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 | 3 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>

Posted in Cardiology, CPR | Leave a comment

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

PREHOSPITAL EXTRICATION TIMES

iPhoneIcon_BigCar accidents with trapped victims can be incredibly frustrating. There is often very little one can do until the rescue services achieve extrication. Sometimes, because of limited patient access, all you can achieve during extrication is some very basic airway management, pain relief through a crap IV and ‘neck stabilisation’ while waiting for the firemen to fully extricate. Everyone on scene knows how every minute counts, and it feels like it is taking forever. A British study in EMJ looks at how long the various stages of extrication takes. More>>

Posted in Prehospital Medicine, Uncategorized | 3 Comments

EGDT IS DEAD, LONG LIVE EGDT

Rivers iconAnd so the EGDT trilogy is complete. The results of the ProMISe trial was published, after we’ve recently had the results from the ARISE and ProCESS trials. They all compared EGDT (Early Goal-Directed Therapy) to “standard care”. And they were all agreeing: Standard care is as good as EGDT. But who has practices orthodox EGDT this last decade? Not anyone I’ve spoken to. And what is “standard care” – it’s mostly a tweaked version of EGDT. So as far as we’re concerned, not much new here, and the legacy of EGDT is still very much alive and kicking. More>>

Posted in Emergency Medicine, Infectious diseases, Intensive Care | 5 Comments

IMAGING CASE OF THE WEEK

sphinctergraph

Full post describing the study at gomerblog.com …jokes aside, there is actually a real study on “changes in anal sphincter tone at induction of anaesthesia” – but it was done on the patients, not the anaesthetists…

Posted in Humour | 1 Comment

TEE DURING CARDIAC ARREST

TEE and cardiac arrestTransesophageal echocardiography (TEE or TOE) used to be the domain of cardiologists. It has lately seeped into other areas of medicine where hemodynamic evaluation is crucial. ICU’s and occasionally OR’s use them even for non-cardiac surgery. But the TEE probe can quite easily be used in any unconscious, intubated patient. One obvious indication would be cardiac arrests. More>>

Posted in AHLR, Emergency Medicine, Ultrasound | 2 Comments

THUNDERSTORM ASTHMA

iPhoneIcon_BigI always thought ‘thunderstorm asthma’, localised epidemics of asthma associated with thunderstorms, was semi-factoid.  Not so.  Apparently, thunderstorms do cause asthma spikes in asthma ED attendance. This is elegantly shown in a recent Emerg Med J. More>>

Posted in Emergency Medicine | 1 Comment