Awesome #REBOA sim today @RoyalLondonHosp.

Pre-hospital -> definitive care case, fantastic MDT working with our colleagues from @LDNairamb

Story: Young male, single stab wound to buttock, peri-arrest on LAS arrival.
Awesome #REBOA sim today @RoyalLondonHosp.Pre-hospital -> definitive care case, fantastic MDT working with our colleagues from @LDNairamb Story: Young male, single stab wound to buttock, peri-arrest on LAS arrival.
Awesome #REBOA sim today @RoyalLondonHosp.Pre-hospital -> definitive care case, fantastic MDT working with our colleagues from @LDNairamb Story: Young male, single stab wound to buttock, peri-arrest on LAS arrival.
Patient poorly perfused, cold with obvious evidence of bleeding +++.

Early decision for 8Fr access in groin with decision for REBOA.

Which Zone of REBOA should be utilised for this patient?
Patient poorly perfused, cold with obvious evidence of bleeding +++. Early decision for 8Fr access in groin with decision for REBOA.Which Zone of REBOA should be utilised for this patient?
Patient poorly perfused, cold with obvious evidence of bleeding +++. Early decision for 8Fr access in groin with decision for REBOA.Which Zone of REBOA should be utilised for this patient?
Patient poorly perfused, cold with obvious evidence of bleeding +++. Early decision for 8Fr access in groin with decision for REBOA.Which Zone of REBOA should be utilised for this patient?
Patient poorly perfused, cold with obvious evidence of bleeding +++. Early decision for 8Fr access in groin with decision for REBOA.Which Zone of REBOA should be utilised for this patient?
Rapid decision for Zone 1, with ongoing concurrent blood transfusion.

Challenging access, but successful.

For a peri-arrest patient with challenging femoral access should we aim for:
Pre-alert to hospital:
'Code Red'
Zone 1 REBOA
ETA 10 minutes.
Trauma team assembled and waiting.
Pre-alert to hospital:'Code Red'Zone 1 REBOAETA 10 minutes.Trauma team assembled and waiting.
Pre-alert to hospital:'Code Red'Zone 1 REBOAETA 10 minutes.Trauma team assembled and waiting.
Pre-alert to hospital:'Code Red'Zone 1 REBOAETA 10 minutes.Trauma team assembled and waiting.
Pre-alert to hospital:'Code Red'Zone 1 REBOAETA 10 minutes.Trauma team assembled and waiting.
Rapid primary survey
FAST -ve
ABG:
pH 6.9
Lac 20
K 7.9
Discussion with surgical + anaesthetic colleagues -> hyperkalemia management and move to theatre.
Rapid primary surveyFAST -veABG:pH 6.9Lac 20K 7.9 Discussion with surgical + anaesthetic colleagues -> hyperkalemia management and move to theatre.
Rapid primary surveyFAST -veABG:pH 6.9Lac 20K 7.9 Discussion with surgical + anaesthetic colleagues -> hyperkalemia management and move to theatre.
Rapid primary surveyFAST -veABG:pH 6.9Lac 20K 7.9 Discussion with surgical + anaesthetic colleagues -> hyperkalemia management and move to theatre.
Rapid primary surveyFAST -veABG:pH 6.9Lac 20K 7.9 Discussion with surgical + anaesthetic colleagues -> hyperkalemia management and move to theatre.
Handover in theatre:
Ongoing blood transfusion
Management of electrolyte disturbance
Early decision for pREBOA -> aiming to move from Z1 to Z3 occlusion.
Handover in theatre:Ongoing blood transfusionManagement of electrolyte disturbanceEarly decision for pREBOA -> aiming to move from Z1 to Z3 occlusion.
Handover in theatre:Ongoing blood transfusionManagement of electrolyte disturbanceEarly decision for pREBOA -> aiming to move from Z1 to Z3 occlusion.
Handover in theatre:Ongoing blood transfusionManagement of electrolyte disturbanceEarly decision for pREBOA -> aiming to move from Z1 to Z3 occlusion.
Handover in theatre:Ongoing blood transfusionManagement of electrolyte disturbanceEarly decision for pREBOA -> aiming to move from Z1 to Z3 occlusion.
Joint decision for DCS, ongoing transfusion and early planning for management of ischemic burden from #REBOA.
As with every #medsim the real learning takes place in the debrief.

Thank you to all who came to help today - you guys rock.
@phillpearce @atabraham @laird154 @DobbieAnna @smileywalshey @Bartssim @SamySadek8 @RLH_TAG @NELETN
You can follow @NikkiDavies22.
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