Category Archives: Anesthesia

RINGER’S A LOUSY VOLUME EXPANDER

Posted on April 18, 2013 by Thomas D

With colloids being miscredited by Cochrane and synthetic colloids being hammered by RCTs, it might seem we’re left with crystalloids. So how good is our standard crystalloid, Ringer’s Lactate, at volume replacing a volume depleted patient? This study withdrew blood … Continue reading →

Posted in Anesthesia, Emergency Medicine, Intensive Care | 5 Comments

ULTRASOUND FOR SPINALS AND EPIDURALS

Posted on April 11, 2013 by Thomas D

This is a well known, but fairly novel use of ultrasound. Certainly not standard in any place I’ve worked. But ultrasound for epidurals and spinals seems to be in vogue. Here’s a meta-analysis on ultrasound for spinal and epidural access. … Continue reading →

Posted in Anesthesia, Ultrasound | 2 Comments

NOREPINEPHRINE AND CO

Posted on March 5, 2013 by K

A small study in Crit Care Med reminds me how it is really hard to anticipate the effects of systemic vasoconstrictors. Norepinephrine/noradrenaline is more likely to reduce cardiac output than maintain it.

Posted in Anesthesia, Emergency Medicine, Intensive Care | 1 Comment

RAPTOR SUITE

Posted on February 6, 2013 by Thomas D

So, in our latest Code Brown, I wrote on a crashing trauma patient. Scott Weingart made a comment where he also noted that transfer between OR and angio might come to an end with RAPTOR like operating theatres. RAPTOR is … Continue reading →

Posted in Anesthesia, Trauma | Leave a comment

NASAL PRONG ETCO2

Posted on February 3, 2013 by Thomas D

Monitoring sedated patients without airway devices in place is often based on the time machine, the pulse oximeter, showing you what the patient’s oxygen saturation in the lungs were 30 seconds ago. Also, it doesn’t tell you if the patient … Continue reading →

Posted in Airway management, Anesthesia, Emergency Medicine | 8 Comments

LUNG PROTECTIVE VENTILATION STILL GOOD

Posted on December 6, 2012 by Thomas D

Even if you don’t have ARDS or risk factors for ARDS, a lung protective ventilation strategy seems to be good for your patients according to a recent meta-analysis published in JAMA.

Posted in Anesthesia, Intensive Care | 2 Comments

MORE OXYGEN TOXICITY

Posted on October 8, 2012 by K

Oxygen toxicity has been getting a lot of attention the last couple of years. The evidence of how high FiO2 is harmful for patients who are critically ill is somewhat solid and has to some extent changed resus guidelines. An article … Continue reading →

Posted in Anesthesia | 1 Comment

HB – HOW LOW CAN YOU GO?

Posted on September 23, 2012 by Thomas D

Bleeding down in hemoglobin is a kind of limbo dance for the patient involved. How low can you go? Here’s a case report on a trauma patient with a hemoglobin of 0,7 g/dL(!) yielding a hematocrit of 2.2%(!). O neg … Continue reading →

Posted in Anesthesia, Emergency Medicine, Intensive Care | 2 Comments

ACLS GOES ECMO

Posted on August 12, 2012 by Thomas D

We had a young man with cardiac arrest brought in to our hospital. He had been alternating between VF and spontaneous circulation during resuscitation. As an emergency rescue attempt enroute, he had received thrombolytics. At arrival in our hospital, he … Continue reading →

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

ABSENCE OF TACHYCARDIA USELESS IN ANAESTHETISED BLEEDING PATIENTS

Posted on July 11, 2012 by K

Our teaching and guidelines emphasise using tachycardia as a marker of hypovolemic shock. A paeds study in Anesthesia & Analgesia reminds us how that is far from always the case. The study makes me even more suspicious of the classic … Continue reading →

Posted in Anesthesia, Emergency Medicine, Trauma | 1 Comment