Category Archives: Uncategorized

IMAGE OF THE WEEK – AORTIC STENOSIS

One of the most immediate ways to understand aortic stenosis, and how it affects blood pressure and the heart, is by watching a Transcatheter aortic valve implantation (TAVI) procedure. Catheters are placed in both the left ventricle (LV) and the … Continue reading






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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

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

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






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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






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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

FLUID RESPONSE – SMACC DEBATE

This was one of my favourite SMACC CHICAGO debates: “Predicting Fluid Responsiveness is a Waste of Time” on fluid management, Rob MacSweeney pokes at the fluid response hero/enfant terrible Paul Marik. Great points by both, and Rob’s cartoon is epic! … Continue reading






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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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HITCHEN´S RAZOR

“What can be asserted without evidence can be dismissed without evidence.”  






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