October 10, 2020

From Oct 6th – 8th, 2020, Haney Mallemat (@CriticalCareNow) and his team put on an absolutely amazing online critical care conference called ResusX Rewired.  ResusX is a conference designed by resuscitationists to provide clinicians with the most up to date skills and knowledge to help make a difference in your patients' lives.  Haney and his crew made a combination of short-format, high-yield lectures, and completely customizable small group sessions with procedural demos seem easy.  There were so many high-quality speakers and pearls that I learned from this conference that I wanted to archive them here in one post for reference and to share with our readers/followers.

October 5, 2020

Background: The CRASH-2 trial, published in 2010, showed a survival benefit for patients with traumatic hemorrhage who received TXA compared to placebo.  TXA has become standard practice in many settings as a result of this data. However, patients with significant head injury were excluded in this study and, it was unclear of the effect of TXA in this group. In 2019, CRASH-3 examined the use of TXA in traumatic brain injury (TBI) and found the overall effect size of TXA on ICH was not statistically significant compared to placebo.  Subgroup analysis demonstrated that certain patients (<3hrs, GCS 9 – 15, and ICH on baseline CT) showed benefit with TXA. However, this data was hypothesis generating only: not the primary outcome of the trial and with wide confidence intervals.  Further data is clearly needed to elucidate the role of TXA in those with TBI.

April 21, 2016

Background: Airway management is a critical part of the management of patients presenting with traumatic brain injury (TBI). Emergency Physicians (EPs) have no ability to change the primary injury once it has occurred and so our focus is on preventing secondary brain injury. Hypoxemia and hypercarbia are major contributors to morbidity and mortality and management must focus on preventing them. Patients with TBI and depressed mental status frequently require definitive airway management in order to avoid these secondary insults. Rapid sequence intubation (RSI) with serial administration of a neuromuscular blocking agent (NMBA) and an induction agent is common practice. The most commonly used NMBAs are the depolarizing agent succinylcholine and the non-depolarizing agent rocuronium. There are strong proponents arguing for the dominance of one agent over the other based on qualities of the drugs but scant data investigating the question has led to clinical equipoise.