• INTRODUCTION
  • 3. MICROCIRCULATION
  • 6. CARDIOGENIC SHOCK
  • 10. GI HAEMORRHAGE
  • 11. RESUSCITATION OF THE PRE-OPERATIVE PATIENT
  • 12. ANAPHYLAXIS
  • 13. ORGAN DONATION
  • 14. WHICH FLUID?
  • 15. OXYGEN AND FLUID VOLUMES IN RESUSCITATION
  • 16. SHOCK
  • 17. BLOOD AND BLOOD PRODUCTS
  • 18. DAMAGE CONTROL RESUSCITATION
  • 19. PERMISSIVE HYPOTENSION
  • 20. VASCULAR ACCESS
  • EARLY RESUSCITATION

Welcome to module 2 - THE PHYSIOLOGY OF SHOCK, SHOCK SYNDROMES AND TOOLS OF RESUSCITATION

Tim Harris

MODULE LEAD: TIM HARRIS

Aims:

This module aims to teach the student how to identify which patients require resuscitation and the tools by which this is achieved. 


Objectives:

By the end of this module students will have learned how to apply the material studied in Module Two into clinical practice. Students will have gained further insights into cardiovascular physiology and will have a clear idea of what is meant by resuscitation and how to classify shock. The most common causes of shock will be reviewed in detail. Students will gain an understanding of the tools of resuscitation: oxygen, fluids, inotropes, vasopressors and blood transfusion.


Learning outcomes:

At the end of this module the student will have consolidated the pathophysiology studied in module two. They will have a clear understanding of how to classify shock and the relative value of each component of resuscitation. They will be able to apply this knowledge to the critically unwell patient and have a clear knowledge of the current best practice in treating a wide range of critical illness. Students will have a clear understanding of the place of intravenous fluids, blood products and catecholamines in the process of resuscitation.


The microcirculation – clinical relevance and assessment

Sam Hutchings

SAM HUTCHINGS

Defence Senior Lecturer in Critical Care
Sam Hutchings is two years into a PhD program of research, based at Kings College London and DSTL Porton Down, the main focus of which is targeted resuscitation of patients with traumatic injuries. Particular themes are the use of focused echocardiography to guide systemic resuscitation and the response of the microcirculation to injury, shock and resuscitation.


THE MICROCIRCULATION – CLINICAL RELEVANCE AND ASSESSMENT BY SAM HUTCHINGS


Cardiogenic Shock

Mike Patterson

MIKE PATTERSON 

Mike Patterson is a consultant in intensive care and emergency medicine. 


CARDIOGENIC SHOCK BY MIKE PATTERSON 


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RESUSCITATION IN GI HAEMORRHAGE

Bernard Foex

BERNARD FOEX

Bernard Foëx's special interest is in biomedical ethics relating to the critically ill. He is a consultant in Emergency Medicine and Critical Care and trained in Emergency Medicine and Intensive Care Medicine in Manchester. His PhD was on the cardiovascular responses to haemorrhage and injury.



RESUSCITATION IN GI HAEMORRHAGE BY BERNARD FOEX


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Resuscitation of the pre-operative patient

Neil MacDonald

NEIL MACDONALD

Dr Neil MacDonald is a consultant in anaesthesia and pre-operative assessment at the Royal London Hospital. He graduated from the University of Glasgow and completed his anaesthetic training at Barts and The London school of anaesthesia.. His clinical interests include the perioperative management of the patient undergoing major abdominal surgery and the patient undergoing emergency surgery. 


 Dr MacDonald is actively involved in research of the high risk surgical patient partculary those undergoing major abdominal surgery and emergency surgery. He has contributed to large trials studying these populations including OPTIMSE, OPTIMISE 2 and VISION. His research interests centre on patients undergoing high risk surgery including risk stratification during the perioperative period and fluid management. He teaches on both undergraduate and post-graduate programmes at QMUL


RESUSCITATION OF THE PRE-OPERATIVE PATIENT BY NEIL MACDONALD


ANAPHYLAXIS

Joe Wood

ANAPHYLAXIS BY JOE WOOD

Joseph Wood is assistant professor of Emergency Medicine and works in the Department of Emergency Medicine, Mayo Clinic Arizona.


ANAPHYLAXIS BY JOE WOOD


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Organ donation after cardiac death in ED

Matt Reed

MATT REED

Matt Reed graduated from Cambridge University in 1997. He joined the South East Scotland Emergency Medicine Training Programme in 2002 and has been a Consultant in Emergency Medicine in Edinburgh since 2007.

After completing his Doctorate of Medicine thesis in 2009 on the risk stratification of syncope in the ED, he has continued research work in this area focusing on the use of biomarkers and ambulatory monitoring in syncope.

Matt is currently Chief Investigator on two exciting CHSS funded studies looking at an ambulatory patch monitor and a smart phone based event recorder in the ED.


ORGAN DONATION AFTER CARDIAC DEATH IN ED BY MATT REED


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Which fluid to use for resuscitation?

Tim Harris

TIM HARRIS

Tim Harris is Professor Emergency Medicine at Barts Health NHS Trust and QMUL, London, UK. He trained in Emergency Medicine, Pre-hospital care and Intensive Care Medicine in Australia, New Zealand and the UK. He has also worked in Africa, India, various Pacific Islands and on a few cruise boats. Currently his roles include research lead, Department Emergency Medicine at Barts Health & QMUL, CLRN injuries and Emergencies lead for North Thames region and chair London School Emergency Medicine Academic committee. He works in pre-hospital care at East Anglia Air Ambulance. His interests are focussed ultrasound, resuscitation, point of care diagnosis, medical education and procedural sedation.


WHICH FLUID TO USE FOR RESUSCITATION? BY TIM HARRIS


Oxygen and fluid volumes in resuscitation

Tim Harris

TIM HARRIS

Tim Harris is Professor Emergency Medicine at Barts Health NHS Trust and QMUL, London, UK. He trained in Emergency Medicine, Pre-hospital care and Intensive Care Medicine in Australia, New Zealand and the UK. He has also worked in Africa, India, various Pacific Islands and on a few cruise boats. Currently his roles include research lead, Department Emergency Medicine at Barts Health & QMUL, CLRN injuries and Emergencies lead for North Thames region and chair London School Emergency Medicine Academic committee. He works in pre-hospital care at East Anglia Air Ambulance. His interests are focussed ultrasound, resuscitation, point of care diagnosis, medical education and procedural sedation.


OXYGEN AND FLUID VOLUMES IN RESUSCITATION BY TIM HARRIS 


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Shock, vasopressors, inotropes and mech circ devices

Scott Weingart

SCOTT WEINGART

My name is Scott Weingart. I am a physician specialising in Resuscitation & Emergency Department Critical Care. My career so far has been devoted to bringing Upstairs Care, Downstairs. That is bringing ICU care down to the ED–where it needs to be. I love my job taking care of the sickest patients, innovating new ways to do it better, and then teaching these concepts to my residents.

I host a blog and podcast called EMCrit; it has gotten a bit popular. I also  tweet tumble consult , and sometimes even get a chance to read a book.


SHOCK, VASOPRESSORS, INOTROPES AND MECH CIRC DEVICES BY SCOTT WEINGART


BLOOD AND BLOOD PRODUCTS

Laura Green

LAURA GREEN

I am a consultant in haemostasis and transfusion medicine, with joint appointments at Barts Heatlh Trust and NHS Blood and Transplant (NHSBT). I also hold an academic position as senior clinical lecturer at the Blizard Institute, Barts and the London School of Medicine & Dentistry, Queen Mary University of London. My research remit focuses on improving the understanding of the coagulation abnormalities of acquired bleeding disorders, including those associated with trauma, obstetrics and oral anticoagulant agents; these in turn will provide the evidence base upon which to promote the appropriate use of blood transfusion for the treatment of such bleeding disorders.



BLOOD AND BLOOD PRODUCTS BY LAURA GREEN

DAMAGE CONTROL RESUSCITATION: Evolving use of Blood Products for Resuscitation

Tim Harris

JOHN HOLCOMB

John Holcomb is the Director of the Center for Translational Injury Research, Chief, Division of Acute Care Surgery, Professor of Surgery and Vice Chair, Department of Surgery at The University of Texas, Houston Health Sciences Center.

Before joining Memorial Hermann in 2008 to lead the charge for trauma care at the Texas Trauma Institute, Col. (ret. U.S. Army) John B. Holcomb, M.D., F.A.C.S., spent 23 years as an active-duty Army surgeon. Having deployed six times to Operation Iraqi Freedom, Dr. Holcomb was awarded numerous commendations and combat awards including the Army’s Greatest Invention award, the Honorary Medal for Combat Surgical Care by the American Association for Surgeons of Trauma, the Defense Meritorious Service Medal and the United States Special Operations Command Medal.

Dr. Holcomb is an international leader in the research and development of next-generation medical technologies for trauma patients. Among these groundbreaking studies are novel therapies using frozen blood, implementing state-of-the-art ultrasound equipment in air ambulances, looking at new ways of utilizing stem cells for traumatic injury, using hyperbaric medicine to treat patients with traumatic brain injuries and pioneering new devices to fix broken bones in a better way.

His medical career was inevitable. “My mom has a picture when I was five wearing a stethoscope and checking on my little brother,” he says. “And I always liked science.”

During high school in Ft. Smith, Arkansas, Holcomb worked part-time on a factory assembly line. “The guys there told me to study hard so that I didn’t end up working there for the rest of my life.”

He took their advice, and later joined the Army to pay for medical school; he did his surgical residency in El Paso. As part of his Army commitment, he was a general surgeon in Somalia during the Black Hawk Down incident.

Holcomb and his wife, an endocrinologist and UT Professor of Medicine, have a 12-year-old son. Holcomb was certified in Scuba in 1975, and is now getting recertified again with his son. “It‟s absolutely peaceful, being in the water.”

According to Holcomb, there are no car “accidents.” He believes that very few people who drive safely, while sober and while wearing a seat belt have accidents. “When you look at it that way, ‘accidents’ are really predictable.


RESUSCITATION: EVOLVING USE OF BLOOD PRODUCTS FOR RESUSCITATION BY JOHN HOLCOMB  


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THE EARLY RESUSCITATION OF TRAUMA SHOCK

Dan Nevin

DAN NEVIN

Dr. Dan Nevin is a Consultant Anaesthetist at the Royal London Hospital (UK) where he works as a key member of the Trauma Anaesthesia Group in both the ED and the operating theatres. He is originally from South Africa where he grew up, was schooled and trained. Amongst his diverse interests he enjoys anaesthesia for complex major general surgery, vascular surgery and, of course, trauma. Professionally, he has interest in complex resuscitative interventions, acute traumatic coagulopathy and the use of point-of-care testing in treating the same. Additionally he has spent many years working in the pre-hospital environment in both South Africa and the UK and is a Consultant in Pre-hospital Care for London’s Air Ambulance Helicopter Emergency Medical Service. In his spare time he tries to keep fit and is an ardent supporter of Springbok rugby!



  




VASCULAR ACCESS

Tom Hurst

VASCULAR ACCESS BY TOM HURST

Tom is a consultant in pre-hospital care with London’s Air Ambulance and consultant in intensive care medicine and major trauma at King’s College Hospital. He trained predominantly in Greater Manchester before undertaking a secondment to London’s Air Ambulance in 2008. He was clinical lead at East Anglian Air Ambulance from 2011 to 2014 and is now the sub-specialty lead for training in Pre-Hospital Emergency Medicine (PHEM) in London. 


VASCULAR ACCESS BY TOM HURST


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The early RESUSCITATION of trauma shock

Tim Harris

TIM HARRIS

Tim Harris is Professor Emergency Medicine at Barts Health NHS Trust and QMUL, London, UK. He trained in Emergency Medicine, Pre-hospital care and Intensive Care Medicine in Australia, New Zealand and the UK. He has also worked in Africa, India, various Pacific Islands and on a few cruise boats. Currently his roles include research lead, Department Emergency Medicine at Barts Health & QMUL, CLRN injuries and Emergencies lead for North Thames region and chair London School Emergency Medicine Academic committee. He works in pre-hospital care at East Anglia Air Ambulance. His interests are focussed ultrasound, resuscitation, point of care diagnosis, medical education and procedural sedation.


THE EARLY RESUSCITATION OF TRAUMA SHOCK BY TIM HARRIS