There’s been a lot of debate and controversy over spinal stabilisation in traume the last couple of years. Per Kristian Hyldmo is a HEMS anaesthetist, has done a PhD focusing on transportation of trauma patients including the lateral trauma position, and engaged in spinal stabilisation. He is part of the national Norwegian taskforce that published the Norwegian guidelines for spinal stabilisation in trauma two years ago. This formalised the move away from cervical collars in trauma, that had started a few years earlier.
Watch Hyldmo’s take on spinal stabilisation in 2018 in this presentation from TBS18:
It’s hard to know what machine to pick, and hard to find good reviews, especially reviews of the machines in daily clinical use. Luckily a bunch of ultrasound nerds, the #ultrascoundrels, have taken it upon themselves to remedy this. Currently, the reviews of the latest GE VScan, the SonoSite iViz, the Clarius and the Sonon are up. And the Philips Lumify and possibly the Butterfly are in the pipeline for coming reviews More>>
The Jim DuCanto experience at The Big Sick. We got our favourite airway big bear over from the states: Jim DuCanto, equal parts mad scientist and airway afficionado. Published paper on CPR, intubation and ventilation under water, or the beeryngoscope the best laryngoscope for entertaining, competitive laryngoscopy training.
DuCanto’s always full of energy, postive vibes and great airway tricks – he’s a fantastic guy to hang out with. You’ll have a great time, and learn lots in the process.
SALAD is DuCanto’s project of Suction Assisted Laryngoscopy Airway Decontamination, and is the focus of both his talk and the workshop they had later in the day.
The SALAD airway workshop was done together with Carmine Della Vella and Erika Panaro, who both came driving over the alps to Zermatt from Italy in Carmine’s Fiat Cinquecento filled with mannequins and airway gear. The workshop was just next to the hotel bar, and it was amazing how the SALAD team kept it professional and focused and still super friendly, and airway pearls were flying through room. If you weren’t at TBS18, you missed out.
We were fortunate to have Geir Strandenes in Zermatt for The Big Sick conference, TBS18. Dr. Strandenes is medical head of Norwegian Naval Spec Ops forces and one of the founders of the THOR network and heavily into hemorrhagic shock resuscitation and whole blood.
Geir is a true eccentric. New and creative ways of thinking, but always founded in research, history and physiology. True to his style, he delivered his talk in his “Make Whole Blood Great Again” and barefoot in hotel slippers.
His talk ventures into frontiers not reached by RCTs, so he explores fascinating historical research and goes into physiology and animal experiments to make a great case for attacking hemorrhagic shock and bleeding in a different way. You’ll get some eye-openers during this talk, and lots of stuff to think through and discuss. Enjoy.
We’ve written on Prof Tisherman’s Suspended Animation before. We found it very intriguing and were thrilled to be able to have Tisherman over from the Shock Trauma Center in Baltimore to TBS18 in Zermatt, Switzerland to explain the concept and take us through its history and at the same time giving a fascinating take on physiology at the edge of life.
The real name of the concept is EPR: Emergency Preservation and Resuscitation. The plan is using EPR for cardiac arrest after exsanguinating trauma, a situation where CPR does little good, and we have very few treatment options. So cool the body down, fix it, then warm it back up and bring it back to life. Let Tisherman take you through it.
The Big Sick conference TBS18 was a big success, and please get in touch if you’d want to join us for TBS19.
From our ECMO session at The Big Sick 2018, #TBS18:
Lionel Lamhaut on Prehospital ECMO (39:30)
Zack Shinar on EDECMO (1:04:30)
Håkan Kalzen on the Karolinska experience with ECMO and ECMO transports (1:31:35)
Magnus Larsson on ECMO in trauma patients (2:34:24)
BONUS: Professor Tim Harris on Resuscitation (3:05:18)
The Big Sick conference 2018 in Zermatt was a blast! We’re going to post some of the talks from TBS18. Some of them, like this from the ECMO session and beyond, are quite raw and un-edited as they are recorded directly from our live transmission of the sessions. That means there are some pauses you have to fast forward through, and that the technical parts could be optimised. Still, here you have some of the best ECMO lecturers available, talking on exciting parts of frontier ECMO use. We hope you enjoy it.
Also, check out The Big Sick 2019 6-8. February 2019, #TBS19 here.
ECMO is usually applied to the whole body. In VA-ECMO, we often use a smaller side cannula to supply the lower limb with circulation and oxygenated blood, when its femoral artery is partially occluded by the main ECMO cannula. >>
This experimental study puts most common assumptions about hyperventilation in hemorrhagic shock on its head. Common thinking is that trauma pts breathe faster because of shock and metabolic demands not being met. This study suggests trauma pts are breathing faster to elicit a respiratory pump with the negative inspiratory pressures that will enhance cardiac preload. More>>
Is systolic blood pressure (SBP) of 90 the magic threshold in traumatic brain injury (TBI)? This observational paper goes through a large prehospital database, and found an association between lower systolic BP and higher mortality. This has created a lot of discussion on current goals for BP in TBI – but it needs to be pointed out the article is observational – we don’t yet know if manipulating these blood pressures higher will be good for TBI patients. More>>
The Big Sick 18 #TBS18 conference is done and we’re catching up on sleep and all the impressions from a great week with learning, discussions and fantastic people, check out our programme on www.bigsick18.org – and here’s an excellent recap video of #TBS18 from Marius Klausen (also, read more below).