Author Archives: K

STILL NO EVIDENCE FOR PPI IN ICU

We believe that the ICU-patients, especially ventilated patients, are prone to having stress ulcers and one of the components of the daily ICU drill is to ensure that the patient is on ulcer prophylactics. We do this despite how the … Continue reading






Posted in Intensive Care | Leave a comment

BCheE

I found an editorial in BJA that describes an issue with succinylcholine I wasn’t really aware of. Butyrylcholinesterase (BCheE) hyperactivity. BCheE is the non-specific cholinesterase that rapidly hydrolyses succinylcholine in the blood so that only 10% of the injected drug … Continue reading






Posted in Airway management, Anesthesia, Emergency Medicine | Leave a comment

GCS IN OLD PEOPLE

We traditionally use GCS to triage patients who sustained traumatic brain injury. Some previous studies have reported how the accuracy of using GCS decreases with increasing age. Specifically, the elderly present with a higher GCS than younger patients when suffering the same injury. … Continue reading






Posted in Trauma, Uncategorized | 2 Comments

FIELD AMPUTATIONS

A paper in EMJ compares various methods for performing field amputations. I can’t say I ever had to do one myself. However, some of the people I work with have performed amputations on rapidly deteriorating entrapped trauma victims. Most them have relied on the … Continue reading






Posted in Prehospital Medicine, Trauma | 4 Comments

BP MANAGEMENT IN BRAIN BLEEDS – ATACH 2

 A trial called ATACH-2 (Antihypertensive Treatment of Acute Cerebral Hemorrhage II), recently published in NEJM, is likely to temper the enthusiasm for aggressively lowering blood pressure in patients with intracranial bleeds.






Posted in Emergency Medicine, Neurology, Uncategorized | 1 Comment

UNDERESTIMATING BLEEDING

Some years ago, while working for an air ambulance, me and an experienced paramedic responded to a pedestrian-vs-car accident. A young female was out driving when she had a flat tire. As she opened the rear compartment to get the spare tire, a second … Continue reading






Posted in Prehospital Medicine, Trauma, Uncategorized | 2 Comments

LONGEST VF

A fascinating case report was recently published in Resuscitation. A young female speleologist was avalanched in the polish Tatra mountains. As she had access to an air pocket and some degree of ventilation she didn’t to succumb to the asphyxiation … Continue reading






Posted in Cardiology, Prehospital Medicine, Wilderness Medicine | 3 Comments

HEAD-UP INTUBATION

In anaesthetics we are trained to pre-oxygenate and intubate our theatre patients in a flat supine position. Then, when we graduate to intubating the really gnarly ICU/ED patients in severe heart or respiratory failure, we wise up. A paper in Anaesthesia & Analgesia demonstrates how patients who … Continue reading






Posted in Uncategorized | 5 Comments

SHOCK LIVER AFTER CARDIAC ARREST

Interesting paper in AJEM. Hypoxic hepatitis (HH), ‘shock liver’, is defined as an increase in serum aminotransferase levels (20 times the upper normal level) after respiratory or circulatory failure. It is commonly seen in critical illness and after cardiac arrest. In … Continue reading






Posted in Cardiology, CPR, Intensive Care, Uncategorized | Leave a comment

BP MANAGEMENT IN BRAIN BLEEDS

There´s a nice Best BET mini review in EMJ April 2016. The authors ask if it is safe and beneficial to control hypertension in the acute/hyperacute phase (~<6h from presentation) in patients with acute intracerebral haemorrhage.






Posted in Emergency Medicine, Intensive Care, Neurology, Prehospital Medicine, Uncategorized | 1 Comment