MEGAN’S SONG

There is an important article about intubation in EMSWorld. It is about a prehospital intubation gone terribly wrong. It is essential reading for all of us who manage airways outside or inside hospitals.

Read it here.Screen Shot 2014-09-16 at 10.57.15

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ETT DEPTH CONFIRMATION BY TRACHEAL PALPATION

iPhoneIcon_BigA study in Can J Anesth looks at the accuracy of confirming endotracheal tube position by palpating the sternal notch. More>>

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THE BOTTOM LINE

Bottom Line iconWhile we at ScanCrit were thinking about what a great idea it would be, The Bottom Line just went ahead and did it. And they’re still doing it: Making a library of the key articles and most important trials in intensive care medicine – and appraising them. More>>

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DONUT OF LIFE?

Randy's DonutsIt’s long been an accepted standard to stay and stabilise or go directly to OR with any unstable trauma patient – and never EVER take them to CT first. And it made sense, as radiology has never been a good place to be with critical patients. But as radiology is getting a central place in trauma care, new thinking is changing all this. Instead of keeping away, lets make the CT lab a safe critical environment. More>>

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LET´S NOT EVER HAVE THAT DISCUSSION AGAIN

Most of us know this so just a quickie post about ketamine and ICP. This paper lives here.

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QUOTE OF THE MONTH

@SydneyHEMS defines the #FOAM mantra:

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ALL YOUR BAYES ARE BELONG TO US

pvalueYou’re being tricked – by your own medical mind. Pretest probabilities mean more to your clinical work than you might think. While sensitivity, specificity and P value, the ‘gold standard’ of statistical validity, is not as universally applicable as many of us, including many scientist assume.

This is an attempt of explaing pretest probabilities, the basis of Bayesian statistics and why it is important to our everyday clinical work. Don’t fall asleep yet, but read through and see what you think. More>>

Posted in Statistics | 6 Comments

DEATH TO THE YELLOW CATHETER OF DEATH

It’s not news but I recommend you read Paul E Marik’s review of the Pulmonary Artery Catheter (PAC) from Annals of Intensive Care 2013. Basically he tears the whole thing apart, writes an obituary and suggest we make it a historical curiosity. I think very few authors can get away with what he does there.

Please spam the paper to your ICU colleagues so that we can get rid of this abomination once and for all.

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Paper (available for free) lives here:

Obituary: pulmonary artery catheter 1970 to 2013. Marik PE. Ann Intensive Care. 2013 Nov 28;3(1):38. doi: 10.1186/2110-5820-3-38.

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MANUAL AORTIC COMPRESSION

iPhoneIcon_BigThere´s an interesting case report in Annals of Emergency Medicine. It describes a case where massive bleeding from the lower abdomen and pelvis was successfully stopped by a burly first responder who applied manual aortic compression. More >>

Posted in Emergency Medicine, Trauma | 6 Comments

STEWART’S ACID TRIP

Stewarts acid tripAcid-base calculations. The ones that make my head hurt. Every time I read up on it, I seem to almost grasp it and get a deeper understanding – which slips away slightly after a week or two. And a few weeks later, I read up on acid-base again to repeat the cycle… There are many ways to explain the acid-base balance in the body. To me, the Stewart approach has been the most helpful. Here are three steps, three links, to understanding Stewart. More>>

Posted in Anesthesia, Emergency Medicine, Intensive Care | 2 Comments