Hemorrhagic shock is the major preventable cause of morbidity and mortality in patients who suffer trauma. The management of traumatic hemorrhagic shock has evolved, with increasing emphasis on damage control resuscitation principles, and it requires swift coordination of ED resources and protocols.

This 1-hour didactic, by leading critical care expert Dr. Scott Weingart, will present evidence-based recommendations for:

When and how to intubate a bleeding patient

Dr. Weingart received his medical degree and completed a residency in emergency medicine at the Mount Sinai School of Medicine. He then went on to fellowships in Trauma, Surgical Critical Care, and ECMO at the Shock Trauma Center in Baltimore. He is currently an attending in and Chief of the Division of Emergency Critical Care at Stony Brook Hospital. He is a tenured Professor of Emergency Medicine at Stony Brook Medicine and an Adjunct Professor at the Icahn School of Medicine at Mount Sinai. He is best known for his podcast on resuscitation and ED critical care called the EMCrit Podcast; it currently is downloaded more than 400,000 times per month.

What changes do you anticipate making in your practice as a result of this activity?

Better identification of MTP patients and improved understanding of REBOA and ROTEM testing. 

Better understanding of appropriate MTP activation criteria, VCT-guided therapy.

Close monitoring of electrolytes during MTP administration. Additionally, hope to more actively incorporate VCT in conjunction with our trauma surgeons.

Earlier identification and more precise management of traumatic hypovolemic shock

Employ a better strategy to conserve products while decreasing patient morbidity and mortality.

Ensure proper hemostasis is achieved in all trauma patients when indicated.

Use of ABC in predicting need for MTP. Strategy for dealing with hypotension during / post intubation. Rewarming patients and also awareness of of limitations crystalloid use.

I am now more cognizant of validated shock assessment scores. I am now more comfortable approaching hemorrhage in patients taking DOACs.

Improved recognition of need for transfusion and selection of appropriate blood products

Increased use of cryoprecipitate in my resuscitation.  Less crystalloid when advising pre-hospital providers.

More aware of calcium status in trauma resuscitation. Also, my first priority is to stop the bleeding.

This helped me review the management of traumatic hemorrhagic shock specifically especially initiation of mass transfusion and when to stop it as well as the role of TXA and fibrinogen.

Use of ABC scores and Shock index. Using TXA if available. Using less crystalloid in initial resuscitation. Delaying intubation and using BMV resuscitation in hemorrhagic shock. This was a great help!

Using Shock index more frequently in my assessments. (I work at a community ED that doesn't have a robust Trauma Team).

Traumatic Hemorrhagic Shock in the ED