Author Archives: K

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

ONSD NORMAL VALUES

Optic Nerve Sheath Diameter (ONSD) on ultrasound has been used to identify patients with high intracranial pressure. ONSD threshold measurements for high ICP range from 5 to 6mm. Unfortunately there´s not really been any reference values. A study in Journal of … Continue reading






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PAIN CAN´T BE USED TO DIFFERENTIATE BETWEEN PARTIAL AND FULL THICKNESS BURNS

The absence of of pain has even been used to differentiate between partial and full thickness burn injury. Traditional teaching is that full thickness burns are painless due to the cutaneous nerve endings being destroyed. A paper in AJEM suggest it´s … Continue reading






Posted in Emergency Medicine, Prehospital Medicine | Leave a comment

THE LATERAL TRAUMA POSITION

Transporting unconscious or obtunded victims supine can be dangerous as it may result in mechanical obstruction of the airway or fluid aspiration unless the airway is secured. Traditionally, EMS have used the recovery position with the victim lying on his/her side , … Continue reading






Posted in Prehospital Medicine, Trauma | 6 Comments

LUNG US AND BNP

A small study in Ann Intensive Care reminds me that lung ultrasound is  good at detecting heart failure and differentiating against other causes of acute dyspnoea.






Posted in Emergency Medicine, Intensive Care, Ultrasound | Leave a comment