Propofol administration for induction is associated with peri-intubation instability in trauma critical care unit patients.

INTRODUCTION: Peri-intubation hypotension is associated with increased hospital length of stay and morbidity. Propofol is associated with alterations in hemodynamics. We hypothesize that using propofol for induction leads to peri-intubation hypotension in trauma critical care patients. METHODS: Patients that underwent unplanned intubation in the trauma intensive care unit (TICU) were prospectively enrolled. Peri-intubation vitals and medications were recorded to assess hypotension within 10 â€‹min of intubation. Patients were divided into propofol (PROP) or other medication (OTR) groups. RESULTS: Data was complete for 69 patients; 31 PROP and 38 OTR. In OTR there was an 8.8-point (-21.1, 3.6) SBP decrease (p â€‹= â€‹0.159) and in PROP there was a 30.8-point (-45.6, -16.0) SBP decrease (p â€‹= â€‹0.0002) with significant increases in heart rate (HR) and shock index (SI) (HR p â€‹= â€‹0.001, SI p â€‹< â€‹0.0001). CONCLUSION: In patients without hypotension prior to intubation, we observed a statistically significant drop in the patients' SBP with use of propofol. In trauma critical care unit patients, we recommend considering an induction medication for unplanned intubation other than propofol.

Prehospital tourniquet placement in extremity trauma.

BACKGROUND: Extremity tourniquets (ET) use has increased in trauma systems to manage traumatic hemorrhage. This study aims to evaluate prehospital ET placement. METHODS: This is a retrospective review of a prospectively collected cohort of 211 adult patients who underwent prehospital ET placement over 3 ½ years. Data regarding ET placement was analyzed regarding ET applier, reported indications, extremity appearance at arrival and outcomes. RESULTS: A total of 211 patients had completed data sheets. Of these patients, 63.2% had no other intervention prior to ET placement. On arrival, nearly 1/3 of the patients had palpable pulses with ET in place and less than ½ had arterial bleeding upon ET release. DISCUSSION/CONCLUSIONS: This study shows that ET are frequently used as the initial intervention in the field. It is of paramount importance that we adapt our first responders training to teach wound assessment and appropriate steps in management of extremity hemorrhagic trauma.