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Ian L. - May 25, 2021 3:44 PM
What is the treatment for bleeding wounds in the axilla chest groin or neck -is the foley catheter balloon tamponade method used ? How does bilateral needle compression work with cardiac arrest ?
Daniel M. - June 14, 2022 2:53 PM
Apologies for the late reply as I just saw that there was a question.
I personally prefer digital control with point pressure and guaze for most of those areas. The old foley trick can be used but can be tricky to pull off. Unfortunately there isn't a lot of research on this with lots of anecdotes.
Needle decompression during traumatic cardiac arrest makes a lot of sense. I can't think of many reasons not to at least try it. Since CPR is controversial and unlikely to help during traumatic cardiac arrest, it can be done with no compressions happening. DId that answer your question?
Brian T. - June 13, 2021 4:52 AM
Dear EM:RAP, any tips for controlling the ischemic pain after a tourniquet while the patient is still undergoing resuscitation and a soft blood pressure necessitates minimal narcotics? Thanks!!
Daniel M. - June 14, 2022 2:54 PM
Sounds like a job for ketamine! I'd go analgesic dose at 0.1 mg/kg IV. Fentanyl can be relatively safe in these situations, but all analgesics have at least some potential for hypotension. Once adequately transfused, hypotension shouldn't be a problem from a limb tourniquet unless there is bleeding elsewhere.
tom f. - June 24, 2021 3:28 AM
excellent pod. I work at a large rural community hospital in merced, ca where we have no trauma service. after many years (and maybe because of many years) trauma still scares me.
never heard a lecture with so much music. love it. Taylor Swift. amazing. thank you.
Daniel M. - June 14, 2022 2:55 PM
Thanks, Tom! Community folks without extra trauma support are exactly who I was trying to help. Be well!
Derek B. - May 21, 2022 11:59 AM
Late reply, but answer for junctional (axilla, groin) bleeds. There are Junctional Tourniquet devices that place direct pressure on either the point of bleeding or on the axillar/femoral artery. Some are more user friendly. SAM Junctional tourniquet and JETT are the ones I most commonly see used. There are also techniques for using hemostatic gauze (or regular gauze) and ACE bandage wrap that require practice but are extremely effective. Direct digital pressure is also an option and can be performed by a non-medical assistant. Depending on the Scope of Practice and environment (time to surgeon), REBOA may be utilized.
Pain control in hypotensive recommended by TCCC is low dose Ketamine (20-30mg IV) or IM/IN dosing. Fentanyl can also be used at lower doses, but isn't recommended in the guidelines for hypotensive or at risk patient.