Combat Casualty Care with Ed Barnard

In this session we will examine the bleeding patient in the
tactical and combat environment. We will dig into some of the
fundamental education that has changed practice in recent years,
we will also look at the sequential approach to bleeding control,
second and third generation haemostatics, pharmacological agents,
tourniquets, neck zones and injuries, blunt injury and junctional
wounds, hypotensive management and finally pain management in the
combat arena. We also examine the utility and success of highly
interventional skills at or near point of wounding such as REBOA.
Finally we will examine Traumatic Cardiac Arrest (TCA) and the
utility (or not) of an algorithmic approach to management.


To do this, Ed Barnard joins me. Ed is an emergency medicine
consultant within Cambridge University hospital and has undergone
sub-specialty training in pre-hospital EM, working in more than
five EMS systems, educating and mentoring medical students and
doctors in training, giving national and international lectures,
delivering a national research and clinical innovation meeting,
completing a PhD from a top-100 research university, publishing
over 30 journal articles, receiving five national-level research
awards, and being appointed as a Senior Lecturer for the
military.


Topics covered: 


Sequential approach to arresting bleeding

Look at second/third/fourth generation haemostatic compounds
(celox, quik-clot)

Utility of tourniquets (origins, usage and types)

Neck zones and wounds

Blunt injury and junctional wounds

Hypotensive mx - utility of this

Critical Hypovolaemia and tx modality

Interventions at point of wounding - REBOA

TCA management and algorithmic approaches

Ed's reflections and perspectives over the past 5 years on
bleeding 



Some of the concepts and evidence that Ed mentions in the episode
can be found here: 
A comparison of Selective Aortic Arch Perfusion and
Resuscitative Endovascular Balloon Occlusion of the Aorta for the
management of hemorrhage-induced traumatic cardiac arrest: A
translational model in large swine
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5526509/ The outcome
of patients in traumatic cardiac arrest presenting to deployed
military medical treatment facilities: data from the UK Joint
Theatre Trauma Registry
https://militaryhealth.bmj.com/content/164/3/150.abstract
Prehospital determinants of successful resuscitation after
traumatic and non-traumatic out-of-hospital cardiac arrest
Epidemiology and aetiology of traumatic cardiac arrest in England
and Wales — A retrospective database analysis
https://www.sciencedirect.com/science/article/abs/pii/S030095721630538X 

Please enjoy this episode with an insightful and engaging guest.