THE GCS STILL DOES NOT BELONG IN EMERGENCY MEDICINE

Posted on March 19, 2013 by K

A while ago we wrote about the Glasgow Coma Scale and how it can´t be relied on for trauma patients or in emergency medicine in the acute phase.  We based it on an excellent editorial written by a Dr Stephen Greene. Now a study in EMJ seems to confirm Dr Greenes concerns. This time they tested the people who really should know the GCS, paramedic students. More>>

Posted in Emergency Medicine, Prehospital Medicine, Trauma | 1 Comment

ARCTIC CPR

Posted on March 18, 2013 by K

Just wanted to share this photo that was on the front page of a norwegian national paper called Verdens Gang. It is from the evacuation of an avalanche victim that tragically passed away a few hours after this photograph was taken. The 100 m long avalanche came crashing down on a party of three that were backcountry skiing in one of the mountains near Tromsø in Northern Norway.

The victim was evacuated, using a stretcher sledge through the woods with CPR ongoing. The paramedic is sitting on the sledge, straddling the patient, performing CPR while the patient is evacuated through the woods from the avalanche runout-zone.

 

 

 

 

 

 

 

 

Photographer: Kaisa Hallset

Posted in Prehospital Medicine, Wilderness Medicine | 5 Comments

CODE BROWN: CENTRAL LINE GOES WRONG

Posted on March 15, 2013 by Thomas D

This one I got from a colleague of mine at a Scandinavian hospital, and it’s a scary reminder of the dangers of central cannulations. Placement of a large dialysis catheter went wrong – very wrong. More>>

Posted in Code Brown, Intensive Care | 26 Comments

LOST & FOUND: TRAUMA UPDATE

Posted on March 14, 2013 by Thomas D

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I wanted to have a permanent link to this excellent trauma update and review of recent litterature by David Anderson of Greater Sydney HEMS. If you watch this 30 minute talk and look up the references I’ve listed in this post for convenience, you’ll be well informed about the current state of trauma resuscitation. Click on post for references. More>>

Posted in Trauma | Leave a comment

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. More>>

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

CVC AND US

Posted on February 23, 2013 by K

A meta-analysis in Anesthesiology confirms how central line cannulation is a lot safer when guided by ultrasound. Does that mean we don’t need blind landmark techniques? More>>

Posted in Emergency Medicine, Intensive Care | 7 Comments

THAW SOME BLOOD PLEASE

Posted on February 19, 2013 by Thomas D

Frozen Blood bust "Self" bought by SaatchiCryopreserved blood can last longer, and might have superior RBC function to standard, cooled SAG-Ms. As a bonus, cryo always sounds good in a sci-fi kind of way, even if it does just mean frozen. More>>

Posted in Tech | Leave a comment

TUNNEL CREEK AVALANCHE

Posted on February 17, 2013 by K

In NY times I found this incredible piece about avalanches and avalanche survival. It is a detailed description of what went down (other than heaps and heaps of snow…) when an avalanche hit 16 backcountry skiers in the Cascades. A classic and a must read  if you are even remotely interested wilderness medicine. Find it here. 

 

Posted in Prehospital Medicine, Wilderness Medicine | Leave a comment

BNP AND WEANING

Posted on February 16, 2013 by K

B-type or Brain Natiuretic Peptide (BNP) is secreted by the heart ventricles in response to excessive stretching of the heart. It’s physiologic actions is to decrease vascular resistance and increase natiuresis, thereby off-loading the strained heart ventricle. Recently BNP is finding more and more applications as a marker of fluid overload in critical care. A study in Am J Respir Crit Care Med demonstrates how BNP can be used to shorten ventilator weaning times. More>>

Posted in Intensive Care | Leave a comment

ULTRASOUND BEST FOR PNEUMOTHORAX

Posted on February 11, 2013 by Thomas D

We know ultrasound is great for detecting pneumothorax, there’s been lots of studies confirming this, and here’s the final meta-analysis from Chest – print it and use it to slap colleagues who still want x-rays over ultrasound scans. More>>

Posted in Ultrasound | 1 Comment