Takotsubo Cardiomyopathy
REBOA Catheter in Penetrating Trauma
- Takotsubo cardiomyopathy: middle to older aged adults with a recent physical or emotional stressor, more common in women, usually patients do well but approximately 10% may experience shock
- May need to differentiate between patients with left ventricular outflow tract obstruction and those without. Avoid inotropy in patients with murmur or other concerning signs for obstruction
- Consider aortic balloon pump in complete LV failure
- Avoid phenylephrine push dose boluses prior to RSI when you’re concerned about cardiogenic shock. Have other vasopressors ready and potentially the drip started
- V fib arrest: think ischemia first! You need an EKG and if it’s concerning, need to stabilize the patient for the cath lab
- Sedating a patient with recent ROSC can be tricky. Start low on the sedatives and increase as needed to as to not compromise hemodynamics
- Bloody airway? Anticipate needing to use direct laryngoscopy. Have back up items ready for bagging including a supraglottic airway in case you are unable to find the cords on first view
REBOA Catheter in Penetrating Trauma
- If systolic blood pressure around or below 90 in setting of trauma, arterial femoral access should be gained
- Thoracotomy in isolated abdominal penetrating trauma has dismal outcomes and is generally not indicated
- REBOA catheter can be used in penetrating trauma but with caution: it is contraindicated in thoracic penetrating trauma
- Some studies suggest that REBOA may have better outcomes in penetrating abdominal trauma but numbers are still low to draw major conclusions
- CPR is of little utility in pulseless trauma, particularly penetrating trauma. These patients need copious amounts of blood and potentially decompression of the chest. Additionally, performing procedures during chest compressions endangers staff and providers
- Do not forgot the basics of trauma when performing procedures. Basic venous access and a good primary survey are paramount. A great deal of attention can go into procedures but the trauma captain needs to stay in control of the case
- Order massive transfusion pack in advance; it does not have to be opened but should be available