When You Can’t Stop the Bleeding: Inside A Massive Trauma Case

Episode overview

About This Episode

A mangled extremity, uncontrolled bleeding, bad weather grounding every helicopter nearby, and a trauma center nearly an hour away. Sometimes the biggest challenge is  figuring out what to do when the ideal plan is no longer available.

Ross talks with critical care flight paramedic Jim Phipps about a severe farm-auger injury that pushed

multiple teams to adapt in real time. Jim walks through how the responding EMS crew, local hospital, flight team, and receiving trauma center each had to solve a different part of the problem while keeping the patient moving toward definitive hemorrhage control.

This episode covers tourniquet reassessment during resuscitation, wide-band and junctional hemorrhage control, hypotensive resuscitation, whole blood, contingency planning, and the communication required when a team realizes its current strategy is not going to work. Jim also explains the workable solution that helped get this patient to the operating room alive.

In this episode, you’ll learn:

• Why a tourniquet that controlled bleeding initially may need to be tightened again 

• How wide circumferential compression can help when a tourniquet no longer has enough usable tissue to work with

• What “accuracy, brevity, and clarity” sounds like when a resuscitation team needs to change plans quickly

• Why asking yourself for 3 things that went well and 3 things to improve can make a post-call reflection more useful

Resources:

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Episode 136: From Tractor Rollovers to Grain Entrapment: A Field Guide to Farm Emergencies

Guests:

Jim Phipps, Critical Care Flight Paramedic, UNC Air Care