Oxygen can be a real idiot sometimes…
Recently saw BIS discussion re-surface. NICE recommends it, yet very few use it. We could make a long discussion about this, but the short version is we sometimes use it, despite its shortcomings. Its best use would presumably be in patients with neuromuscular blockers onboard. Problem is BIS value seems to be affected by neuromuscular block alone. More>>
A great Scandinavian conference is coming up October 10-11th 2017! In the small, but beautiful town of Sundsvall, Fredrik Granholm has managed to lure some of the great minds and presenters within tactical trauma and trauma care to gather there. The ScanCrit team is coming as well. We’re proud to be part of this, and we’re greatly looking forward to hanging out with like-minded trauma heads and nerdily discuss and enjoy these two days!
It will be a diverse gathering of physicians, EMS, police anti terror units, military and fire & rescue services working with pre-hospital trauma in a tactical/hostile environment. In the spirit of SMACC and its likes, TacTrauma17 will focus on world class presentations as well as the networking and discussions within the group of delegates and presenters mingling throughout the conference.
Several well know presenters will be there. Among them: Mark Forrest of ATACC fame, Mike Lauria who’s into decision making and CRM, Stephen Sollid with great experience from Norwegian HEMS operations, and the always entertaining and interesting Richard Dutton of Maryland Shock Trauma center – you can catch an entertaining and interesting interview of him at EMCRIT to warm up for Tactical Trauma 17. And if you can’t make it, be sure to follow the #TacT17 hashtag on Twitter!
Have a look at the full programme here.
Hope to see many of you there!
Iloprost is a powerful vasodilator, but I have never seen it used as an intravenous infusion to improve general microcirculation in septic shock, like in this interesting, albeit very small, case series from Intensive Care Med.
In septic shock, one of big “organs” affected is the microcirculation. In addition to being a vasodilator, iloprost hampers clot formation and induces fibrinolysis, all of which can be beneficial in improving microcirculation in septic shock. More>>
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. <More>
There’s not much left of poor MONA. We’ve written on unnecessary O2 treatment before, ie the AVOID trial. And now, one of the large RCTs on the subject is out. The DETO2X-SWEDEHEART investigators (love the acronym) have published their findings in NEJM: Routine oxygen therapy gave no advantage over breathing ambient air. More>>
Another study on airway management in cardiac arrest was just published in JAMA. The study was done in Denmark, where all intubations elective and emergency are done by anaesthestetists. It was a retrospective study, where they matched intubated patients with historical arrest patients not intubated at that same point in resus time. Intubation lowered the pt’s chance of survival to discharge with CPC 1-2. So, another study against intubation in cardiac arrest. Or? More >>
For vascular access, you still hear the old “We don’t have time for using ultrasound – this is an emergency!”. In many settings, the old landmark techniques are quick and good in experienced hands. But when going for the femoral vessels in cardiac arrest, you would want to use ultrasound. More>>
Old dogma die hard. One of them is not heating platelets when giving transfusions. This breaks up the flow of transfusions and makes the process somewhat erratic. But the platelets are obviously heated when entering the body – the extra few, fever-like degrees of a fluid warmer can hardly matter. So many ignore this guideline, and just heat. But the question often surfaces, and sometimes brings a slight unease to the trauma team. More>>
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 tend to treat that hyperthermia with paracetamol, ibuprofen or external cooling.
A large Swedish study in Crit Care Med suggests that increasing temperatures might actually be a good thing. Increasing body temperatures on sepsis recognition is associated with improved outcomes. More>>