EWWW!

iPhoneIcon_BigI found two interesting papers in EMJ. Both recently published. If you intubate a fresh frozen cadaver and ventilate you will get a transient capnography trace very similar to a trace from a living patient. I had heard about it before but haven’t seen any evidence until now. More>>

Posted in Airway management, Cardiology, CPR, Emergency Medicine | 1 Comment

ARCHAIC TRAUMA LIFE SUPPORT

imageThere’s an interesting, important, editorial in Anaesthesia. It is a fair criticism of ATLS. It starts with the historical background, details it’s modern weak points and concludes with how ATLS should be regarded as an entry level course for clinicians who won’t frequently manage trauma. More>>

Posted in Trauma | 3 Comments

WHAT THE HELL I AM DOING? I AM ENGORGING A VEIN IS WHAT I AM DOING!

iPhoneIcon_BigI’m not sure where this fits in, in this age of ultrasounding everything, but there is an interesting short report in EMJ. It describes a simple technique to achieve IV access in patients where the periphery is shut down.  A typical scenario could be a patient in shock were all you can get in is a pathetic 22-24G cannula on the hand, when what you really want to do is a rapid infusion through a 14-16G in the cubital vein. More>>

Posted in Emergency Medicine, Prehospital Medicine | 3 Comments

CRACK THE CHEST – GET CRUCIFIED

This is John Hinds. Recorded at the fantastic SMACC Chicago conference, June 24th 2015.

Also, if you do any ICU stuff, go over to EMCRIT at this link and listen to John’s brilliantly provoking ICU talk. This is sheer genius – and entertaining. We’ll miss you.

Posted in Uncategorized | 1 Comment

THE ONE-TWO PUNCH

iPhoneIcon_Big (1)Interesting case report on cardiac arrest patient with refractory VF. Shocked 7 times – with a change in pad location. No luck. For the 8th shock, they hooked the patient up to a second defibrillator, and shocked him sequentially. One defib fired straight after the other in a 1-2 punch fashion. And got him into sinus rhythm. More>>

Posted in CPR, Emergency Medicine | 3 Comments

E-CPR STRIKES AGAIN

iPhoneIcon_BigECMO for cardiac arrest, E-CPR, has been shown several times to increase survival more than any other intervention we have available. Here’s yet another retrospective study to support the findings in previous trials (links at end of post). Survival with good neurological outcome increased from 7.5% to 40% with E-CPR! More>>

Posted in Cardiology, ECMO, Emergency Medicine | 11 Comments

IO DRUGS AS QUICK AS IV

iPhoneIcon_BigIO needles are always said to be able to deliver any drug, and with the same speed and onset as their IV cousins – also in critical patients. Most of use don’t really trust that fully, I think. The ones who trust the IO route are the ones that have been forced to rely on them – like military medical services. Especially front line services like the British MERT. So, to document the IO’s usefulness, they made a trial to convince us. More>>

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

PERIPHERAL NORADRENALINE

iPhoneIcon_Big-34Peripheral noradrenaline (or norepinephrine), or any peripheral pressor, is shunned in many centers. High doses can cause gangrene. If extravasated, it can cause tissue necrosis. But is this a big risk? Also, weighing against the risks of CVC or delayed pressor start-up – what’s the best approach? I work in a teaching hospital where short-term noradrenalin infusions are fully acceptable, and the norm in many settings – but other places I’ve worked, it’s a big no-no. Recently, we got a systematic review on the subject. More>>

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

IMAGING CASE OF THE WEEK

Blood

Posted in Uncategorized | Leave a comment

CODE BROWN: COMBATIVE AND BLEEDING

iPhoneIcon_Big-31I’ve had combative patients in my ER lots of times. Combative enough to warrant sedation or anaesthesia. And bleeding patients. Serious bleeding. Lots of times. But not the extremes of both at the same time. More>>

Posted in Code Brown, Emergency Medicine, Trauma, Ultrasound | 11 Comments