ERcast: Clinical Perspectives Podcast Preview
The summary below is from an episode of ERcast: Clinical Perspectives
Hemorrhagic trauma kills through coagulopathy, occult shock, and missed vascular injury before classic hypotension declares itself. Early calcium replacement during massive transfusion, narrow pulse pressure as a pre-crash warning sign, and broader CT angiography use for blunt cerebrovascular injury all have practice-changing implications in trauma resuscitation.
Practice-Changing Trauma Resuscitation Pearls
- Early calcium replacement: Hypocalcemia is common from hemorrhagic shock and citrate load during transfusion, and ionized calcium below 1 mmol/L tracks with higher mortality, greater blood use, and worse coagulopathy.
- Massive transfusion calcium strategy: Calcium gluconate should be started early when massive transfusion begins rather than waiting for the labs to drift, with a practical ED dosing cadence we lay out in the episode.
- Narrow pulse pressure warning: A pulse pressure under 30 mmHg can signal acute blood loss before hypotension appears, because systolic pressure falls while diastolic pressure is temporarily preserved by catecholamine surge.
- Prehospital crash predictor: Normotensive trauma patients with narrow pulse pressure still carry higher mortality and greater need for emergent intervention, making this an early cue to have blood products ready.
- BCVI stroke prevention: Blunt cerebrovascular injury includes carotid or vertebral dissection and pseudoaneurysm, and missed lesions can progress to thromboembolism and stroke despite an initially distracting trauma presentation.
- CTA screening expansion: Denver criteria miss a meaningful share of clinically important BCVI, especially higher-grade injuries, so CTA deserves a lower threshold in major blunt trauma. We get into the imaging trigger points in the chapter.
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References:
- Vasudeva M, et al. Hypocalcemia in trauma patients: A systematic review. J Trauma 2020, 90(2) 396-402. PMID: 33196630.
- Schellenberg M, et al. Prehospital Narrow Pulse Pressure Predicts need for Resuscitative Thoracotomy and Emergent Intervention after Trauma. J Surg Research 2021, 268: 284-290. PMID: 34392182.
- Leichtle SW, et al. Blunt cerebrovascular injury: The case for universal screening. J Trauma 2020, 89(5): 880-886. PMID: 32520898.
Faculty
- Chris Hicks, MD
Chris Chris Hicks is an emergency physician, trauma team leader, educator, and speaker with expertise in resuscitation, simulation, and psychological performance in healthcare. His work has focused on areas such as mental practice, stress inoculation training, and improving team performance in high-stakes clinical environments. He has contributed to the development of interprofessional and simulation-based medical education initiatives and has collaborated with healthcare organizations on the design of systems, spaces, and teams to support high-performance care delivery. Chris is also a longtime supporter of the FOAMed movement and is widely recognized for his engaging and practical approach to medical education. Outside of medicine, he enjoys running, cycling, boxing, music, and spending time with his family.
- Andy Little, DO
Dr. Andy Little is an emergency medicine physician and educator. He earned his medical degree from the Ohio University Heritage College of Osteopathic Medicine and completed his emergency medicine residency at OhioHealth Doctors Hospital Emergency Medicine Residency, where he served as Chief Resident. He has received multiple national awards, including recognition from the American Osteopathic Association, American College of Osteopathic Emergency Physicians, and Emergency Medicine Residents' Association.
- Drew Kalnow, DO
Dr. Drew Kalnow is an emergency medicine physician and educator based in Columbus, Ohio. He completed his emergency medicine training at OhioHealth Doctors Hospital Emergency Medicine Residency. Dr. Kalnow is passionate about advancing emergency medicine through high-quality education, with a particular focus on simulation, learning theory, and innovative teaching.
