I had to intubate a patient on the unit the other day who was at high risk of progressing to airway compromise from edema.

The intubation turned out to be more difficult than I had expected, but the procedure was ultimately successful for a number of reasons:

1/x Anticipation of clinical course - in my mind I had anticipated this airway to worsen.

By addressing the issue immediately, I would be able to provide a buffer of safety to the patient and the team. This airway would therefore be more semi-elective now than "crash" later

2/x

Let's focus again on potentially preventable death from torso #hemorrhage.

Our paper in @ShockJournal highlighted the need to refocus our efforts on the prehospital setting (🧵here:

https://twitter.com/resusone/status/1409859844086116358

)

But can we ID those patients successfully who might need ARC? 🧵 2/
We attempt to do so in this paper published in @JTraumAcuteSurg

Link here: journals.lww.com/jtrauma/Abstra…

Thanks to lead author @AhmerIrfanMBChB and coauthors at @uabmedicine for their hard work

1/
Just out today (free) in @JAMASurgery
@Guyettef @Jjasonsperrymd @joshua_b_brown et al.
#TXA During Prehospital Transport in Patients at Risk for Hemorrhage After Injury: A Double-blind, Placebo-Controlled, Randomized Clinical Trial

jamanetwork.com/journals/jamas…

#staamptrial 2/
The role of #TXA has been the subject of varying debate.

This study asks if giving #TXA to #bleeding trauma patients in the #prehospital setting affects 30-day outcomes

This is a critical questions as #trauma remains a leading cause of death around the world

#StopTheBleed

1/
How does a city's trauma system come together to both prepare for the expected surge of the #COVIDー19 #pandemic & manage the ongoing #epidemic of #gunviolence & other trauma?

Through a great collaborative effort, we published the #Philadelphia experience in @JTraumAcuteSurg 2/

The full paper is published ahead of print here: journals.lww.com/jtrauma/Citati…

It represents the importance of #teamwork in ensuring a robust, rapid, coordinated effort to manage an evolving threat

Important paper in @NEJM coming out of #Pakistan

RCT of amoxicillin for pneumonia in #Pakistan - the world’s largest community-based assessment of the use or withholding of antibiotics in children with mild pneumonia

Fantastic to see @FyezahJehan as 1st author

#welldone 2/
.@WHO recommendations for pneumonia recommend amoxicillin, but this conflicts with trial data showing possibility noninferiority of using amoxicillin.

Overuse of course leads to antibiotic resistance

Recently our team had to manage a patient who presented critically unwell from post-tonsillectomy hemorrhage - something you may not see that often but can be a true life-threat!

(pictured is only one of several buckets)

My tips here:

1/x

#tweetorial
#foamed Tip 1: Call for help early!

This patient did well because of excellent #teamwork from scene to OR. We received an alert from the EMS team, and informed ENT early (not in house) to the situation and need for OR. Anesthesia and OR team were also informed to prepare for this

2/x

Just released in @TSACO_AAST: Clinical use of #REBOA in civilian trauma systems in the USA: joint statement from @ACSTrauma @EmergencyDocs @NAEMSP @NAEMSP (utilizing best available evidence & expert consensus opinion)

Full text: tsaco.bmj.com/content/4/1/e0…

Key points (thread): 1/x This document focuses on the use of REBOA
in civilian trauma patients & integration w/i
civilian trauma systems in the US. Emphasis
is on patient safety as the most important principle
while recognizing the variability in trauma systems, centers, and clinician training 2/x