Trauma 1 · 12 min · ground

VTE is falling — why?

ATS 2024 · 6 mL/kg · Pplat ≤30 · 92–96% (trainer band — avoid hyperoxia) · 6 mL/kg PBW (4–8) · Pplat ≤30 · ΔP ≤14 (trainer) · PaCO2 ~35–45

41-year-old GSW right chest. Finger thoracostomy in the bay, poorly taped. Tubed, one more hospital 12 minutes away. Starts okay. Then it doesn't.

Handoff

You are on PCV+. Peak looks 'fine.' The tell is VTE. If you miss the pneumo he will arrest in the ramp.

1
Recognize falling VTE as tension
Pressure-driven T1 will not gift you a high PIP.
2
Don't crank PEEP into a tension
That is how you finish the job.
3
Arrive with a pulse
Treat the chest, then the vent.

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