ECMO at the Louvre, two art forms meet. We first tweeted this photo back in 2014, and now the case report behind the image has just been published. The case report highlights both the possibilities of new frontiers in medicine, as well as their shortcomings. These high-tech interventions come at a cost, and could end up just complicating things without saving lives. Classic sexy way of wasting money. Or, with the right patient selection, it could save lives. More>>
The Norwegian guidelines for spinal immobilisation were recently published in SJTREM. (Open Access)
Our involvement with the development of these started back in 2013 and 2014, when we published some posts that were highly critical of the dominating doctrine of extremely liberal immobilisation and especially of the rigid cervical collar. Much to our surprise, those posts exploded in the FOAMed community and, even more so, beyond. As of today, they have been accessed hundreds of thousands of times. More>>
Cooling in cardiac arrest has had its ups and downs. First, it was cool with 32-34 degrees, then TTM said 36 degrees was fine. So, what’s the optimal brain temperature post arrest? One of the problems with the TTM study was the time from ROSC to target temperature: 8 hours after randomisation. You won’t get any difference between 33 and 36 degrees if you reach 33 degrees after 8 hours. Could there be a hidden benefit with lower temperatures in the long cooling times? More>>
Experimental. On a goat. But still, 151 days on ECMO without any heparinisation is very impressive and promising. One big draw-back of ECMO treatment has been the need for full heparinisation to avoid clotting of the ECMO circuit. Heparin coated circuits have lessened the need for heparinisation, and it’s become routine to run heparin-free for shorter periods if the patient’s bleeding risk demands it. More>>
ECMO in multitrauma patients sounds like asking for complexity and lots of oozing blood – but it seems to have potential for actually stabilising the patient’s systems and get better outcome. The short version: ECMO restores normal physiology and unloads the venous system. More>>
SonoScandinavia is the melting of the successful SonoSweden/SonoSTHML and SonoNorway, bringing together the best of Scandinavian ultrasound teachers – and a bunch of ultrasound folks from the land of the Trump, like Matt Dawson of the excellent ultrasoundpodcast.com, as well as Bret Nelson (who’s also written a great textbook on EM ultrasound with Vicky Noble), Jacob Avila of 5minsono.com and Joe Wood of the Mayo clinic as well as other top quality teachers from around the globe.
We have been concerned about hyperoxaemia for a long time. Numerous studies have documented how supranormal O2-concentrations are harmfull in critical illness. Unfortunately, as far as I can tell anyway, ICU practice hasn’t changed much. We deal with hypoxia straight away, but otherwise we leave our patients marinating in reactive oxygen species for substantial periods of time before someone thinks to reduce FiO2. Maybe a paper published in JAMA will make us pay more attention. More>>
We believe that the ICU-patients, especially ventilated patients, are prone to having stress ulcers and one of the components of the daily ICU drill is to ensure that the patient is on ulcer prophylactics.
We do this despite how the incidence of stress-induced GI-bleeding has been steadily decreasing, possibly due to earlyer initiation of enteral feeding. We do this despite how studies have reported associations between proton pump inhibitors and ventilator-associated pneumonias and c. difficile infections. Therefore, as per our current guidelines, virtually all intubated ICU-patients are on proton pump inhibitors. A paper in Crit Care Med, however, could find no evidence of that actually benefiting patients. More>>
I found an editorial in BJA that describes an issue with succinylcholine I wasn’t really aware of. Butyrylcholinesterase (BCheE) hyperactivity. BCheE is the non-specific cholinesterase that rapidly hydrolyses succinylcholine in the blood so that only 10% of the injected drug eventually reaches the neuromuscular endplate. More>>
One of the most immediate ways to understand aortic stenosis, and how it affects blood pressure and the heart, is by watching a Transcatheter aortic valve implantation (TAVI) procedure. Catheters are placed in both the left ventricle (LV) and the aorta. The measuring of pressures in the left ventricle overlaid on the pressure in the aorta is telling. Especially seeing how they are equalised after getting a new aortic valve that restores free flow through the LV outflow tract.
Below, you’ll see the left ventricle pressures in yellow, and aortic pressures in red (colors represented both in the graph tracings and the numbers left of them). More>>