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: 

1. 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/
2. 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
3. Prehospital determinants of successful resuscitation after traumatic and non-traumatic out-of-hospital cardiac arrest
4. 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.