THE DOPPLER EFFECT

Posted on May 17, 2013 by K

We are both incredibly busy at the moment but will hopefully soon be back with posts and replies to comments.

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RSI AND PERMISSIVE HYPOTENSION

Posted on May 8, 2013 by K

A study in Injury looks at what happens to our patients´ blood pressures when we do rapid sequence inductions for intubation. With all the talk of ´permissive hypotension´  in modern trauma management this could be important. More>>

Posted in Airway management, Emergency Medicine, Prehospital Medicine | 3 Comments

LUCAS

Posted on May 1, 2013 by K

Here is some i-phone footage from the OR that demonstrates how effective mechanical compressions can be. The patient is a hypothermic cardiac arrest victim. He was put on LUCAS2 as a bridge to ECMO-cannulation. On this transesophageal echo view the left ventricle is on the screen’s right. The video is crap, but it does give you an idea of what compressions does to the heart.

Posted in CPR, ECLS, Emergency Medicine | Leave a comment

DAILY SEDATION INTERRUPTION STILL CONTROVERSIAL

Posted on April 27, 2013 by K

 The average intensive care patient spends 40% of her/his ICU time being weaned from the ventilator. Reduced weaning times means freeing up an enormous amount of floor-space, manpower and resources. Two important causes for prolonged weaning are over-hydration and excessive sedation. A study in JAMA looks at how daily sedative interruptions affect time on mechanical ventilation. More>>

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HELPING BABIES BREATHE

Posted on April 25, 2013 by Thomas D

Every once in a while there’s a different research project, something that actually makes a difference. This is one of them. A great example of how simple interventions can lead to significant results in low resource settings. The “Helping Babies Breathe” program focuses on stimulation and, if needed, ventilation of flaccid, unresponsive newborns. This almost halved the newborn 24hr mortality rate! More>>

Posted in Emergency Medicine | 2 Comments

RINGER’S A LOUSY VOLUME EXPANDER

Posted on April 18, 2013 by Thomas D

With colloids being miscredited by Cochrane and synthetic colloids being hammered by RCTs, it might seem we’re left with crystalloids. So how good is our standard crystalloid, Ringer’s Lactate, at volume replacing a volume depleted patient? This study withdrew blood and replaced it with 3 times the volume of Ringer’s Lactate. Very little of it stayed in the blood stream. More>>

Posted in Anesthesia, Emergency Medicine, Intensive Care | 5 Comments

SAM

Posted on April 15, 2013 by K

Until recently I didn´t really know what SAM was. I do now. Boy am I happy. SAM stands for Systolic Anterior Motion of the Mitral valve and is a not too uncommon complication of hypertrophic cardiomyopathies (HCM), myocardial infarction and mitral valve repair or dysfunction. More>>

Posted in Cardiology, Emergency Medicine, Ultrasound | 1 Comment

ULTRASOUND FOR SPINALS AND EPIDURALS

Posted on April 11, 2013 by Thomas D

This is a well known, but fairly novel use of ultrasound. Certainly not standard in any place I’ve worked. But ultrasound for epidurals and spinals seems to be in vogue. Here’s a meta-analysis on ultrasound for spinal and epidural access. Several smaller studies have looked at this combo, but most of them have been underpowered. This recent meta-analysis from BMJ comes to the conclusion that ultrasound eases access and lowers risk of complications: More>>

Posted in Anesthesia, Ultrasound | 2 Comments

A LETTER TO THE EDITOR…

Posted on April 5, 2013 by Thomas D

Anyone who knows the frustrations of submitting a paper to a review panel of a peer reviewed journal must read this letter to the editor. It quite accurately describes one’s feelings during the review process. As the letter says: “We could not – or would not – have done it without your input”. More>>

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INSIDE COMBAT RESCUE

Posted on March 22, 2013 by Thomas D

A pretty interesting look inside the US Air Force’s Combat Rescue Choppers in Afghanistan. A five part series on youtube. Having worked in helicopters, I’m impressed with all the procedures these guys perform in-flight.
BONUS: Airway porn in episode 5 (above): in-flight surgical airway on facial trauma patient at 40 minute mark. Saves the day.

Posted in Prehospital Medicine | 2 Comments