How’s this for thinking outside the box in the approach to the difficult airway!? Difficult airway algorithms and advanced management options for difficult airways mostly concentrate on getting into the trachea. But what happens if getting into the trachea is the easy bit? What happens if that’s where you run into a dead end? How do you manage the crashing airway where the problem lies just after the end of your tube? I stumbled across this case report published in the Annals of Thoracic Surgery this year which provides an elegant solution to managing a near total tracheal occlusion. More>>
Passing the orogastric tube can be difficult or sometimes impossible. Unfortunately a lot of patients really need their OGs and in a time-critical scenario you don’t want to spend too much time struggling with it. Here is a simple trick a senior colleague showed me. Many of you probably already know of this technique and may already be doing it. My colleague says he has been doing this since back in the seventies. I find that hard to believe as he was born in the late 1960s. More>>
An interesting survey recently published in Resuscitation looks at arrest teams for in-hospital cardiac arrest. As anyone in the FOAM-o-sphere is well aware, trauma teams, prehospital teams and ED cardiac arrest teams are increasingly well oiled and the importance of a designated team leader has never been more apparent. Are teams for in-hospital arrests lagging behind? Is the in-hospital arrest the neglected problem child in the resus family? More>>
The ERC, the European Resuscitation Council, have issued new guidelines for first aid, section 9 of their guidelines. And it includes an interesting and rather controversial take on cervical collars and spinal immobilisation that’s similar to what we have been propagating for some years now. They say: “The routine application of a cervical collar by a first aid provider is not recommended”, and comment on limitations of the current view of cervical collars as a good routine device in trauma. Read the out-take. More>>
Quickie post about an interesting paper I found. Now there is actual evidence of how being a jerk negatively impacts on team performance. An Israeli paper looks at how being exposed to rudeness affects teams in emergent situations. More>>
After a fantastic SMACC conference in Chicago this Summer, preparations for next year’s SMACC in Dublin is well under way. As a conference for Social Media And Critical Care, the SMACC conference is not just an update on cutting edge in Emergency Medicine and Critical Care, it is also very much a conference the way conferences should be: It adds to your motivation and inspires to drive yourself further.
It does this through the talks, and also through the social side of SMACC: it is a place to meet and network. Not network in the formal business understanding, but in the way of meeting and interacting with real people with similar interests. The social side of SMACC is its major point. It makes SMACC unique.
And the best part is that this is driven by you – the delegates. And it works. People meet, interact, learn and have a great time. Dublin promises to be a great setting for the SMACC crew and delegates to make this happen again!
We hope to see you at SMACC in Dublin 13th to 16th of June!
Ultrasound is being used for procedures and decision making everywhere. Now, someone’s evaluated it for decision making in penetrating trauma cardiac arrest emergent thoracotomies. Is there a place (and time) for ultrasound in this setting? A new article in Annals of Surgery looks into this. What we can take home is that cardiac standstill on ultrasound is always a bad sign. More>>
ECMO can fix anything. But, surprisingly, it has some limitations. One of them is differential oxygenation in VA-ECMO, also known as watershed. A recent paper looks into new ECMO set-ups in an experimental animal model that seeks to solve the differential oxygenation problem, and it seems they’re on to something. Now, this is a rather long post, but hopefully it’s worth it. More>>
I found two interesting papers in EMJ. Both recently published. If you intubate a fresh frozen cadaver and ventilate you will get a transient capnography trace very similar to a trace from a living patient. I had heard about it before but haven’t seen any evidence until now. More>>
There’s an interesting, important, editorial in Anaesthesia. It is a fair criticism of ATLS. It starts with the historical background, details it’s modern weak points and concludes with how ATLS should be regarded as an entry level course for clinicians who won’t frequently manage trauma. More>>