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Joshua Bucher

Pearls for the management of GSW associated traumatic injury

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The patient with GSW can present in a variety of states ranging from hemodynamic stability to loss of pulses. Several literature updates have evaluated specific components of the care of these patients including airway, breathing, hemorrhage control, thoracotomy, and REBOA. This post evaluates the updated literature and provides pearls and pitfalls in the care of these potentially sick patients.

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The Difficult Airway: Common Errors During Intubation

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Airway management is a vital component to caring for critically-ill patients in the emergency department. The peri-intubation time can be chaotic. Planning for the difficult airway and preparing for all possible scenarios is best done before the arrival of a crashing patient. The following post explores some common failures in airway management and how to avoid making fatal mistakes in a critical situation.

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Bleeding Hand Wounds

1 Comment / practice updates /

Hand and digital wound bleeding should be managed with hemorrhage control, an adequate exam and proper treatment. There are many tools to help manage bleeding and allow for an adequate exam. Using a topical analgesic such as lidocaine, can be helpful with pain control. The addition of epinephrine to a topical analgesic in hand and digital wounds may not be as scary as once thought and may be considered to help with hemorrhage control in certain wounds.

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Neuro Intubation Highlights

1 Comment / practice updates /

You are working a busy shift when you receive a phone call from EMS that they are bringing in a “sick trauma patient.” As you prepare the trauma bay, the patient arrives. He is the victim of an assault and in clear need of intubation. He is unconscious with a GCS of 5, HR 125, BP 180/11, Sp02 88% on NRB 15 lpm, RR 22. As you prepare your medications, what are the best options for this scenario? Pre-treatment with lidocaine, fentantyl or esmolol? Is it okay to use ketamine in trauma patients in traumatic brain injury (TBI)?

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