Author Archives: K

NOSE CLIPS MAY NOT BE THE WAY FORWARD IN MASK VENTILATION AFTER ALL

An small but elegant experimental study in CJA explores the impact of nasal passage occlusion on mask ventilation in the unresponsive patient. Tidal volumes may be reduced by more than half when the nose is totally occluded.

Posted in Airway management, Anesthesia, Uncategorized | Leave a comment

IS FEVER THE NORMAL TEMPERATURE OF SEPSIS?

We know that hypothermia in sepsis is associated with increased mortality but other than that we tend to see fever in sepsis as something bad. We tend to perceive sepsis patients as more sick the more the temperature is elevated. We then … Continue reading

Posted in Intensive Care | 4 Comments

NORWEGIAN GUIDELINES

The Norwegian guidelines for spinal immobilisation were recently published in SJTREM. (Open Access) Our involvement with the development of these started back in 2013 and 2014, when we published some posts that were highly critical of the dominating doctrine of extremely liberal … Continue reading

Posted in Prehospital Medicine, Trauma | 1 Comment

THE OXYGEN-ICU TRIAL

We have been concerned about hyperoxaemia for a long time. Numerous studies have documented how supranormal O2-concentrations are harmfull in critical illness. Unfortunately, as far as I can tell anyway, ICU practice hasn’t changed much. We deal with hypoxia straight away, but otherwise we leave … Continue reading

Posted in Intensive Care | 3 Comments

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 | 1 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