SCARY ARTERIAL AIRWAY DRAMA

Found an interesting case report in intensive care med. It describes a case where an anaesthetist found a pulsating mass in the lateral wall of the oropharynx. MR revealed the patient’s internal carotid artery was kinked, aberrant and indented way into the pharyngeal wall. This could obviously restrict laryngoscopy view but more importantly bleed massively if torn.

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Case report/image lives here:

Intensive Care Med. 2015 Jan 10. Aberrant internal carotid artery: a risky condition for tracheal intubation.Prokopakis E, Lyronis G, Kaprana A, Velegrakis G.

Posted in Airway management | 2 Comments

LATERAL VIEW OF THE AORTA

We normally visualise the aorta on ultrasound by scanning down the midline. However, we frequently fail to visualise the entire aorta. The view is often obscured by bowel gas. Abdominal pain often makes the examination intolerable. A small proof-of-concept study in AJEM suggest a right lateral approach, using the liver as an acoustic window, improves visualisation. More>>

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QUOTE OF THE MONTH

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EARLY VS LATE INTUBATION OF BURNS

iPhoneIcon_BigWe are taught to intubate victims with inhalational injury early. If we delay for too long the tongue, epiglottis and other structures can swell and cause airway obstruction, forcing an emergency intubation that is more likely to be difficult or failed. A french study in AJEM looks at the incidence of difficult intubations in patients with face and neck burns and the possible consequences of airway tardiness. More>>

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IMAGING CASE OF THE MONTH

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XKCD nails it. Again.

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HOW I TREAT PATIENTS WITH MASSIVE HEMORRHAGE

RBC bagThis is the rather peculiar title of an great summary paper on the transfusion pratice in massive hemorrhage, mainly focusing on trauma. It describes the background, evidence and use of 1:1:1 transfusions as well as pro-hemostatics and the use of TEG/ROTEM in an easy to follow fashion. This is incorporated into the description of the slightly different approaches of two large Level 1 trauma centers with very active blood banks and transfusion docs, in Copenhagen and Houston, TX. A recommended read on current practice. More>>

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AVOID THE OXYGEN REFLEX

Avoid wrong wayWe’ve been waiting for the AVOID study, since we mentioned it a few years ago in another post on the harm of excessive oxygen. AVOID (Air Versus Oxygen in Myocardial Infarction). Now, it’s out. As expected, it shows that unnecessary oxygen supplement worsens outcome. The surprise is just how big a difference it makes! In this study, too much oxygen increased recurrent MI fivefold! More>>

Posted in Cardiology, Emergency Medicine, Intensive Care | 29 Comments

QUOTE OF THE MONTH

Q: How do you approach teaching the honing of skills to picking up high risk disease with a low prevalence?

A: “It is a shit-show. let’s just get it out there. these conditions should be missed or we should accept an enormous amount of overtesting.

Our society should issue a statement that missing pulmonary embolism, dissection (of any vessel), necrotizing fascitis – unless the pt presents with totally classic symptoms, should be considered the standard of care”

– Scott Weingart, emcrit.org.

Posted in Emergency Medicine | 2 Comments

GOOOOOD MORNING, EUROPE!

Gooood morningSMACC registration is now open! As with previous years, reservations are going fast. Two thirds of the early bird reservations are already gone, so this will be another fantastic SMACC conference! Have a look at the program and the workshops, not to mention the awesome people being there! It all goes down in Chicago June 23-26, 2015. More>>

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THE STEEL WINDPIPE

Mikhail BulgakovWe’ve read and heard many accounts of emergency surgical airways over the years. They’re always exciting, and there’s always something new to be learned. Most written accounts are very clinical, so we were thrilled about discovering this story. It’s not new, by any means, but might be new to many of you. Written by Mikhail Bulgakov, one of the great Russian authors, around the 1920s. There’s prose to this account. And thrill. More>>

Posted in Airway management, Emergency Medicine, Medical teaching | 4 Comments