Monthly Archives: January 2013

CODE BROWN: CRASHING TRAUMA PATIENT

We all know the rules for damage control resuscitation. Often the lines are clear. But sometimes it’s hard to make that call. We received a MVA trauma: a young man trapped in a wrecked vehicle for hours in the Norwegian … Continue reading

Posted in Code Brown, Trauma | 18 Comments

FATTIES IN SMALL CARS

An article in EMJ confirms a very valuable lesson I once learnt from a veteran paramedic. Fat people are more prone to suffering serious injury or death in car accidents.

Posted in Prehospital Medicine, Trauma | 1 Comment

IMAGING CASE OF THE MONTH

OK, that’s it! I’m off to Germany! I don’t care if they treat their registrars like shit, as long as I get to drive a Porsche with prehospital ECMO.

Posted in ECMO, Prehospital Medicine | 2 Comments

IVC DIAMETER AND HYPOVOLEMIC SHOCK

AJEM recently published a meta-analysis of the evidence supporting making blood volume assessments in hypovolemic patients based on the ultrasound diameter of the inferior vena cava. Five studies met the authors’ selection criteria.

Posted in Emergency Medicine, Intensive Care | 4 Comments

DEFINE THE MOMENT…..

There is a lot to learn about emergency medicine from movies about sport. Tin Cup, the best sports movie ever made, is a treasure trove of wisdom. The first quote speaks for itself. The second is true too. Anaesthesia is … Continue reading

Posted in Medical teaching | Leave a comment

YOU SAY GURNEY, THEY SAY TROLLEY, I SAY BÅRHELVETE

I didn´t know what a gurney was (I do now), but I did know that performing effective CPR while transporting a patient, through a hospital or in a road ambulance, is hard. I didn´t know it was this bad though. … Continue reading

Posted in CPR, Emergency Medicine | Leave a comment

OFFICER, YOU´RE STANDING ON A FOREIGN INVASIVE OBJECT!

Prehospital emergent intubations are messy affairs. There are the risks inherent to intubating a critically ill patient where vomit, blood and secretions risk blocking your laryngoscopy view or risk contaminating the patients airway. The fact that you are performing an … Continue reading

Posted in Airway management, Prehospital Medicine | 1 Comment

TRANSESOPHAGEAL ECHO HELPS PLACE EPIDURAL CATHETER

It seems ultrasound really can be used for anything. Epidurals in small children are hard to place, and have to be done while the child is anaesthetised. So it’s hard to say if you placed the catheter correctly for subsequent … Continue reading

Posted in Uncategorized | 1 Comment

QUOTE OF THE MONTH

“The evidence is clear: when an Emergency Surgical Airway is required, it is not the procedure that kills the patients, but delaying or not doing it is what causes harm.” – Dr Cook & Dr MacDougall-Davis, Complications and failure of … Continue reading

Posted in Airway management, Anesthesia, Emergency Medicine | 1 Comment

FLUID CHALLENGES AND ARTERIAL BLOOD PRESSURE

A study in Intensive Care Med reminds me of how arterial blood pressure is a crappy substitute for proper invasive monitoring or echo when treating hypovolemic sepsis patients.

Posted in Emergency Medicine, Intensive Care | 2 Comments