Professor Richard Lyon MBE gives a follow up to his 2018 talk on prehospital care about what has changed in his practice over the past year. A very well delivered update on the newest evidence in prehospital care. The recorded talk, along with everything else from the Big Sick conference in Zermatt can be found at https://scanfoam.org/

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No Twittering…
ILCOR will fire me!

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TBS 2018

5. !4
TBS 2018

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11. 140
70
40
30

12. !10
CV physiology in patients with isolated TBI
HR < 100
BP > 100
56 %
44 %
Gavrilovski, Injury 2018

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CV physiology in patients with isolated TBI
HR < 100
BP > 100
32 %56 %
HR > 100
BP > 100
HR < 100
BP < 100
HR > 100
BP < 100
Gavrilovski, Injury 2018
3 % 9 %

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NEJM 2018: 379
Prehospital plasma during air
medical transport in trauma
patients at risk for
haemorrhagic shock
Sperry et al, on behalf of PAMPer Study Group
501
trauma
BP<90 HR>100

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2 units

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10% reduction in
30 day mortality

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TBI present
No pre-hospital packed cells

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19. 140
70
40
30
? RSI

21. 100% O2
EtCO2 35-40
SBP>90
BM 5-10
Head up 30°

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Lancet 2018: 391
25 trials
16,037 patients

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Liberal
oxygen
Conservative
oxygen
Mortality
(in hospital)
3.7% 3.0%

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Favours less oxygenFavour more oxygen
1.0 2.0 5.00.50.2
In-hospital mortality, overall (p=0.02)
30-day mortality, overall (p=0.033)
Mortality at longest follow-up (p=0.044)

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Favours less oxygenFavour more oxygen
1.0 2.0 5.00.50.2
In-hospital mortality, overall (p=0.02)
30-day mortality, overall (p=0.033)
Mortality at longest follow-up (p=0.044)
NN to harm = 71

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? FiO2 21%

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28. Aim to achieve SaO2 96-98%
12 L O2/min at 10 breaths/min 100% O2
SaO2 > 96%
Reduce to 4 L O2/min 60% O2
Reduce to 2 L O2/min 40% O2
SaO2 > 96%
Reduce to 0.5 L O2/min 30% O2
SaO2 > 96%
Reduce to air 21% O2
SaO2 > 96%

29. 100% O2
EtCO2 35-40
SBP>90
BM 5-10
Head up 30°

30. !28
Mortality & prehospital blood pressure in patients with major traumatic
brain injury: implications for the hypotension threshold
JAMA Surg 2017; 152

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vs

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1389 aged ≥ 65 years
45% TBI
28% had neurosurgery
Traumatic brain injuries in older adults—6 years
of data for one UK trauma centre: retrospective
analysis of prospectively collected data
Hawley, EMJ 2017

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1389 aged ≥ 65 years
45% TBI
28% had neurosurgery
78 % survived TBI
57 % had a good outcome - GOS
Traumatic brain injuries in older adults—6 years
of data for one UK trauma centre: retrospective
analysis of prospectively collected data
Hawley, EMJ 2017

36. vsETI SGA

40. ETI
first
4410
9296 patients
SGA first
4886

41. ETI
first
4410
9296 patients
SGA first
4886
mRS (0-3)
6.4%
mRS (0-3)
6.8%

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48. !46
Association of Prehospital Mode of Transport With Mortality
in Penetrating Trauma: A Trauma System-Level Assessment
of Private Vehicle Transportation vs Ground EMS
103 ,029 patients
Wandling et al, JAMA Surg. 2018

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51. the road to self insight,
runs through others

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