THE ONE-TWO PUNCH

iPhoneIcon_Big (1)Just a short post on a case report on cardiac arrest patient with refractory VF. Shocked 7 times – with a change in pad location. No luck. For the 8th shock, they hooked the patient up to a second defibrillator, and shocked him sequentially. One defib fired straight after the other in a 1-2 punch fashion. And got him into sinus rhythm. More>>

Posted in CPR, Emergency Medicine | 2 Comments

E-CPR STRIKES AGAIN

iPhoneIcon_BigECMO for cardiac arrest, E-CPR, has been shown several times to increase survival more than any other intervention we have available. Here’s yet another retrospective study to support the findings in previous trials (links at end of post). Survival with good neurological outcome increased from 7.5% to 40% with E-CPR! More>>

Posted in Cardiology, ECMO, Emergency Medicine | 6 Comments

IO DRUGS AS QUICK AS IV

iPhoneIcon_BigIO needles are always said to be able to deliver any drug, and with the same speed and onset as their IV cousins – also in critical patients. Most of use don’t really trust that fully, I think. The ones who trust the IO route are the ones that have been forced to rely on them – like military medical services. Especially front line services like the British MERT. So, to document the IO’s usefulness, they made a trial to convince us. More>>

Posted in Anesthesia, Emergency Medicine, Trauma | Leave a comment

PERIPHERAL NORADRENALINE

iPhoneIcon_Big-34Peripheral noradrenaline (or norepinephrine), or any peripheral pressor, is shunned in many centers. High doses can cause gangrene. If extravasated, it can cause tissue necrosis. But is this a big risk? Also, weighing against the risks of CVC or delayed pressor start-up – what’s the best approach? I work in a teaching hospital where short-term noradrenalin infusions are fully acceptable, and the norm in many settings – but other places I’ve worked, it’s a big no-no. Recently, we got a systematic review on the subject. More>>

Posted in Anesthesia, Emergency Medicine, Intensive Care | 5 Comments

IMAGING CASE OF THE WEEK

Blood

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CODE BROWN: COMBATIVE AND BLEEDING

iPhoneIcon_Big-31I’ve had combative patients in my ER lots of times. Combative enough to warrant sedation or anaesthesia. And bleeding patients. Serious bleeding. Lots of times. But not the extremes of both at the same time. More>>

Posted in Code Brown, Emergency Medicine, Trauma, Ultrasound | 11 Comments

THE MOST SPECTACULAR HELICOPTER RESCUE

iPhoneIcon_Big-33A quick non-medical post, but it involves helicopters! There are loads of good Helicopter Emergency Medical Services (HEMS) around. One of the most famous is Rega, a Swiss based HEMS. And they did a spectacular job back in the 80s. As many of the spectacular things done by helicopter services back then, it was also dangerous, and would never have been done today. More>>

Posted in Prehospital Medicine | 3 Comments

COUGH CPR

CoughThere are a few magic lo-tech treatments about. There’s the precordial thump, but there’s also the self administered cough CPR. Documented in several case series from the cath labs of the 70s and 80s, coughing every 1-3 seconds was shown to keep patients alive and conscious despite VF cardiac arrest, for up to 39 seconds. More>

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WHY MORE PEOPLE LITERALLY WALK AWAY FROM CAR CRASHES

Posted in Prehospital Medicine, Trauma | Leave a comment

HUNGARIAN APNOEIC OXYGENATION

iPhoneIcon_BigApnoeic oxygenation in anaesthesia is the concept of providing oxygenation without ventilation. The idea is that even without lung expansion, oxygen will passively be dragged into the alveoli along the oxygen gradient caused by alveolar oxygen being transported away by the bloodstream. Hope that makes sense. If not, theres a better explanation at LITFL.  In theory, and in experimental conditions, the apnoeic patient will remain oxygenated indefinitely, given that the FiO2 in the pharynx is high enough and given that the airway is perfectly patent. The problem is rather hypercapnia and acidosis building up. More>>

Posted in Airway management, Prehospital Medicine | 7 Comments