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>>

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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>>

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ECMO – MIXING IT UP

iPhoneIcon_Big-30ECMO is all the rage, and ScanCrit is a fanatical believer. However, ECMO has its problems and challenges. The challenge we’ll look into here, is choosing between VV or VA ECMO – sometimes the choice is straightforward, other times not. And on VA ECMO – how do you circulate and oxygenate the whole body, not just from the waist down? Maybe you don’t have to choose? An article in the ASAIO Journal looks into hybrid configurations of ECMO. More>>

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CERVICAL COLLARS SLASHED FROM GUIDELINES

cervical-collar-slashThere’s been a big discussion on cervical collars in trauma the recent years. We’ve covered the controversy here. Guidelines are usually slow to adapt, but now both national guidelines from the Netherlands and state guidelines from Queensland in Australia seems to be removing the hard collar from their guidelines, as we have in Bergen, Norway. And recently ILCOR has released a preliminary guideline on spinal stabilisation. They conclude that with current evidence, cervical collars can’t be recommended for routine application in trauma(!) More>>

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SCARY ARTERIAL AIRWAY DRAMA

Found an interesting case report in intensive care med. It describes a case where an anaesthetist found a pulsating mass in the lateral wall of the oropharynx. MR revealed the patient’s internal carotid artery was kinked, aberrant and indented way into the pharyngeal wall. This could obviously restrict laryngoscopy view but more importantly bleed massively if torn.

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Case report/image lives here:

Intensive Care Med. 2015 Jan 10. Aberrant internal carotid artery: a risky condition for tracheal intubation.Prokopakis E, Lyronis G, Kaprana A, Velegrakis G.

Posted in Airway management | 2 Comments

LATERAL VIEW OF THE AORTA

We normally visualise the aorta on ultrasound by scanning down the midline. However, we frequently fail to visualise the entire aorta. The view is often obscured by bowel gas. Abdominal pain often makes the examination intolerable. A small proof-of-concept study in AJEM suggest a right lateral approach, using the liver as an acoustic window, improves visualisation. More>>

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QUOTE OF THE MONTH

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EARLY VS LATE INTUBATION OF BURNS

iPhoneIcon_BigWe are taught to intubate victims with inhalational injury early. If we delay for too long the tongue, epiglottis and other structures can swell and cause airway obstruction, forcing an emergency intubation that is more likely to be difficult or failed. A french study in AJEM looks at the incidence of difficult intubations in patients with face and neck burns and the possible consequences of airway tardiness. More>>

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IMAGING CASE OF THE MONTH

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XKCD nails it. Again.

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HOW I TREAT PATIENTS WITH MASSIVE HEMORRHAGE

RBC bagThis is the rather peculiar title of an great summary paper on the transfusion pratice in massive hemorrhage, mainly focusing on trauma. It describes the background, evidence and use of 1:1:1 transfusions as well as pro-hemostatics and the use of TEG/ROTEM in an easy to follow fashion. This is incorporated into the description of the slightly different approaches of two large Level 1 trauma centers with very active blood banks and transfusion docs, in Copenhagen and Houston, TX. A recommended read on current practice. More>>

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