ETM Podcast Episode 6 – Brian Burns

I was lucky enough to attend the SWAN Trauma Conference over the last 2 days, and while there, managed to catch up with Brian Burns, a Sydney based Emergency Physician and retrievalist. I spoke with Brian about a great talk he did at the conference, and some of the cutting edge developments in pre-hospital trauma care.

Play

Emergency Trauma Management Podcast
We covered a lot of ground in a short space of time, and Brian threw out a tonne of pearls. Here’s some of the things we covered in this episode.

Dichotomous opinions about prehospital care

  • Scoop & run vs Stay & Play – just don’t use those words any more, please!

REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta)

Pre-hospital interventions

  • Rapid sequence intubation
  • EFAST/Ultrasound in the prehospital environment
  • Prehospital echocardiography: here’s a great case report Brian wrote up about this
  • Chest decompression/open thoracostomy
  • Pre-notification & preparation of subspecialty units at receiving hospitals e.g. Neurosurgery, hybrid suites or operating theatres

Reduced use, or no use of crystalloid for shocked trauma patients

Acute coagulopathy of trauma (ATC)

  • COAST Score (also covered by Cliff Reid here)
  • Tranexamic acid
    • Karim Brohi’s CRYOSTAT study
      • If you don’t know who Karim is, you need to go here
      • CRYOSTAT study description here
    • PATCH Trial
      • Background article here
      • Lead investigator Russell Gruen explains here
    • Use of tranexamic acid pre-hospital in NSW
  • ROTEM & TEG for diagnosing ATC
  • Future: freeze dried fibrinogen and FFP in helicopters

Another study that we didn’t mention but which is very but relevant:

  • FI in TIC – Fibrinogen in Trauma Induced Coagulopathy

Decision making in trauma care:

  • One of the key issues in trauma management is decision making capacity
  • Having senior staff onsite as key decision makers is crucial for best outcome, efficient trauma care

All that in around 20 minutes… Wow.

For those that tweet, follow Brian on Twitter.

Brian Burns

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