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>

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WHY MORE PEOPLE LITERALLY WALK AWAY FROM CAR CRASHES

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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 | 4 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

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>>

Posted in ECMO, Intensive Care | 1 Comment

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>>

Posted in Emergency Medicine, Prehospital Medicine | 13 Comments