In anticipation of EM Cases Episode 118 Trauma: The First and Last 15 minutes with Andrew Petrosoniak, Kylie Bosman and Chris Hicks we have Joe Nemeth, Trauma Fellowship Director at Montreal General and Associate Professor at both McGill University and University of Toronto discussing his Best Case Ever of a teenager who was “stabbed in the box”. Rajiv and Joe discuss preparation for trauma, the role of POCUS in predicting survival in traumatic cardiac arrest, the HOTT mnemonic for reversible causes of trauma arrest and more…

Podcast production by Rajiv Thavanathan. Editing and sound design by Richard Hoang.

December, 2018

Prepare your team, your environment and yourself for traumatic cardiac arrest

Prepare your team (Team Preparation with Hicks from SMACC), your gear/environment (consider patient cruciform position) and yourself (consider ‘Beat the Stress Fool‘).

traumatic arrest

Cruciform position in trauma resus








Can cardiac POCUS predict survival in traumatic cardiac arrest?

A large prospective study out of Los Angeles in 2015 found that no patient with a traumatic cardiac arrest and absence of both cardiac motion and pericardial effusion on POCUS survived ED thoracotomy.


HOTT mnemonic for immediate reversible causes of traumatic arrest

Hemorrhage -> pressure/tourniquet for external hemorrhage, blood products ASAP

Oxygenation (critical hypoxia)

Tension pneumothorax -> bilateral finger thoracostomies

Tamponade (cardiac) -> thoracotomy


2015 Guidelines for ED thoracotomy – Eastern Association for the Surgery of Trauma Full PDF


Drs Thavanathan, Hoang and Nemeth have no conflicts of interest to declare



Petrosoniak, A. Hicks, C. Beyond crisis resource management: new frontiers in human factors training for acute care medicine. Curr Opin Anaesthesiol. 2013 Dec;26(6):699-706.

Lauria MJ, Gallo IA, Rush S, Brooks J, Spiegel R, Weingart SD. Psychological Skills to Improve Emergency Care Providers’ Performance Under Stress. Ann Emerg Med. 2017(6);884-890.

Inaba K, Chouliaras K, Zakaluzny S, et al. FAST ultrasound examination as a predictor of outcomes after resuscitative thoracotomy: a prospective evaluation. Ann Surg. 2015;262(3):512-8.

Mitra B, Fitzgerald MC, Olaussen A, et al. Cruciform position for trauma resuscitation. Emerg Med Australas. 2017;29(2):252-253.