening episode is a must-listen for anyone interested in the intricate world of military medicine, where lives are saved on the front lines every day.   Chapters: (00:00) Innovations in Combat Casualty Care (17:01) Vascular Shunts, Infections, Amputations, Rehabilitation (25:29) Advancements in Military Trauma Care (30:48) Ukrainian Military's Tactical Healthcare Initiatives   Chapter Summaries: (00:00) Innovations in Combat Casualty Care    Combat casualty care advancements and challenges, eliminating preventable deaths, in-route care, and need for paramedics in the field.   (17:01) Vascular Shunts, Infections, Amputations, Rehabilitation    Nature's extremity trauma management in military settings, including vascular shunts, venous repair, transport time, infections, amputations, irrigation, orthosis, and rehabilitation.   (25:29) Advancements in Military Trauma Care    Advancements in military trauma care from 1993-2012, including transport challenges, education, collaboration, and technological innovations, leading to decreased case fatality ratio.   (30:48) Ukrainian Military's Tactical Healthcare Initiatives    Military medical care in conflict zones: tactical combat training, rethinking traditional practices, damage control, continuity of care, and evacuation challenges.   Take Home Messages: Battlefield medicine has undergone significant evolution over the past two decades, with considerable advancements in combat casualty care. The Ranger Regiment has been at the forefront of efforts to eliminate preventable deaths in pre-hospital settings on the battlefield, highlighting the importance of mastery and continuous rehearsal of basic life-saving skills. The mandate to deliver surgical care to combat patients within an hour has substantially improved survival rates, underscoring the critical nature of rapid medical intervention in combat zones. Continuous in-route care and the presence of paramedics in the field are vital for improving outcomes for military personnel who sustain injuries during combat. The management of extremity trauma, particularly in military settings, presents unique challenges that have led to innovations like temporary vascular shunts and increased focus on preventing osteomyelitis in long-term patient care. Rehabilitation initiatives, such as the Integrated Orthotic Rehabilitation Initiative, are transformative in helping service members return to duty and maintain unit cohesion and operational readiness. The introduction of CCATT (Critical Care Air Transport Teams) has revolutionized the transport of critically injured service members, ensuring they receive the necessary care during transport from the combat zone to medical facilities. Military trauma care from 1993 to 2012 witnessed remarkable advancements, with a decrease in case fatality ratios despite an increase in the severity of injuries, demonstrating improved effectiveness of trauma care systems. Education, collaboration, and technological innovations are crucial in advancing military medicine and enhancing the ability to save lives in combat scenarios, as seen with tools like the REBOA catheter. Tactical healthcare initiatives, such as those adopted by the Ukrainian military, illustrate the ongoing need to adapt and improve combat casualty care in response to different conflict environments and challenges. Episode Keywords: Combat Casualty Care, Trauma Surgeon, Military Veteran, American College of Surgeons, Battlefield Medicine, Preventable Deaths, Secretary Gates, Surgical Care, Paramedic, Extremity Trauma Management, Vascular Shunts, Osteomyelitis, Lower Extremity Amputations, Integrated Orthotic Rehabilitation Initiative, CCATT, Advancements, Military Trauma Care, Ukrainian Military, Tactical Healthcare Initiatives, Education, Collaboration, Technological Innovations, Acute Lung Rescue Team, Senior Visiting Surgeon Program, Conflict Zones, Targeted Attacks, Medical Personnel, Military Damage Control Techniques, Continuity of Care, Evacuation Hashtags: #BattlefieldMedicine #CombatCasualtyCare #MilitaryTrauma #LifeSavingInnovations #TraumaSurgery #MilitaryMedics #WarriorHealth #TacticalHealthcare #MedicalAdvancements #VeteranSurgeons   Honoring the Legacy and Preserving the History of Military Medicine   The WarDocs Mission is to honor the legacy, preserve the oral history, and showcase career opportunities, unique expeditionary experiences, and achievements of Military Medicine. We foster patriotism and pride in Who we are, What we do, and, most importantly, How we serve Our Patients, the DoD, and Our Nation.   Find out more and join Team WarDocs at https://www.wardocspodcast.com/ Check our list of previous guest episodes at https://www.wardocspodcast.com/episodes Listen to the “What We Are For” Episode 47. https://bit.ly/3r87Afm   WarDocs- The Military Medicine Podcast is a Non-Profit, Tax-exempt-501(c)(3) Veteran Run Organization run by volunteers. All donations are tax-deductible and go to honoring and preserving the history, experiences, successes, and lessons learned in Military Medicine. A tax receipt will be sent to you. WARDOCS documents the experiences, contributions, and innovations of all military medicine Services, ranks, and Corps who are affectionately called "Docs" as a sign of respect, trust, and confidence on and off the battlefield, demonstrating dedication to the medical care of fellow comrades in arms.     Follow Us on Social Media Twitter: @wardocspodcast Facebook: WarDocs Podcast Instagram: @wardocspodcast LinkedIn: WarDocs-The Military Medicine Podcast

In this podcast episode, Dennis interviews Eric and Ted from Prytime Medical about the P-REBOA catheter. They discuss the training process in Ukraine, the differences between the P-REBOA and the original REBOA catheter, the benefits of the P-REBOA in terms of balloon times and blood product use, and the complications and monitoring for reperfusion injury. They also address the placement of the catheter and the challenges of using it in the field. The episode concludes with information about future plans and research, as well as contact information for Prytime Medical. Takeaways The P-REBOA catheter is used to stabilize patients with severe hemorrhage in the field, particularly in situations where immediate surgical intervention is not possible. Training for the P-REBOA catheter involves a combination of didactic instruction and hands-on practice with simulation devices. The P-REBOA catheter has a semi-compliant balloon that allows for partial occlusion, maintaining some blood flow below the balloon and reducing the risk of reperfusion injury. The P-REBOA catheter can be used to extend the time window for surgical intervention, allowing for stabilization and transport of critically injured patients. Securing the P-REBOA catheter during transport involves suturing or using a catheter clamp to prevent dislodgement. Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com For more content go to www.prolongedfieldcare.org

   Step into the vanguard of battlefield medicine with Dr. John M. Croushorn, an engineer-turned-emergency physician whose innovations are redefining trauma treatment. From his pivotal career switch of joining Army Medicine post-9/11 to creating the Abdominal Aortic Junctional Tourniquet (AAJT-S), this episode weaves together the personal and the technical, providing an intimate look at the challenges and triumphs of military medicine.   As we converse with Dr. Croushorn, you'll be transported to the front lines of tactical emergency medical solutions, where the origins of such practices in the military and law enforcement laid the groundwork for today's life-saving techniques. Discover the birth of the AAJT-S, spurred by tragedy and necessity, and how a chance encounter with a Special Forces Medic brought the device's development full circle. This narrative captures the essence of innovation — where creativity meets critical needs, and every step in the design process can mean the difference between life and death. The trenches of tactical medicine are filled with stories of lives saved and legacies forged, and each tale tightens the bond between trauma care advancements and those who stand ready at the front lines.   Dr. Croushorn continues to pull back the curtain on the dynamic field of military medicine, guiding us through the application of junctional tourniquets and their profound impact on saving lives in pre-hospital scenarios. We'll also cast an eye to the future, examining ongoing research and the global implications of these medical advancements. Hear tales of the AAJT-S's deployment in diverse environments, from the deserts of the Middle East to the conflict in Ukraine, and learn how this technology is not just a tool but a testament to human resilience and the relentless pursuit of advancing trauma treatment.   Chapters: (00:00) Military Medicine and Trauma Treatment Innovation (15:08) Developing Tactical Emergency Medical Solutions (21:26) Junctional Tourniquets for Hemorrhage Control (35:19) Junctional Tourniquet Application and Future Innovations (45:38) Physiologic Effects of a Cardiac Device   Chapter Summaries: (00:00) Military Medicine and Trauma Treatment Innovation Former Army Medical Corps officer shares journey from engineering to military medicine, including deployment experiences and innovative contributions.   (15:08) Developing Tactical Emergency Medical Solutions Tactical medicine's role in the FBI, development of the AAJT-S for pelvic bleeding, and a serendipitous encounter with a Special Forces Medic.   (21:26) Junctional Tourniquets for Hemorrhage Control Junctional tourniquets are crucial in trauma care, effectively controlling hemorrhage in extremity-torso junctions and surpassing other methods.   (35:19) Junctional Tourniquet Application and Future Innovations Versatile junctional tourniquet device for pediatric to 64-inch circumference patients, efficacy compared to REBOA, and use in trauma centers and NCTH.   (45:38) Physiologic Effects of a Cardiac Device Innovative application of the AAJT-S has shown impressive results in traumatic cardiac arrest scenarios, leading to protocol changes and ongoing studies in Ukraine.   Take Home Messages: The tragic events of 9/11 inspired a shift in career from electrical engineering to Military Medicine, highlighting the profound impact significant historical events can have on individual life choices. The development of the Abdominal Aortic Junctional Tourniquet (AAJT-S) marked a significant advancement in pre-hospital trauma care, particularly for severe hemorrhage control in areas where traditional tourniquets are ineffective. Innovation in military medical devices can stem from unexpected places, including the adaptation of materials like bike shop inner tubes, demonstrating resourcefulness in the face of challenges. Collaboration between medical professionals and those with hands-on battlefield experience, such as Special Forces Medics, is crucial for the practical development of life-saving medical technologies. Tactical emergency medical solutions, like the AAJT-S, have evolved to meet the specific needs of military and emergency response situations, including combat scenarios and disaster relief efforts. The versatility of junctional tourniquets makes them a critical tool not only for the military but also for civilian emergency services, as evidenced by their use by air ambulance services and fire departments. Emergency Medicine is continually advancing, with a focus on developing solutions for non-compressible torso hemorrhage, which presents new challenges in the field of trauma care. Groundbreaking research into the physiologic effects of medical devices in traumatic cardiac arrest scenarios is paving the way for updated emergency protocols and potentially higher survival rates. The global impact of military medical innovations can be seen in various international settings, including conflict zones like Ukraine, where they play a vital role in saving lives on the battlefield. Effective hemorrhage control, particularly in junctional areas, is essential for improving survival rates in trauma patients, emphasizing the importance of continuous innovation and application of medical devices in pre-hospital settings.   Episode Keywords: Military Medicine, Trauma Treatment, Emergency Medical Protocols, Abdominal Aortic Junctional Tourniquet, Tactical Medicine, Hemorrhage Control, Pre-hospital Setting, Medical Device Development, Special Forces Medic, Junctional Tourniquet, Extremities, Combat Gauze, Expandable Foams, Pediatric Patients, Non-compressible Torso Hemorrhage, Physiologic Effects, Traumatic Cardiac Arrest, Return of Spontaneous Circulation, Porcine Model, Emergency Protocols, Ukrainian Vascular Surgeon, Bakhmut Conflict, Military Medical Authorities   Hashtags: #wardocs #military #medicine #podcast #MilMed #MedEd #MilitaryMedicineInnovation #AbdominalAorticTourniquet #TacticalMedicineTech #TraumaCareBreakthroughs #LifesavingInventions Honoring the Legacy and Preserving the History of Military Medicine The WarDocs Mission is to honor the legacy, preserve the oral history, and showcase career opportunities, unique expeditionary experiences, and achievements of Military Medicine. We foster patriotism and pride in Who we are, What we do, and, most importantly, How we serve Our Patients, the DoD, and Our Nation.   Find out more and join Team WarDocs at https://www.wardocspodcast.com/ Check our list of previous guest episodes at https://www.wardocspodcast.com/episodes Listen to the “What We Are For” Episode 47. https://bit.ly/3r87Afm WarDocs- The Military Medicine Podcast is a Non-Profit, Tax-exempt-501(c)(3) Veteran Run Organization run by volunteers. All donations are tax-deductible and go to honoring and preserving the history, experiences, successes, and lessons learned in Military Medicine. A tax receipt will be sent to you.   WARDOCS documents the experiences, contributions, and innovations of all military medicine Services, ranks, and Corps who are affectionately called "Docs" as a sign of respect, trust, and confidence on and off the battlefield, demonstrating dedication to the medical care of fellow comrades in arms.     Follow Us on Social Media Twitter: @wardocspodcast Facebook: WarDocs Podcast Instagram: @wardocspodcast LinkedIn: WarDocs-The Military Medicine Podcast

This chapter we talk with Dr. Henry Schiller, trauma surgeon and professor of surgery at Mayo Clinic, about a variety of hematomas including Morel Lavellee lesions, retroperitoneal hematomas, rectus sheath and more! Alex even gets to ask a question about REBOA that he has been hoping to do for a long time.  CONTACTS X - @AlwaysOnEM; @VenkBellamkonda YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com REFERENCES & LINKS Nickerson TP, Zielinski MD, Jenkins DH, Schiller HJ. The Mayo Clinic Experience with Morel-Lavallee lesions: Establishment of a practice management guideline. J Trauma Acute Care Surg. 2012. Vol 76, Number 2 493-497 Demetriades D, Chan LS, Velmahos G, Berne TV, Cornwell III EE, Belzberg H, Asensio JA, Murray J, Berne J, Shoemaker W. TRISS methodology in trauma: the need for alternatives. British Journal of Surgery 1998, 85,379-384 Meyer DM, Jessen ME, Grayburn PA. Use of echocardiography to detect occult cardiac injury after penetrating thoracic trauma: A prospective study. J Trauma. 1995 Nov;39(5):902-7      

Tänään tutustutaan lääkärihelikopteritoimintaan Lontoossa, jossa London's Air Ambulance Charity -järjestön lahjoitusvaroin pyörittämä pelkästään traumapotilaiden hoitoon keskittynyt yksikkö kohtaa päivittäin kaikkein vaikeimmin loukkaantuneita potilaita. Otetaan selvää miten brittiläinen HEMS-toiminta eroaa suomalaisesta, miten Lontoossa hyödynnetään lääkärihelikopteria ja minkälaisia haastaviakin toimenpiteitä yksikön miehistö tekee kaikkein vaikeimmin loukkaantuneille potilaille. Käydään myös läpi minkälaisia toimintamalleja voisi kernaasti tuoda kotimaiseen ensihoitoympäristöömme ja vastaavasti mitkä asiat voisi Suomesta viedä maailmallekin.  Jakson vieraan aikaansaannoksista lääketieteen ja ensihoidon saralla riittäisi läpi käytävää vaikka useampaankin jaksoon. Kosti Koivisto-Kokko on anestesiologian ja tehohoidon erikoislääkäri, joka on uransa aikana työskennellyt lääkärihelikoptereissa niin Australiassa, Uudessa-Seelannissa kuin Iso-Britanniassakin peräti kahdessa eri yksikössä, mukaan lukien legendaarisessa London's Air Ambulance -lääkärikopterissa, eli London HEMS:issä. Suomessa Kosti on työskennellyt sekä FinnHEMS 50:ssa Oulussa että 20:ssa Turussa. Lisäksi lääkärin työ on vienyt Kostin kansainvälisten järjestöjen matkassa kriisipisteisiin eri puolille maailmaa, muun muassa Syyriaan, Yemeniin, Ukrainaan ja Gazaan. #laadukastaensihoitoa #FOAMed #ensihoito #akuuttihoito #lääketiede #HEMS #trauma #lääkärihelikopteri #londonHEMS #londonsairambulance #torakostomia #torakotomia #REBOA

In this episode of PragChat, Aaron and Jason sit down with Dr. Jeremy Kaswer and discuss REBOA. REBOA has been a hot topic recently due to a recent paper that presented some new information concerning patient outcomes. Dr. Kaswer discusses what REBOA is, how it works, why it could become a valuable tool in trauma, and other aspects.  Dr. Kaswer a surgical critical care fellow at the Hospital of the University of Pennsylvania and a flight surgeon with the 28th ECAB in the Pennsylvania Army National Guard. He worked EMS during medical school and continues to volunteer as a lieutenant with the Avon Fire Department and EMT with New Hartford Volunteer Ambulance.  Thanks to Dr. Kaswer for taking time out of his busy schedule to talk with us and if you're not following him, check out his Instagram and LinkedIn. Follow the PragMedics on Instagram and Twitter. 

Well this has been a huge month for Emergency Medicine and Critical Care in terms of papers! We start off looking at REBOA; many resuscitationist's favourite concept or device with the much awaited UK-REBOA trial. What does the paper mean for practice in our Resus Rooms? Is this about to become a key part of trauma management? The paper is fascinating and one of the most though provoking we've discussed in a while. Next up we look at CROYSTAT-2, another such anticipated trial looking at whether survival could be improved by administering an early and empirical high dose of cryoprecipitate to all patients with trauma and bleeding that required activation of a major hemorrhage protocol. Finally we look at a paper which describes a taxonomy of key performance errors in intubation and may inform our review and improvement of intubation in the ED. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon & Rob

In this episode, we review Resuscitative endovascular balloon occlusion of the aorta (REBOA), notably dissecting the recent Jansen et al trial in JAMA. Shownotes / References:  FOAMcast.org Thanks for listening! Jeremy Faust & Lauren Westafer

Jan Jansen (Birmingham, USA) & Marion Campbell (Aberdeen) present the results of the UK-REBOA trial, investigating the use of REBOA in trauma patients with severe non-compressible torso haemorrhage. The editorial is delivered by John Holcomb (also from Birmingham, USA) and the session is chaired by Catriona Kelly from Dublin. The panel discussing the trial are Diana Cimpoesu (Ilsa, Romania), Caroline Leech (Coventry), Stephen Bernard (Melbourne) and Roger Lewis (Los Angeles).

After a long, hot and relaxing summer (!) Simon and Iain return with all the content from the St Emlyn's blog in July and August. They discuss four papers in detail, including the ARREST trial about cardiac arrest centres, whether clinical examination can identify life threatening injuries in trauma, the TOP-ART study looking at a novel agent in trauma management and the use of REBOA.  Please do like and subscribe and get in touch if you would like to contribute to the blog site. 

In the high-stakes world of emergency medicine, innovations continually push the boundaries of what's possible. One such groundbreaking procedure is Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA). Dr. Ernest E Moore, who has literally written the book on trauma surgery, teaches us what REBOA is and how it is being used to save lives in critical situations. Another episode from the Rocky Mountain Trauma and Emergency Medicine Conference.  See more on this topic from the blog post on our website: https://emspodcast.com/resuscitative-endovascular-balloon-occlusion-of-the-aorta-reboa/  

Dr. Nayantara Coelho-Prabhu, Mayo Clinic gastroenterologist specializing in the care of patients with gastrointestinal bleeding and endoscopy, talks through many aspects of acute GI bleeding. She helps to clarify the prioritization of medications, when to incorporate imaging, broadens our differentials for upper and lower GI bleeding, gives mindblowing advice on stool guiac testing and SO much more in this over-stuffed (or should we say constipated) chapter of Always on EM. There is also a special cameo from Dr. Luke Wood going over how to insert a Minnesota tube (esophageal balloon tamponade device)!   CONTACTS X - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com   RECOMMENDATION: Dieulafoy lesion video from New England Journal of Medicine: https://youtu.be/tzJQDen1nug?si=zOmywZ1VN3VvA004    REFERENCES: Drescher MJ, Stapleton S, Britstone Z, Fried J, Smally AJ. A call for reconsideration of the use of fecal occult blood testing in emergency medicine. Journal of Emerg Med. 2020. 58(1)54-58 Mathews BK, Ratcliffe T, Sehgal R, Abraham JM, Monash B. Fecal Occult Blood testing in hospitalized patients with upper gastrointestinal bleeding. Journal of Hospital Medicine. 2017. 12(7)567-569 Harewood GC, McConnell JP, Harrington JJ, Mahoney DW, Ahlquist DA. Detection of occult upper gastrointestinal bleeding: performance in fecal occult blood tests. Mayo Clin Proc. 2002 Jan;77(1):23-28 Blatchford O, et al. A risk score to predict need for treatment for upper gastrointestinal haemorrhage. Lancet 2000. Oct 14;356(9238):1318-21 Blatchford O, Davidson LA, Murray WR, Blatchford M, Pell J. Acute upper gastrointestinal haemorrhage in west of scotland: case ascertainment study. BMJ 1997. Aug 30;315(7107):510-4 Chen IC, Hung MS, Chiu TF, Chen JC, Hsiao CT. Risk scoring systems to predict need for clinical intervention for patients with nonvariceal upper gastrointestinal tract bleeding. Am J Emerg Med. 2007 Sep;25(7):774-9 Laine L, Barkun AN, Saltzman JR, Martel M, Leontiadis GI. ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding. Am J Gastroenterol. 2021 May 1;116(5):899-917 Roberts I, Shakur-STill H, Afolabi A, et al. Effects of High-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial. Lancet 2020. 395(10241):1927-1936 Aziz M, Haghbin H, Gangwani MK, Weissman S, Patel AR, Randhawa MK, Samikanu LB, Alyousif ZA, Lee-Smith W, Kamal F, Nawras A, Howden CW. Erythromycin improves the quality of esophagogastroduodenoscopy in upper gastrointestinal bleeding: a network meta-analysis. Dig Dis Sci 2023. Apr;68(4):1435-1446 Abraham NS, Barkun AN, Sauer BG, et al. American College of Gastroenterology-Canadian Association of Gastroenterology Clinical Practice Guideline: Management of anticoagulants and antiplatelets during acute gastrointestinal bleeding and the periendoscopic period. Am J Gastroenterol 2022;00:1-17 Vigano GL, Mannucci PM, Lattuada A, Harris A, Remuzzi G. Subcutaneous desmopressin (DDAVP) shortens the bleeding time in uremia. Am J Hematol 1989. May;31(1):32-5 Chavez-Tapia NC, Barrientos-Gutierrez T, Tellez-Avila FL, Soares-Weiser K, Uribe M. Antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding. Cochrane Database Syst Rev 2010. Sep 8;2010(9):CD002907 Gao Y, Qian B, Zhang X, Liu H, Han T. Prophylactic antibiotics on patients with cirrhosis and upper gastrointestinal bleeding: A meta-analysis. PLoS One 2022. Dec 22;17(12):e0279496 Steffen R, Knapp J, Hanggi M, Iten M. Use of the REBOA catheter for uncontrollable upper gastrointestinal bleeding with hemorrhagic shock. Anaesthesiologie 2023. May;72(5):332-337 Sato M, Kuriyama A. Countering hemorrhagic shock due to duodenal variceal rupture with resuscitative endovascular balloon occlusion of the aorta. Am J Emerg Med 2023. Feb;64:204.e1-204.e3

This is the first of a special podcast series on obstetric critical care.  I am joined on this series by Dr. Elizabeth Garchar, MD, FACOG.  She is an OB/GYN and Maternal Fetal Medicine (MFM) specialist who has a special interest in obstetric critical care.  She is also unique in that she flies regularly with our critical care transport teams and acts as one of our Assistant Medical Directors for the flight program.  So, Dr. Garchar has unique insight into managing this population in transport. This podcast focuses on severe postpartum hemorrhage.  We discuss the epidemiology and risk factors as well as the nuances of diagnosis, specifically how blood loss is actually quantified in this setting.  We also go through the importance of point-of-care ultrasound to help identify and manage the causes of postpartum hemorrhage.  Then, we transition to the discussion of management, focusing on the medical management of uterine atony, and also go over advanced interventions such as uterine packing, balloon tamponade devices, and REBOA.  Finally, Dr. Garchar discusses the indication and procedure for emergent hysterectomy as well as the post-procedure management critical care transport crews may have to perform.   References   Practice Bulletin No. 183: Postpartum Hemorrhage. Obstet Gynecol. Oct 2017;130(4):e168-e186. doi:10.1097/aog.0000000000002351 Abdel-Aleem H, Singata M, Abdel-Aleem M, Mshweshwe N, Williams X, Hofmeyr GJ. Uterine massage to reduce postpartum hemorrhage after vaginal delivery. Int J Gynaecol Obstet. Oct 2010;111(1):32-6. doi:10.1016/j.ijgo.2010.04.036 Abul A, Al-Naseem A, Althuwaini A, Al-Muhanna A, Clement NS. Safety and efficacy of intrauterine balloon tamponade vs uterine gauze packing in managing postpartum hemorrhage: A systematic review and meta-analysis. AJOG Glob Rep. Feb 2023;3(1):100135. doi:10.1016/j.xagr.2022.100135 Aibar L, Aguilar MT, Puertas A, Valverde M. Bakri balloon for the management of postpartum hemorrhage. Acta Obstet Gynecol Scand. Apr 2013;92(4):465-7. doi:10.1111/j.1600-0412.2012.01497.x Bagga R, Jain V, Kalra J, Chopra S, Gopalan S. Uterovaginal packing with rolled gauze in postpartum hemorrhage. MedGenMed. Feb 13 2004;6(1):50. Borger van der Burg BLS, van Dongen T, Morrison JJ, et al. A systematic review and meta-analysis of the use of resuscitative endovascular balloon occlusion of the aorta in the management of major exsanguination. Eur J Trauma Emerg Surg. Aug 2018;44(4):535-550. doi:10.1007/s00068-018-0959-y Castellini G, Gianola S, Biffi A, et al. Resuscitative endovascular balloon occlusion of the aorta (REBOA) in patients with major trauma and uncontrolled haemorrhagic shock: a systematic review with meta-analysis. World J Emerg Surg. Aug 12 2021;16(1):41. doi:10.1186/s13017-021-00386-9 Collaborators WT. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet. May 27 2017;389(10084):2105-2116. doi:10.1016/S0140-6736(17)30638-4 Cunningham FG, Nelson DB. Disseminated Intravascular Coagulation Syndromes in Obstetrics. Obstet Gynecol. Nov 2015;126(5):999-1011. doi:10.1097/AOG.0000000000001110 D'Alton M, Rood K, Simhan H, Goffman D. Profile of the Jada(R) System: the vacuum-induced hemorrhage control device for treating abnormal postpartum uterine bleeding and postpartum hemorrhage. Expert Rev Med Devices. Sep 2021;18(9):849-853. doi:10.1080/17434440.2021.1962288 Dildy GA, 3rd. Postpartum hemorrhage: new management options. Clin Obstet Gynecol. Jun 2002;45(2):330-44. doi:10.1097/00003081-200206000-00005 Dueckelmann AM, Hinkson L, Nonnenmacher A, et al. Uterine packing with chitosan-covered gauze compared to balloon tamponade for managing postpartum hemorrhage. Eur J Obstet Gynecol Reprod Biol. Sep 2019;240:151-155. doi:10.1016/j.ejogrb.2019.06.003 Erez O. Disseminated intravascular coagulation in pregnancy: New insights. Thrombosis Update. 2022;6doi:10.1016/j.tru.2021.100083 Erez O, Mastrolia SA, Thachil J. Disseminated intravascular coagulation in pregnancy: insights in pathophysiology, diagnosis and management. Am J Obstet Gynecol. Oct 2015;213(4):452-63. doi:10.1016/j.ajog.2015.03.054 Erez O, Othman M, Rabinovich A, Leron E, Gotsch F, Thachil J. DIC in Pregnancy - Pathophysiology, Clinical Characteristics, Diagnostic Scores, and Treatments. J Blood Med. 2022;13:21-44. doi:10.2147/JBM.S273047 Feng S, Liao Z, Huang H. Effect of prophylactic placement of internal iliac artery balloon catheters on outcomes of women with placenta accreta: an impact study. Anaesthesia. Jul 2017;72(7):853-858. doi:10.1111/anae.13895 Higgins N, Patel SK, Toledo P. Postpartum hemorrhage revisited: new challenges and solutions. Curr Opin Anaesthesiol. Jun 2019;32(3):278-284. doi:10.1097/ACO.0000000000000717 Ji SM, Cho C, Choi G, et al. Successful management of uncontrolled postpartum hemorrhage due to morbidly adherent placenta with Resuscitative endovascular balloon occlusion of the aorta during emergency cesarean section - A case report. Anesth Pain Med (Seoul). Jul 31 2020;15(3):314-318. doi:10.17085/apm.19051 Kellie FJ, Wandabwa JN, Mousa HA, Weeks AD. Mechanical and surgical interventions for treating primary postpartum haemorrhage. Cochrane Database Syst Rev. Jul 1 2020;7(7):CD013663. doi:10.1002/14651858.CD013663 Kogutt BK, Vaught AJ. Postpartum hemorrhage: Blood product management and massive transfusion. Semin Perinatol. Feb 2019;43(1):44-50. doi:10.1053/j.semperi.2018.11.008 Levi M, Toh CH, Thachil J, Watson HG. Guidelines for the diagnosis and management of disseminated intravascular coagulation. British Committee for Standards in Haematology. Br J Haematol. Apr 2009;145(1):24-33. doi:10.1111/j.1365-2141.2009.07600.x Liu C, Gao J, Liu J, et al. Predictors of Failed Intrauterine Balloon Tamponade in the Management of Severe Postpartum Hemorrhage. Front Med (Lausanne). 2021;8:656422. doi:10.3389/fmed.2021.656422 Lohano R, Haq G, Kazi S, Sheikh S. Intrauterine balloon tamponade for the control of postpartum haemorrhage. J Pak Med Assoc. Jan 2016;66(1):22-6. Maier RC. Control of postpartum hemorrhage with uterine packing. Am J Obstet Gynecol. Aug 1993;169(2 Pt 1):317-21; discussion 321-3. doi:10.1016/0002-9378(93)90082-t Makin J, Suarez-Rebling DI, Varma Shivkumar P, Tarimo V, Burke TF. Innovative Uses of Condom Uterine Balloon Tamponade for Postpartum Hemorrhage in India and Tanzania. Case Rep Obstet Gynecol. 2018;2018:4952048. doi:10.1155/2018/4952048 Natarajan A, Alaska Pendleton A, Nelson BD, et al. Provider experiences with improvised uterine balloon tamponade for the management of uncontrolled postpartum hemorrhage in Kenya. Int J Gynaecol Obstet. Nov 2016;135(2):210-213. doi:10.1016/j.ijgo.2016.05.006 Natarajan A, Kamara J, Ahn R, et al. Provider experience of uterine balloon tamponade for the management of postpartum hemorrhage in Sierra Leone. Int J Gynaecol Obstet. Jul 2016;134(1):83-6. doi:10.1016/j.ijgo.2015.10.026 Okoye HC, Nwagha TU, Ugwu AO, et al. Diagnosis and treatment of bbstetrics disseminated intravascular coagulation in resource limited settings. Afr Health Sci. Mar 2022;22(1):183-190. doi:10.4314/ahs.v22i1.24 Ordonez CA, Manzano-Nunez R, Parra MW, et al. Prophylactic use of resuscitative endovascular balloon occlusion of the aorta in women with abnormal placentation: A systematic review, meta-analysis, and case series. J Trauma Acute Care Surg. May 2018;84(5):809-818. doi:10.1097/TA.0000000000001821 Papageorgiou C, Jourdi G, Adjambri E, et al. Disseminated Intravascular Coagulation: An Update on Pathogenesis, Diagnosis, and Therapeutic Strategies. Clin Appl Thromb Hemost. Dec 2018;24(9_suppl):8S-28S. doi:10.1177/1076029618806424 Pingray V, Widmer M, Ciapponi A, et al. Effectiveness of uterine tamponade devices for refractory postpartum haemorrhage after vaginal birth: a systematic review. BJOG. Oct 2021;128(11):1732-1743. doi:10.1111/1471-0528.16819 Quandalle A, Ghesquiere L, Kyheng M, et al. Impact of intrauterine balloon tamponade on emergency peripartum hysterectomy following vaginal delivery. Eur J Obstet Gynecol Reprod Biol. Jan 2021;256:125-129. doi:10.1016/j.ejogrb.2020.10.064 Rattray DD, O'Connell CM, Baskett TF. Acute disseminated intravascular coagulation in obstetrics: a tertiary centre population review (1980 to 2009). J Obstet Gynaecol Can. Apr 2012;34(4):341-347. doi:10.1016/S1701-2163(16)35214-8 Revert M, Rozenberg P, Cottenet J, Quantin C. Intrauterine Balloon Tamponade for Severe Postpartum Hemorrhage. Obstet Gynecol. Jan 2018;131(1):143-149. doi:10.1097/AOG.0000000000002405 Sadek S, Lockey DJ, Lendrum RA, Perkins Z, Price J, Davies GE. Resuscitative endovascular balloon occlusion of the aorta (REBOA) in the pre-hospital setting: An additional resuscitation option for uncontrolled catastrophic haemorrhage. Resuscitation. Oct 2016;107:135-8. doi:10.1016/j.resuscitation.2016.06.029 Schmid BC, Rezniczek GA, Rolf N, Saade G, Gebauer G, Maul H. Uterine packing with chitosan-covered gauze for control of postpartum hemorrhage. Am J Obstet Gynecol. Sep 2013;209(3):225 e1-5. doi:10.1016/j.ajog.2013.05.055 Shimada K, Taniguchi H, Enomoto K, Umeda S, Abe T, Takeuchi I. Hospital transfer for patients with postpartum hemorrhage in Yokohama, Japan: a single-center descriptive study. Acute Med Surg. Jan-Dec 2021;8(1):e716. doi:10.1002/ams2.716 Simpson KR. Update on Evaluation, Prevention, and Management of Postpartum Hemorrhage. MCN Am J Matern Child Nurs. Mar/Apr 2018;43(2):120. doi:10.1097/NMC.0000000000000406 Singer KE, Morris MC, Blakeman C, et al. Can Resuscitative Endovascular Balloon Occlusion of the Aorta Fly? Assessing Aortic Balloon Performance for Aeromedical Evacuation. J Surg Res. Oct 2020;254:390-397. doi:10.1016/j.jss.2020.05.021 Snyder JA, Schuerer DJE, Bochicchio GV, Hoofnagle MH. When REBOA grows wings: Resuscitative endovascular balloon occlusion of the aorta to facilitate aeromedical transport. Trauma Case Rep. Apr 2022;38:100622. doi:10.1016/j.tcr.2022.100622 Soued M, Vivanti AJ, Smiljkovski D, et al. Efficacy of Intra-Uterine Tamponade Balloon in Post-Partum Hemorrhage after Cesarean Delivery: An Impact Study. J Clin Med. Dec 28 2020;10(1)doi:10.3390/jcm10010081 Stensaeth KH, Sovik E, Haig IN, Skomedal E, Jorgensen A. Fluoroscopy-free Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for controlling life threatening postpartum hemorrhage. PLoS One. 2017;12(3):e0174520. doi:10.1371/journal.pone.0174520 Suarez S, Conde-Agudelo A, Borovac-Pinheiro A, et al. Uterine balloon tamponade for the treatment of postpartum hemorrhage: a systematic review and meta-analysis. Am J Obstet Gynecol. Apr 2020;222(4):293 e1-293 e52. doi:10.1016/j.ajog.2019.11.1287 Theron GB, Mpumlwana V. A case series of post-partum haemorrhage managed using Ellavi uterine balloon tamponade in a rural regional hospital. S Afr Fam Pract (2004). May 11 2021;63(1):e1-e4. doi:10.4102/safp.v63i1.5266 Tran QK, Hollis G, Beher R, et al. Transport of Peripartum Patients for Medical Management: Predictors of Any Intervention During Transport. Cureus. Nov 2022;14(11):e31102. doi:10.7759/cureus.31102 Weir R, Lee J, Almroth S, Taylor J. Flying with a Safety Net: Use of REBOA to Enable Safe Transfer to a Level 1 Trauma Center. Journal of Endovascular Resuscitation and Trauma Management. 2022;5(3)doi:10.26676/jevtm.v5i3.214 Wu Q, Liu Z, Zhao X, et al. Outcome of Pregnancies After Balloon Occlusion of the Infrarenal Abdominal Aorta During Caesarean in 230 Patients With Placenta Praevia Accreta. Cardiovasc Intervent Radiol. Nov 2016;39(11):1573-1579. doi:10.1007/s00270-016-1418-y Zeng KW, Ovenell KJ, Alholm Z, Foley MR. Postpartum Hemorrhage Management and Blood Component Therapy. Obstet Gynecol Clin North Am. Sep 2022;49(3):397-421. doi:10.1016/j.ogc.2022.02.001  See omnystudio.com/listener for privacy information.

Que Tal? Esper que todo vaya super bien. En el Episodio de esta semana conversamos sobre el REBOA (Resuscitative endovascular balloon occlusion of the aorta) por sus siglas en inglés. Para ello conversamos con Rosanna Chorro y Andrés Climent. Quienes tienen mucha experiencia en la instalación de REBOA en escenarios Pre - Hospitalario y en el diseño de programas de formación. Son además readores de la cuenta @prehospital_critical_care en esta cuenta publican información relevante a sus cursos y eventos en los que puedes aprender a instalar un REBOA.  Visita además su sitio web www.prehospitalcriticalcare.net Espero que disfrutes tremendamente este episodio. Un abrazo David Larrondo Fonseca

In this conversation we will examine the prevalence, types, and challenges of pelvic trauma. We will also look at some of the pre-hospital and Emergency Department management of pelvic trauma and why it can be such a critical injury to treat. To do this I am speaking with Ash Vasireddy. Ash is a fellowship-trained Orthopaedic Trauma Surgeon specialising in the management of complex upper limb, lower limb, pelvic and acetabular fractures. He works at King's College Hospital (Major Trauma Centre) in London. He completed further specialist Orthopaedic Trauma training at The Royal London Hospital, as well as Orthopaedic Trauma Fellowships at Queen's Medical Centre in Nottingham and King's College Hospital in London. In addition, Ash has also completed travelling fellowship visits to multiple major trauma centres in America, including the Shock Trauma Centre in Baltimore and Harborview Medical Centre in Seattle. Ash also has extensive experience in Emergency Medicine, Intensive Care and Anaesthesia. He is also a Consultant at Essex and Herts Air Ambulance (EHAAT) and research lead for EHAAT. In the conversation we examine: Why a pelvic fracture is so critical The pre-hospital prevalence What are the main types / classifications The spectrum of injury – pain to life threatening blood loss Pre-hospital assessment of the pelvis Some of the common issues seen as an Orthopaedic Trauma Surgeon IR vs OR Possibilities of REBOA within the Air Ambulance Service Lessons learnt from practice (pre-hospital and in-hospital) Seminal cases Final thoughts & take-home messages. In the conversation Ash mentions the two common types of Pelvic classification, these are: TILE: https://litfl.com/classification-of-pelvic-fractures/ Young and Burgess classification of pelvic ring fractures: https://radiopaedia.org/articles/young-and-burgess-classification-of-pelvic-ring-fractures?lang=gb My thanks to Ash for an insightful and engaging interview.

In this session I am speaking with Robbie Lendrum on the Myocardial Hypoperfusion & injury in Trauma. We examine the Windkessel concept of pulsatile flow to constant flow, reservoir pressure as an analogue of diastolic pressure, coronary perfusion in diastole. We also explore blood pressure targeted intervention, the disparity between NIBP and IBP, the precision of diagnostics versus intervention, and individually patient centred intervention. We finally fundamentally drill down into the true importance of diastolic blood pressure in trauma care and how this is a succinct shift in mindset and teaching to traditional systolic blood pressure measurements and cut offs. To do this I have Robbie Lendrum with me. Robbie is a consultant in cardiac anaesthesia and critical care. He is also a consultant in Pre-Hospital Care working with London's Air Ambulance. Robbie is an honorary senior lecturer at Queen Mary university London and an Endovascular Resuscitation Researcher within the UK. Within the conversation we also examine: Cardiac hypoperfusion – pathophysiology The Windkessel concept – converting pulsatile flow into constant flow, the generation of pressure. Reservoir pressure equal to diastolic pressure Coronary perfusion in diastole and the fundamental importance of diastole in trauma Arterial injury and respective diastolic hypotension – wide pulse pressures - Effect on coronary perfusion pressure & flow CVD – Cardiovascular Dysfunction with early death/72 hour boundary. Physiological targets (targeted intervention) Why should we move on from blood transfusion and drive faster to hospital. The secondary effects on the heart & essentially outcome. Arterial shock and the proximal thoracic aorta. The two main types of patient and how we approach these (Tamponade and exsanguination) My thanks to Robbie for this interview. This is a fundamental shift in teaching and mindset and is seminal in how we see and approach trauma care in the future. The key pieces of research that Robbie mentions in the interview includes: Importance of the aortic reservoir in determining the shape of the arterial pressure waveform. The forgotten lessons of Frank. https://www.sciencedirect.com/science/article/abs/pii/S187293120700155X The Underlying Cardiovascular Mechanisms of Resuscitation and Injury of REBOA and Partial REBOA https://pubmed.ncbi.nlm.nih.gov/35615678/ Trauma Laparotomy in the UK: A Prospective National Service Evaluation https://pubmed.ncbi.nlm.nih.gov/34015456/ My thanks to Robbie for his insights and reflections.

Join Shyam Murali, Mike Radomski, and Jeremy Levin as they talk with Dr. Chance Spalding of Grant Medical Center about their journey in implementing REBOA at their institution and how they have improved over the years.

Join Shyam Murali, Mike Radomski, and Jeremy Levin as they talk with Dr. Chance Spalding of Grant Medical Center about their journey in implementing REBOA at their institution and how they have improved over the years.

Objectives: Understand trauma resuscitation differences in children and adults. Understand management of solid organ injury in children and need for angio/embolization. Understand the indications for REBOA in the adolescent population. Presenter: Alexis Smith, MD Pediatric Trauma Surgeon & TMD at CHOA

In this session we will examine the bleeding patient in the tactical and combat environment. We will dig into some of the fundamental education that has changed practice in recent years, we will also look at the sequential approach to bleeding control, second and third generation haemostatics, pharmacological agents, tourniquets, neck zones and injuries, blunt injury and junctional wounds, hypotensive management and finally pain management in the combat arena. We also examine the utility and success of highly interventional skills at or near point of wounding such as REBOA. Finally we will examine Traumatic Cardiac Arrest (TCA) and the utility (or not) of an algorithmic approach to management. To do this, Ed Barnard joins me. Ed is an emergency medicine consultant within Cambridge University hospital and has undergone sub-specialty training in pre-hospital EM, working in more than five EMS systems, educating and mentoring medical students and doctors in training, giving national and international lectures, delivering a national research and clinical innovation meeting, completing a PhD from a top-100 research university, publishing over 30 journal articles, receiving five national-level research awards, and being appointed as a Senior Lecturer for the military. Topics covered: Sequential approach to arresting bleeding Look at second/third/fourth generation haemostatic compounds (celox, quik-clot) Utility of tourniquets (origins, usage and types) Neck zones and wounds Blunt injury and junctional wounds Hypotensive mx - utility of this Critical Hypovolaemia and tx modality Interventions at point of wounding - REBOA TCA management and algorithmic approaches Ed's reflections and perspectives over the past 5 years on bleeding Some of the concepts and evidence that Ed mentions in the episode can be found here: A comparison of Selective Aortic Arch Perfusion and Resuscitative Endovascular Balloon Occlusion of the Aorta for the management of hemorrhage-induced traumatic cardiac arrest: A translational model in large swine https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5526509/ The outcome of patients in traumatic cardiac arrest presenting to deployed military medical treatment facilities: data from the UK Joint Theatre Trauma Registry https://militaryhealth.bmj.com/content/164/3/150.abstract Prehospital determinants of successful resuscitation after traumatic and non-traumatic out-of-hospital cardiac arrest Epidemiology and aetiology of traumatic cardiac arrest in England and Wales — A retrospective database analysis https://www.sciencedirect.com/science/article/abs/pii/S030095721630538X Please enjoy this episode with an insightful and engaging guest.

On this episode of the BIG T Trauma series Drs. Patrick Georgoff, Teddy Puzio, and Jason Brill discuss hemodynamically unstable pelvic fractures.  These patients are sick!!  Really sick.  Join as for a practical discussion about best to manage gnarly pelvic fractures.  From binders to angioembolization to pelvic packing to REBOA, we cover it all.   Papers:  Burlew et al, Preperitoneal pelvic packing reduces mortality in patients with life-threatening hemorrhage due to unstable pelvic fractures. J Trauma 2017: https://pubmed.ncbi.nlm.nih.gov/27893645/ McDonogh et al, Preperitoneal packing versus angioembolization for the initial management of hemodynamically unstable pelvic fracture: A systematic review and meta-analysis. J Trauma 2022: https://pubmed.ncbi.nlm.nih.gov/34991126/ Li et al, Role of pelvic packing in the first attention given to hemodynamically unstable pelvic fracture patients: a meta-analysis, J ournal of Orthopaedics and Traumatology 2022: https://pubmed.ncbi.nlm.nih.gov/35799073/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out the rest of the BIG T trauma series here: https://behindtheknife.org/podcast-series/big-t-trauma/

xThis month we've got a New in EM examining the use of fluids in RSI, look at a guideline for caring for patients with a learning disability, bring you the highlights of the Thames Valley Air Ambulance Cardiac Arrest Symposium, and then bring you some new articles for New Online. (01:46) New in EM – Fluids in RSI Effect of Fluid Bolus Administration on Cardiovascular Collapse Among Critically Ill Patients Undergoing Tracheal Intubation: A Randomized Clinical Trial Safety of the Peripheral Administration of Vasopressor Agents (09:02) Guidelines for EM – Acute medical care for people with a learning disability Acute care toolkit 16: Acute medical care for people with a learning disability (54:26) Highlights from the Thames Valley Air Ambulance Cardiac Arrest Symposium Thames Valley Air Ambulance Cardiac Arrest Symposium (54:57) James Raitt – Defibrillation Strategies (58:38) Darren Best and Mark Hodkinson – Improving cardiac arrest management at a local level (01:01: 59) Rory Saggers – Experiences from London Advanced Paramedic Practitioners (01:06:15) Paul Rees – Haemodynamic guided CPR and REBOA (01:10:15) Iain Carroll – ECMO CPR (01:16:48) Rupert Simpsons – Cardiac Arrest Centres (01:22:05) New Online – new articles on RCEMLearning for your CPD Creative Careers in Emergency Medicine Part 1 – Career Longevity - Lois Brand Management of STEMI and its Complications - Jason Kendall EM Quizzes

In this week's class, we talk with Dr. Jeremy Kaswer, better known as @TacTraumaMD, about his approach to the initial stabilization of the poly-trauma patient.From Assessment to Chest Tubes, Shock Index to REBOA, Dr. Kaswer shares his experience as an ED physician, Army Flight Surgeon, and Critical Care Fellow at SHOCK Trauma with our community.And be sure to stick around to the end when Dr. Kaswer's drops a BOMB on us about obstructive physiology in the trauma patient and why he believes more prehospital providers should be using POCUS in the field.

Podcast summary of articles from the May 2022 edition of the Journal of Emergency Medicine from the American Academy of Emergency Medicine.  Topics include High Sensitivity Troponins, Modified Shock Index in Dementia, Tramadol, Haloperidol vs Ziprasidone, Masking for COVID, and REBOA.  Guest speaker is Dr. Tyler Hughes.

The mortality rate for unstable pelvic hemorrhage due to blunt trauma remains around 30 percent. However, technological advances promise to finally make a dent. But on the cutting edge, it's not clear which treatments should be used when to maximize lives saved. With life-threatening pelvic exsanguination, time is critical. Do you know when to rush to pack the pelvis? Do you know when to deploy a REBOA instead? Are there scenarios where you should do both? Join Drs. Urréchaga, Neeman, and Rattan from Ryder Trauma Center in Miami as they try to tease out answers using two studies hot off the presses with seemingly contradictory results. Learning Objectives: Blunt Pelvic Hemorrhage ·       Expanding knowledge of management strategies for blunt pelvic hemorrhage ·       Describe propensity score matching and its use in non-randomized studies ·       Compare outcomes of REBOA and preperitoneal pelvic packing (PPP) ·       Critically appraise study design and methods of studies References 1.     S. Mikdad, I.A.M. van Erp, M.E. Moheb, et al. Pre-peritoneal pelvic packing for early hemorrhage control reduces mortality compared to resuscitative endovascular balloon occlusion of the aorta in severe blunt pelvic trauma patients: A nationwide analysis. Injury. 2020; 51:1834–1839. doi.org/10.1016/j.injury.2020.06.003 2.     S. Asmar, L. Bible, M. Chehab, et al. Resuscitative Endovascular Balloon Occlusion of the Aorta vs Pre-Peritoneal Packing in Patients with Pelvic Fracture. Journal of the American College of Surgeons. 2021; 232(1):17-26. doi.org/10.1016/j.jamcollsurg.2020.08.763 3.     B. Joseph, M. Zeeshan, J.V. Sakran, et al. Nationwide Analysis of Resuscitative Endovascular Balloon Occlusion of the Aorta in Civilian Trauma. JAMA Surg. 2019;154(6):500-508. doi:10.1001/jamasurg.2019.0096 Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

We. Are. Back!! After a (brief?!) hiatus, we are launching 2022 with a 2-part series with the one and only Dr. Ken Mattox. In this episode, Dr. Mattox shares with us his thoughts on what the modern general surgeon should look like and how we as surgeons differ from our medicine counterparts. Additionally, we review the history of modern trauma resuscitation, the paradigm shifts that have occurred as it pertains to permissive hypotension, as well as the technological advances that have occurred over the last century that have improved care of the critically injured patient. This is an episode not to be missed!Time Stamps00:12 Welcome & announcements04:21 What does the modern "surgeon" look like?07:48 The interplay between technology & surgery10:15 Serendipity & Dr. Mattox's early career11:28 Finessing & integrating clinical practice with research opportunities13:45 The 2 most impactful advances in trauma care during the last century: the microchip & organized trauma systems17:00 Dr. Mattox's thoughts on REBOA & intravascular control/treatment techniques22:32 MAST pants: lessons learned25:18 Elevate the BP with MAST and fluids? Increase the mortality!!26:30 Permissive hypotension27:06 Vasopressors in the ER?! Hypotension is teleological!! ReferencesBickell WH, Pepe PE, Wyatt CH, Dedo WR, Applebaum DJ, Black CT, Mattox KL. Effect of antishock trousers on the trauma score: a prospective analysis in the urban setting. Ann Emerg Med. 1985 Mar;14(3):218-22. doi: 10.1016/s0196-0644(85)80443-1. PMID: 3977145.Bickell WH, Wall MJ Jr, Pepe PE, Martin RR, Ginger VF, Allen MK, Mattox KL. Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med. 1994 Oct 27;331(17):1105-9. doi: 10.1056/NEJM199410273311701. PMID: 7935634.Hirshberg A, Hoyt DB, Mattox KL. From "leaky buckets" to vascular injuries: understanding models of uncontrolled hemorrhage. J Am Coll Surg. 2007 Apr;204(4):665-72. doi: 10.1016/j.jamcollsurg.2007.01.005. Epub 2007 Feb 23. PMID: 17382227.2022 Mattox Vegas TCCACShttps://www.trauma-criticalcare.com/tccacs/program/Support the show (https://www.patreon.com/traumaicurounds)

COL (ret.) Joseph DuBose joins Trevor and Max to provide an overview of ECMO, and discuss  its use in flight. ECMO isn't a new procedure, but it has become more visible in recent years as its use has expanded. In Europe, there are pre-hospital ECMO teams, and the US Air Force CCAT program has brought the technology far forward. Dr. DuBose has been involved with some of these efforts, along with research supporting its use. Recently, Dr. DuBose co-authored a paper describing a feasibility study of battlefield initiation of ECMO, with follow on rotary-wing evacuation (citation below).In addition to the ins-and-outs of ECMO, Dr. DuBose discusses the real-world challenges of bringing advanced procedures such as ECMO and REBOA to the battlefield, and makes a very compelling case that just because you can do something, doesn't mean you should.   Reva, V. A., Pochtarnik, A. A., Shelukhin, D. A., Skvortzov, A. E., Semenov, E. A., Emelyanov, A. A., Nosov, A. M., Demchenko, K. N., Reznik, O. N., Samokhvalov, I. M., & DuBose, J. J. (2020). Battlefield Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest: A Feasibility Study During Military Exercises. Journal of special operations medicine : a peer reviewed journal for SOF medical professionals, 20(4), 77–83.

You could save a life from catastrophic exsanguination with a simple, recently refined device.  Join Dr. Adam Power and Mark Plaster as they discuss Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA).  

En este nuevo episodio de 99% Emergencias, realizaré un repaso del Balón de Resucitación Aórtico Endovascular o REBOA en el paciente traumático de forma sencilla y lo más clara posible para que nos empecemos a familiarizar en este dispositivo que dará mucho que hablar en los próximos años. Espero que os guste y sea de utilidad. Bibliografía utilizada: - Carlos A. Ordoñez, Ramiro Manzano-Nunez, Ana Milena del Valle, Fernando Rodriguez, Paola Burbano, Maria Paula Naranjo, Michael W. Parra, Paula Ferrada, Mónica Alejandra Solís-Velasco, Alberto F. García, Current use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in trauma, Colombian Journal of Anesthesiology, Volume 45, Supplement 2, 2017, Pages 30-38, ISSN 2256-2087, - NAEMT. Soporte vital de trauma prehospitalario. Ed 9. Colegio Americano de Cirujanos. - Tsurukiri et al. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine (2016) 24:13

In this episode, we discuss the history and development of resuscitative endovascular balloon occlusion of the aorta (REBOA) and its application in civilian and military trauma.  We explore the reasons behind the surge in REBOA research as well as the recent controversy associated with REBOA.  We look at its application in the civilian and military realm and argue that in these settings where injury patterns may differ, REBOA may have different specific roles.  In either case, the specific indications are relatively narrow and REBOA is not a panacea for all trauma.

Dr. Asha Parekh, Co-Founder and CEO of Frontline Medical Technologies joined The Savvy Entrepreneur recently to chat about her company's journey and about how to encourage more women in STEM, entrepreneurship, and especially healthcare startups. Asha is a first-time CEO -- no small feat in the medical device world.  She and her partner have also largely boostrapped their way through regulatory approval, and are nearly ready for commercialization. The device they've invented and are bringing to market through Frontline Medical Technologies is the world's smallest REBOA device.  It's designed to stem traumatic bleeding to allow critically injured patients a better shot at getting to the operating room before they lose too much blood. Currently, 90% of trauma patients with significant internal bleeding never even make it to the OR. Asha candidly shares some of the many challenges she and the company have faced.  She offers several pieces of advice that she's learned along the way. She also is passionate and devotes time to helping girls and young women consider STEM (Science, Technology, Engineering, and Medicine) careers.  She shares her thoughts on how to encourage more women -- not only in technology careers, but also to have the courage and vision to become entrepreneurs and leaders.  On average, only 19% of leadership roles in the MedTech industry are held by women. Similarly, only 10% of healthcare startups are owned and/or founded by women. Click on the arrow to the left to take a listen!  Or, if you prefer, read a transcript of the interview.

Many efforts in the pre-hospital combat environment had been aimed at prolonging the viability of a patient until they are able to make it to a surgeon. The goal of military triage and evacuation is to have urgent surgical patients to a waiting surgical team within 2 hours. Despite our best efforts, this is not always possible. When it is not possible,it is important to do the simple interventions which we know make a difference for combat casualties such as tourniquets, wound packing, needle decompression, airway adjuncts and pelvic binding. Wounds causing non-compressible hemorrhage to the torso need additional strategies to bridge the time and space gap to definitive treatment. A non-surgical adjunct which has shown much promise has been the early transfusion of whole blood and blood products until surgical care can be provided. Our newest Clinical Practice Guideline on Remote Damage Control Resuscitation details what should be done and why. There is an entirely separate working group, The Tactical Hemostasis, Oxygenation and Resuscitation (THOR) group dedicated to exactly those principles which we partnered with early on to help identify solutions dealing with hemorrhagic shock. Despite all that effort and brain power however, blood remains a finite resource in the austere environment and Medics have faced terrible situations where even blood administration is not enough and surgery is too far away. It is in these times of worst-case desperation that we want to do more for our patients. Some of the adjuncts discussed in this episode are abdominal tourniquets, REBOA and open surgical procedures. We don't take any of this lightly and realize that for the vast majority of our pre-hospital audience, many of the procedures discussed are far outside the current scope of practice. What is possible? What is responsible? What is sustainable? Enjoy the talk.

You are in your Team House or BAS. You have given FDP, Whole blood, TXA calcium and don't have much left despite the few units from the walking blood bank. Your patient continues to bleed internally. Nothing in the chest or upper abdomen. Probably pelvic. Damn. MEDEVAC is en route. They will have some blood too. You just need your patient to hold on for another hour before he gets to surgery… Dr. Joe DuBose is an Air Force Trauma Surgeon who recognized early in his career that hemorrhage was the number one killer of potentially survivable patients. This led him to a fellowship in vascular surgery and, as Dennis put it made him a guru in the emerging technology that allows a catheter to be placed in the femoral artery and snaked up past a bleed in the pelvis, abdomen and even chest where a balloon is then inflated cutting off all blood flow below that point. Dr. DuBose was the first to do This in the ED using a newer version that had a small enough diameter that a vascular repair would not be required after use. It is simply placed through a central line and removed as such later on. This is called REBOA or Resuscitative Endovascular Balloon Occlusion of the Aorta. As you can imagine this is not without limits and complications if done improperly. You are in your Team House or BAS. You have given FDP, Whole blood, TXA calcium and don't have much left despite the few units from the walking blood bank. Your patient continues to bleed internally. Nothing in the chest or upper abdomen. Probably pelvic. Damn. MEDEVAC is en route. They will have some blood too. You just need your patient to hold on for another hour before he gets to surgery… Dr. Joe DuBose is an Air Force Trauma Surgeon who recognized early in his career that hemorrhage was the number one killer of potentially survivable patients. This led him to a fellowship in vascular surgery and, as Dennis put it made him a guru in the emerging technology that allows a catheter to be placed in the femoral artery and snaked up past a bleed in the pelvis, abdomen and even chest where a balloon is then inflated cutting off all blood flow below that point. Dr. DuBose was the first to do This in the ED using a newer version that had a small enough diameter that a vascular repair would not be required after use. It is simply placed through a central line and removed as such later on. This is called REBOA or Resuscitative Endovascular Balloon Occlusion of the Aorta. As you can imagine this is not without limits and complications if done improperly. REBOA In this episode we explore the usefulness and limitations of this strategy in deployed settings and discuss the use of REBOA by non-physician providers in austere situations. He has written several articles on use of the REBOA and it is now one of the most promising and controversial adjuncts available for hemorrhage control of bleeding inside the box of the thorax, abdomen and pelvis. In order to do this o e would likely have to be within an hour of a facility that can repair the retired vessel as the lactic acid and other toxins would quickly build up causing a massive repercussion injury. To this end he discusses his strategy for partial REBOA during resuscitation that would leave the balloon partially inflated allowing a clot to strengthen and circulation distal to the balloon. For more content, visit www.prolongedfieldcare.org

ER Innovation Series: PodCast I: AAJT-S (Abdominal Aortic & Junctional Tourniquet - Stabilized) We dive into the creation and evolution of the AAJT-S from its original design as the AAT through its current design & capabilities.  This is a jammed packed and heated discussion with Sean, JJ, and the co-inventor of the AAJT-S, Dr. John Croushorn.  Discussion points include;  Why the AAJT-S excels in rescue situations, How it compares to Zone 3 REBOA, How certain studies either input fraudulent bias or negligently ignore data, The extraordinarily low pain tolerances some physicians involved in a preferential research study apparently have to misinform readers, How JJ signed a contract written on a napkin, selling his soul at an Ozzy / Korn Concert many years ago, Why committees need to re-evaluate their position on medical items that exist in rescue contracts…and actually consider the context / environment in which these medical items will be utilized…or IEBM (Improved Environmental Based Medicine), and a bunch more…

In this episode of Medsider Radio, we're talking with Dr. Asha Parekh, a biomedical engineer and the co-founder & CEO of FrontLine Medical Technologies, a Canadian medical device startup. FrontLine has developed a novel REBOA device that helps trauma patients survive in emergency situations. If you're not familiar, REBOA stands for Resuscitative Endovascular Balloon Occlusion of the Aorta.In this discussion with Asha, we learn about her medtech journey from early-stage device prototypes to raising venture capital to navigating the global regulatory landscape.But first, here's a bit more on Asha's background:Asha has a PhD in biomedical engineering from Western University in Ontario. In 2015, she partnered with Dr. Adam Power, a practicing vascular surgeon, to co-found FrontLine, which makes the COBRA-OS device for trauma patients. Before we jump into the conversation, I wanted to mention a few things:If you're into learning from proven medtech and healthtech leaders, and want to know when new content and interviews go live, head over to Medsider.com and sign up for our free newsletter. You'll get access to gated articles, and lots of other interesting healthcare content. Second, if you want even more inside info from proven experts, think about a Medsider premium membership. We talk to experienced healthcare leaders about the nuts and bolts of running a business and bringing products to market. This is your place for valuable knowledge on specific topics like seed funding, prototyping, insurance reimbursement, and positioning a medtech startup for an exit.In addition to the entire back catalog of Medsider interviews over the past decade, Premium members get exclusive Ask Me Anything interviews and masterclasses with some of the world's most successful medtech founders and executives. Since making the premium memberships available, I've been pleasantly surprised at how many people have signed up. If you're interested, go to medsider.com/subscribe to learn more.Lastly, here's the link to the full interview with Asha if you'd rather read it instead.

Go to HelloFresh.com/Surgery12 to get up to 12 free meals and support Behind The Knife.Host: Kevin KnieryGuest Hosts: Alexis Lauria and Alec KerseyCheck our YouTube tutorial on REBOA https://bit.ly/3uSxLXbFor more in detail vascular trauma discussions check out our previous episodes with Dr. Todd Rasmussen. 

In this episode of the JSOM Podcast, Alex and Josh begin the podcast with an interesting open discussion about recent cases of patients travelling to Mexico to receive plastic surgery during the COVID-19 pandemic. Josh and Alex provide their analysis on the articles outlining the Secondary Traumatic Stress in Emergency Services Systems (STRESS) Project and Conversion of the AAJT to REBOA in a Swine Hemorrhage model. Guest reviewer, Naval Special Warfare medic PJ Pelaez discusses the article on Performance Characteristics of Fluid Warming Technology for Austere Environments. Visit our Social Media @jsomonline https://jsom.us/Podcast

This week Paul Rees returns to discuss the trans specialty procedure of REBOA. He looks at why it isn't commonly used in PHEM but talks about the situations where it could usefully be incorporated into the pre hospital emergency environment.   Key points from this podcast: Adopt a whole system approach and deliver the patient to a centre who can help to stabilise them Access, access, access, start training now with Ultrasound. Know how to subtly manage the probe to get vascular access with ultrasound. If in a system employing the REBOA system consider the inflation time carefully Resources related to this podcast: Norwegian HEMS REBOA paper (open access) – https://www.ahajournals.org/doi/epub/10.1161/JAHA.119.014394 About Paul Paul Rees is a military interventional cardioloist at Barts Heart Centre in London, with a special interest in circulatory support and resuscitation. He is also a HEMS consultant, flying for East Anglian Air Ambulance. As a Surgeon Commander in the Royal Navy, he is their Consultant Advisor in Medicine, as well as Reader in the Academic Department of Military Medicine.  He chairs the Defence Resuscitation Committee, leads the Defence Endovascular Resuscitation Group and has recently designed and delivered a new capability for treating battlefield haemorrhage. He co-leads the new British Cardiovascular Intervention Society group looking at out of hospital cardiac arrest, and teaches as invited faculty on a number of international endovascular resuscitation workshops. Paul's military background includes active service with submarines, combat deployment with Commando forces, being the airborne MERT consultant in Afghanistan and numerous humanitarian and disaster relief missions including work in an Ebola treatment unit in Africa.  

I received a request on itunes reviews for an episode on REBOA so here it goes!    How to use it, when to use and what the data is like.    #reboa #endovascular #trauma #criticalcare #resuscitation

Not Your Typical REBOA Podcast by UC Department of Emergency Medicine

Interview with Gareth Davies about an emerging treatment coming to your ED soon.