A trial called ATACH-2 (Antihypertensive Treatment of Acute Cerebral Hemorrhage II), recently published in NEJM, is likely to temper the enthusiasm for aggressively lowering blood pressure in patients with intracranial bleeds. >>
Some years ago, while working for an air ambulance, me and an experienced paramedic responded to a pedestrian-vs-car accident. A young female was out driving when she had a flat tire. As she opened the rear compartment to get the spare tire, a second car slammed in. Our patient was wedged between the cars. More>>
We all know that there’s so much to learn from other professions whom, although working outside of healthcare, function in comparably unpredictable high risk, high pressure environments. This mutual cross-pollination enriches the way we think about and look at our own practice and gives us new perspectives on what it means to perform under pressure. And this time it’s got nothing to do with aviation. More>>
A fascinating case report was recently published in Resuscitation. A young female speleologist was avalanched in the polish Tatra mountains. As she had access to an air pocket and some degree of ventilation she didn’t to succumb to the asphyxiation that kills most buried avalanche victims. Instead, she was gradually cooled to a core temperature of below 17° C. More>>
In anaesthetics we are trained to pre-oxygenate and intubate our theatre patients in a flat supine position. Then, when we graduate to intubating the really gnarly ICU/ED patients in severe heart or respiratory failure, we wise up. A paper in Anaesthesia & Analgesia demonstrates how patients who are intubated in a semi-sitting position are less likely to suffer complications when intubated. More>>
Interesting paper in AJEM. Hypoxic hepatitis (HH), ‘shock liver’, is defined as an increase in serum aminotransferase levels (20 times the upper normal level) after respiratory or circulatory failure. It is commonly seen in critical illness and after cardiac arrest. In ICU patients HH has been associated with poor outcomes but little is known about what it means in ROSC patients. More>>
We’ve often critisised ATLS. Part of it because many healthcare workers take the ATLS manual as divine law. And many of them don’t keep up with the changes in the new ATLS editions – so they cling to even older dogma. Pretty much everybody has stopped giving 2 L of saline, but many will still say things like the digital rectal exam (DRE) is manadatory in ATLS. It isn’t. Or a hard cervical collar is mandatory. It isn’t.
ATLS is now at the 9th edition, and the 10th edition is around the corner. What other dogma will they get rid of, and what will they add, and get more in line with current trauma thinking? Well, here’s a teaser:
They have moved the temporary measure of needle decompression from the thick pectoral muscles, and out on the side of the chest – although a finger thoracostomy would be more decisive and definitive.
They’ve even gotten rid of the high riding prostate sign, although they should have gotten rid of, or at least toned down the whole DRE – and log roll for that matter.
Now, ATLS is a big organisation and not as fast moving and flexible as we would want to, but they are moving forward. For their 10th edition, it seems they will be catching up on many important areas.
Besides being one of the better study names around, this Norwegian RCT in the Lancet also shifted my prejudice. I was really thinking invasive vs conservative treatment for those over 80 with NSTEMI/UAP would show little difference. Maybe even a win for conservative treatment. But the scales tipped quite heavily in favour of invasive treatment. More>>
Videolarygoscopy (VL). Brave new world. VL makes any intubation easy, and solves airway managment problems. Well, it can be a life-saver, but it also brings its own set of problems. Two new RCTs comparing VL and DL are just out. One study looks at using VL as the primary intubation tool in the pre-hospital setting, and next to the old laryngoscope it pales in comparison. Bit there might be more to the story. Let’s have a look.
We’ve held on to our strict fasting regimes for decades. Gastric ultrasound is here to help us individualise our fasting rules a bit more. Gastric ultrasound has lots of uses, and lately it’s become fashionable to use it for evaluating surgical patients immediately pre-op to see if they’re fasted.