Codes and Crushes

ERcast: Clinical Perspectives Podcast Preview

Jul 21, 2026
1 Chapter
50 min

There are few cases more stressful and fueled with emotion than a pediatric trauma code. What are some ways to ensure your pediatric trauma code runs as smoothly as possible? Join Dr. Tiffany Proffitt and Dr. Ashley Grigsby, dual board-certified ER physicians and pediatricians, as they review practice pearls from real-life pediatric trauma codes. Then, Geoff and Brit Long review crush injury and crush syndrome, including the differences, pearls, and pitfalls in evaluation and management.

Chapters

Pediatric trauma codes fail more often from chaos than from lack of technical skill, and calm closed-loop leadership is a real resuscitation intervention. Crush injury is local tissue destruction; crush syndrome is the systemic reperfusion emergency marked by hyperkalemia, acidosis, and acute kidney injury. Pediatric Trauma Code Pearls Calm code leadership: Pediatric trauma resuscitation runs better when the leader stays visibly composed, because panic from the head of the bed quickly propagates to the whole room and degrades communication. Closed-loop communication: Direct commands with explicit acknowledgment cut through noise and side conversations, especially when a stable trauma bay abruptly converts into a full arrest. Shared leadership model: Co-leadership between EM and trauma surgery can reduce territorial conflict and keep decision-making unified during high-stakes pediatric arrests, a dynamic we get into in the episode. Cognitive offloading strategy: The highest-functioning teams deliberately delegate airway, Broselow-based medication dosing, and transfusion logistics so the leader is free to track the whole resuscitation. Pediatric transfusion logistics: Massive transfusion in small children is not an adult workflow scaled down; under about 40 kg, device limitations may force manual push-pull blood administration instead. Post-code recovery plan: Formal debriefing and protected recovery time matter after a child's death, because emotional whiplash after returning straight to routine patients is a predictable operational risk. Crush Injury and Crush Syndrome Local versus systemic injury: Crush injury is the direct compressive tissue insult, while crush syndrome is the reperfusion-driven systemic collapse marked by potassium release, myoglobin load, and kidney injury. Rescue death phenomenon: Patients can look deceptively stable while entrapped, then crash after extrication from sudden reperfusion and toxin release; that prehospital-to-ED transition is worth hearing in the chapter. Hyperkalemia warning signs: Hyperkalemia is a leading killer in crush syndrome, and peaked T waves or QRS widening should immediately raise concern even though a normal ECG does not exclude it. Early fluid priority: Aggressive fluid resuscitation started as early as possible lowers acute kidney injury risk and remains a cornerstone from the scene through ED disposition. Compartment syndrome clues: Severe pain, pain with passive stretch, swelling, and paresthesias are the named red flags; pulselessness and paralysis are late findings, not screening signs. Contaminated wound approach: Crush wounds should be assumed polymicrobial and heavily contaminated, making extensive irrigation, tetanus update, and piperacillin-tazobactam a reasonable early empiric strategy.

Faculty

Ashley Grigsby, DO
Ashley Grigsby is a double board-certified physician in both Emergency Medicine & General Pediatrics. She currently works as a community emergency physician as well as a newborn hospitalist. She has three young children, an amazing husband, and three dogs that keep her busy outside of work. She is passionate about pediatric education for non-pediatricians, optimizing emergency department efficiency, and caring for her community.
Tiffany Proffitt, DO
Dr. Proffitt is a board-certified Emergency Medicine physician practicing in Scottsdale, Arizona. She completed her medical training at Midwestern University Chicago College of Osteopathic Medicine and found her passion for medical education during her residency at Spectrum Health Lakeland. Tiffany is the co-founder and co-chairwoman of the HonorHealth Women Physicians Leadership Council, where she works to enhance professional development for 550 women clinicians. When she isn’t in the ED or podcasting, she’s chasing twins, dancing with toddlers, and enthusiastically singing the wrong lyrics to every song.
Geoffrey Comp, DO, FACEP
Dr. Comp is an Associate Program Director for the Creighton University / Valleywise Health Emergency Medicine Residency Program in Phoenix. A clinician-educator at heart, Geoff spends his time mentoring the next generation of Emergency Medicine residents and advocating for better ways to teach and learn medicine. His professional world revolves around wilderness medicine, clinician wellness, and finding innovative ways to bridge the gap between theory and the bedside. When he isn’t in the ED or the classroom, you’ll likely find him combining his love for medicine with his passion for the outdoors, always looking for a new trail to explore or a new way to collaborate with fellow clinicians.
Brit Long, MD
Dr. Brit Long is a Professor of Emergency Medicine at the University of Virginia and an emergency medicine physician with experience in both a community ED and at a military academic center ED. He is the Clinical Editor-in-Chief of emDOCs.His professional interests include medical education, evidence-based medicine, and the FOAMed movement. Outside of work, he enjoys spending time with his wife and two daughters
Anne Steckowych, APRN
Emergency medicine is in Anne’s blood; her father has been an Emergency Medicine physician for the last 30 years. After earning her nursing degree from the University of New Hampshire (UNH) in 2018, Anne worked as an EMT at her local fire department, gaining practical experience that prepared her for five years as a nurse in the emergency department. She eventually returned to UNH to become an NP and has spent the last 8 years in the same ED, building relationships with a clinical team dedicated to providing the best possible patient care. Outside of the hospital, she’s usually skiing, hiking, or running in the New Hampshire hills. ERcast is her first podcast, and she’s thrilled to be part of the Hippo team.
Brett Murray, MD
Dr. Murray is an Emergency Medicine physician practicing at a busy community trauma center. After attending Boston University School of Medicine, he completed his residency training at Brown University / Rhode Island Hospital, where he also served as Chief Resident from 2020 – 2021. His clinical interests center on medical education, performance science, and Emergency Medical Services.