May 5, 2021

Take Home Points
  • There is no strict golden hour for wound closure. Location, contamination and patient factors all should be taken into account
  • Dog bites can be closed primarily. Bites on the hand and foot are higher risk for infection. If you close, strongly consider adding antibiotic prophylaxis
  • Sterile water is unnecessary for wound decontamination as are additives (ie betadine). Tap water under reasonable pressure (45 psi) is adequate.

January 11, 2021

Background: Current trauma resuscitation prioritizes control of bleeding and uses massive transfusion protocols to prevent and treat coagulopathy. This is typically done in the form of massive transfusion protocols delivered in proportions that approach the composition of whole blood. Two strategies to help guide this replacement of blood products are conventional coagulation tests and viscoelastic hemostatic assays.

December 28, 2020

Background: Blunt cerebrovascular injury (BCVI) is defined as carotid or vertebral artery injury due to blunt trauma.  There are several screening criteria that have been developed to screen for this injury, however a significant number of patients may still be missed by these screening criteria. Although this is not a common injury, the potential complications if undiagnosed and untreated can be devastating. Current screening criteria (see below) have been refined and expanded over the years, but just how good are they?

November 26, 2020

Background: We have covered tranexamic acid (TXA) on this blog in several posts. Its use has been studied for everything that bleeds from abnormal uterine bleeding to GI hemorrhage and from multisystem trauma to intracranial hemorrhage. While over the past few years it has been touted as the wonderdrug for bleeding, newer research is beginning to challenge that thought (CRASH-3 trial, HALT-IT trial, etc.). The CRASH-2 trial showed that early administration of TXA (within 3 hours) to trauma patients improved all-cause mortality. However, obtaining rapid IV access in low resource, rural, or combat settings can be challenging. Only recently has research been conducted about intramuscular administration of TXA. Actually…we should really say that there has been a resurgence of interest in IM TXA. There were a couple studies published about its pharmacokinetics and pharmacodynamics in the 1970s and 80s, followed by radio silence on the subject.1,2 Curiosity about the drug has picked back up over the past decade as its cost dropped and access to TXA increased exponentially. In fact, finding alternative routes of TXA administration in postpartum hemorrhage is a WHO priority.3 Today, we will review a recent article that explored the pharmacokinetics of intramuscular TXA in bleeding trauma patients.
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