Monthly Archives: November 2011

WHY THE GLASGOW COMA SCALE HAS GOT TO GO

Whenever my colleagues or nurses ask me what GCS a patient has, I just make something up that sounds about right. Judging by their smirks I know they think that they know I didn’t check properly. The truth is far … Continue reading

Posted in Emergency Medicine, Neurology, Trauma | 20 Comments

HI, WE´RE FROM THE NNT

We found a site that is pure genius. The authors list the Number-Needed-to-Treat for heaps of various treatments we put our faith in. It is genius, but also severely demotivating at times. Tranexamic acid in trauma? Only one in 67 … Continue reading

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PREHOSPITAL ACTIVATION IMPROVES D2B

Only in a minority of STEMI-patients do we achieve our goal of PCI in less 90 minutes from them entering the ED. Despite the guidelines clearly recommending a door-to-ballon-time (D2B) of less than 90 minutes. 

Posted in Cardiology, Emergency Medicine | Leave a comment

MAD IS GOOD

With a Mucosal Atomizing Device (MAD) you can deliver many critical drugs intranasally. All you need is a liquid, concentrated drug that will easily cross the nasal mucosa, and give it via something that will atomize your fluid.

Posted in Anesthesia, Emergency Medicine, Prehospital Medicine | 1 Comment

SMOKING ENHANCES ENDURANCE TRAINING

“Cigarette smoking: an underused tool in high-performance endurance training”. This interesting review paper from the Canadian Medical Association Journal (CMAJ) points to scientific evidence that supports cigarette smoking as beneficial for high-performance endurance athletes.

Posted in Humour | Leave a comment

OSIRIX DICOM VIEWER

You’ve done an interesting case pre-hospital, in the ED or in the OR or ICU. After the CT/MRI scan, you go to get some images from the radiologist for later reference and teaching.

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PARKLAND REVISITED

We received an excellent talk by plastic surgeon O’Hara from the burns unit of Concord Hospital. Here are some key points. She stressed the importance of the Parkland formula as a guide. Both due to individual differences between patients, but also … Continue reading

Posted in Emergency Medicine, Trauma | Leave a comment

REVERSING NEUROMUSCULAR BLOCK

Maybe it’s time to take proper  reversal of neuromuscular blockade more seriously? A study just published in European Journal of Anesthesiology compares patients who have their blockade reversed with patients who are extubated without reversal. A lot of heartbreak can … Continue reading

Posted in Anesthesia | Leave a comment

THE PREHOSPITAL CONTROVERSY, IF THERE STILL IS ONE

I read an article in European Emergency medicine Journal. It compares prehospital skillsets of prehospital physicians with ambulance nurses. It is a descriptive study of the Dutch prehospital system but most of it should translate to most western environments. 

Posted in Prehospital Medicine | Leave a comment

ANOTHER HOLY COW

There’s a whole herd of ‘holy cows’ in anaesthesia. Practices we have despite total lack of evidence, that are so holy that we are afraid to discuss them. It seems to take few decades and a generational shift before they … Continue reading

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