NOSE CLIPS MAY NOT BE THE WAY FORWARD IN MASK VENTILATION AFTER ALL

UnknownAn small but elegant experimental study in CJA explores the impact of nasal passage occlusion on mask ventilation in the unresponsive patient. Tidal volumes may be reduced by more than half when the nose is totally occluded. <More>

Posted in Airway management, Anesthesia, Uncategorized | Leave a comment

O2 NOT NEEDED IN MYOCARDIAL INFARCTION

sweetheartThere’s not much left of poor MONA. We’ve written on unnecessary O2 treatment before, ie the AVOID trial. And now, one of the large RCTs on the subject is out. The DETO2X-SWEDEHEART investigators (love the acronym) have published their findings in NEJM: Routine oxygen therapy gave no advantage over breathing ambient air. More>>

Posted in Anesthesia, Cardiology, Emergency Medicine, Prehospital Medicine | Leave a comment

INTUBATION IN ARREST – AGAIN

intubatedAnother study on airway management in cardiac arrest was just published in JAMA. The study was done in Denmark, where all intubations elective and emergency are done by anaesthestetists. It was a retrospective study, where they matched intubated patients with historical arrest patients not intubated at that same point in resus time. Intubation lowered the pt’s chance of survival to discharge with CPC 1-2. So, another study against intubation in cardiac arrest. Or? More >>

Posted in Airway management, Anesthesia, CPR, Emergency Medicine, Prehospital Medicine | 8 Comments

USE ULTRASOUND FOR FEMORAL CANNULATION IN ARREST

No thanks were too busyFor vascular access, you still hear the old “We don’t have time for using ultrasound – this is an emergency!”. In many settings, the old landmark techniques are quick and good in experienced hands. But when going for the femoral vessels in cardiac arrest, you would want to use ultrasound. More>>

Posted in Anesthesia, Cardiology, CPR, ECLS, ECMO, Emergency Medicine, Ultrasound | Leave a comment

CAN PLATELETS TAKE THE HEAT – OR CRACK UNDER PRESSURE?

Old dogma die hard. One of them is not heating platelets when giving transfusions. This breaks up the flow of transfusions and makes the process somewhat erratic. But the platelets are obviously heated when entering the body – the extra few, fever-like degrees of a fluid warmer can hardly matter. So many ignore this guideline, and just heat. But the question often surfaces, and sometimes brings a slight unease to the trauma team. More>>

Posted in Anesthesia, Emergency Medicine, Trauma | Leave a comment

IS FEVER THE NORMAL TEMPERATURE OF SEPSIS?

imagesWe know that hypothermia in sepsis is associated with increased mortality but other than that we tend to see fever in sepsis as something bad. We tend to perceive sepsis patients as more sick the more the temperature is elevated. We then tend to treat that hyperthermia with paracetamol, ibuprofen or external cooling.

A large Swedish study in Crit Care Med suggests that increasing temperatures might actually be a good thing. Increasing body temperatures on sepsis recognition is associated with improved outcomes. More>>

Posted in Intensive Care | 4 Comments

AVALANCHE

Image (1)ScanCrit is currently having a mini-symposium in Zermatt, and it includes leisure-time skiing. The conditions have been less than favourable, windy with low cloud cover and bad visibility – but also lots of fresh snow. This creates a high risk setting, as the conditions are avalanche prone – but are also very tempting for off-piste skiing. So, it was time to revisit our article on avalanches published in Journal of Royal Army Med Corps in 2016. More>>

Posted in Emergency Medicine, Prehospital Medicine, Trauma, Wilderness Medicine | Leave a comment

ECMO AT THE LOUVRE

louvre ecmo

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>>

Posted in CPR, ECLS, ECMO, Emergency Medicine | 3 Comments

NORWEGIAN GUIDELINES

Screen Shot 2017-01-15 at 14.18.04The 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>>

Posted in Prehospital Medicine, Trauma | 1 Comment

TIME TO BE COOL

Frosty the snowmanCooling 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>>

Posted in Cardiology, Emergency Medicine | 3 Comments