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 | 4 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.

Posted in Cardiology, Intensive Care | Leave a comment

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

BACK BOARDS AND SPINE IMMOBILISATION

Dr. Ryan Jacobsen, director of the Johnson County EMS in the States, explains why his EMS system isn’t transporting patients on the hard back boards for spine immobilisation. And he makes a great case of it, although they still – reluctantly – use c-collars more than they’d like to. Take the time to watch this talk!

Also, a few practical video examples at the end, both for ER use as well as for the ambo guys.

Around 1:18:30 he shows off the Scandinavian lateral trauma position with a Norwegian ambulance in the background (and mocking our ambulance vehicles in the process).

Posted in Emergency Medicine, Prehospital Medicine | 2 Comments

PROVHILO – IT’S INDIVIDUAL

PROVHILONew RCT on intraoperative ventilation strategies is out: PROVHILO. Low tidal volume ventilation (LTVV) has been settled as the way to go, but what about PEEP and recruitment maneuvers? Wouldn’t high PEEP and regular lung recruitment make sense in patients at risk for post-OP lung complications? Apparently not. This rather big multi-centre trial showed no difference in lung complications between the groups. But a higher incidence of intraoperative hypotension in the high PEEP group. But is that the whole story? More>>

Posted in Anesthesia | 2 Comments

FROM RUSSIA WITH – A HEART-LUNG MACHINE

A short weekend dip into obscure history: The Cardiohelp ECMO machine is an impressive piece of equipment, but the origins of the heart-lung machine is equally impressive for its time – even if the experiments are rather animal unfriendly. The following film is a documentary on the Soviet research by Sergei Brukhonenko in the 1940s, using his self-invented “Autoinjektor”, and led to professor Vishnevsky performing the first Soviet open-heart operation in 1957.

The film is slightly sensationalistic and seems to consist, at least in part, of re-enactments of the experiments rather than real experiment footage. It gives a feeling of watching Plan 9 From Outer Space instead of serious research, but the experiments described in the movie were actually carried out by Brukhonenko, and seem to be the first successful use of a heart-lung machine.

More>>

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NOT SO IMPRESSIVE CICV MANAGEMENT

iPhoneIcon_BigThe outcomes from a Canadian questionnaire study of anaesthetists preferences in difficult airway management is disappointing. When faced with establishing an airway in cannot-intubate-cannot-ventilate scenarios, the majority would go for  seldinger- or needle-techniques ie one of the ready-made kits. More>>

Posted in Airway management, Anesthesia, Emergency Medicine | 2 Comments

COPD ICU MORTALITY

iPhoneIcon_BigIn intensive care, we are often called to deal with marginal or crashing COPD patients. Often, we end up intubating them. Then, in the morning rounds there always seems to be at least one passive-aggressive (†) colleague in the back, shaking their heads in disgust, not saying (you see, they’re passive-aggressive) we shouldn’t have done that, because the patient won’t survive anyway. Still, the passive-aggressive dudes are often right. Patients hospitalised for a COPD exacerbation have a 2 year life expectancy and those who end up on mechanical ventilation should do a whole lot worse. A study in Thorax helps me understand what can be expected of these patients. More>>

Posted in Airway management, Intensive Care | 1 Comment