PAIN CAN´T BE USED TO DIFFERENTIATE BETWEEN PARTIAL AND FULL THICKNESS BURNS

UnknownThe absence of of pain has even been used to differentiate between partial and full thickness burn injury. Traditional teaching is that full thickness burns are painless due to the cutaneous nerve endings being destroyed. A paper in AJEM suggest it´s not as simple as that. More>>

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THE LATERAL TRAUMA POSITION

Transporting unconscious or obtunded victims supine can be dangerous as it may result in mechanical obstruction of the airway or fluid aspiration unless the airway is secured. Traditionally, EMS have used the recovery position with the victim lying on his/her side ,  maintaining airway patency. The recovery position is less useful in trauma victims as it generates unacceptable spinal movement, contradicting the principles of spinal immobilisation in trauma victims. More>>

Posted in Prehospital Medicine, Trauma | 4 Comments

LUNG US AND BNP

lung-zonesA small study in Ann Intensive Care reminds me that lung ultrasound is  good at detecting heart failure and differentiating against other causes of acute dyspnoea. More>>

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HITCHEN´S RAZOR

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

 

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TRAUMA IS THE OLD MAN´S DISEASE

Screen Shot 2015-12-07 at 11.44.46Traditional teaching is that trauma is the young male´s disease. Young males are exposed to accidents and violence. Young males also tend to engage in profoundly stupid activities. However, since a decade or so there is a shift. Major trauma in the elderly has become increasingly common. Authors have since long predicted that the elderly eventually will be the dominant demographic. A study in EMJ suggests that has already happened. More>>

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IT ALL STARTED WITH A PLUNGER

apple-touch-icon-144x144Anesthesia and Analgesia just published a superb review on the current edge of CPR. But everything started with a plunger. Yup! A plunger ! In the late eighties, a son resuscitated his father with the help of a plunger. Poorly accustomed to standard CPR, he snapped a plunger to his father’s chest. This strategy may have amplified the chest decompression and he successfully resuscitated his father. More>>

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SONA – SIDE OF NECK ACCESS

Avalon iconHow’s this for thinking outside the box in the approach to the difficult airway!? Difficult airway algorithms and advanced management options for difficult airways mostly concentrate on getting into the trachea. But what happens if getting into the trachea is the easy bit? What happens if that’s where you run into a dead end? How do you manage the crashing airway where the problem lies just after the end of your tube? I stumbled across this case report published in the Annals of Thoracic Surgery this year which provides an elegant solution to managing a near total tracheal occlusion. More>>

Posted in Airway management, Anesthesia, ECMO | 1 Comment

OWN THE O.G.

iPhoneIcon_BigPassing the orogastric tube can be difficult or sometimes impossible. Unfortunately a lot of patients really need their OGs and in a time-critical scenario you don’t want to spend too much time struggling with it. Here is a simple trick a senior colleague showed me. Many of you probably already know of this technique and may already be doing it. My colleague says he has been doing this since back in the seventies. I find that hard to believe as he was born in the late 1960s. More>>

Posted in Airway management, Anesthesia, Emergency Medicine, Intensive Care, Prehospital Medicine, Uncategorized | 8 Comments

ARRESTED DEVELOPMENT?

adAn interesting survey recently published in Resuscitation looks at arrest teams for in-hospital cardiac arrest. As anyone in the FOAM-o-sphere is well aware, trauma teams, prehospital teams and ED cardiac arrest teams are increasingly well oiled and the importance of a designated team leader has never been more apparent. Are teams for in-hospital arrests lagging behind? Is the in-hospital arrest the neglected problem child in the resus family? More>>

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ERC CERVICAL COLLAR SCEPTICS

iPhoneIcon_BigThe ERC, the European Resuscitation Council, have issued new guidelines for first aid, section 9 of their guidelines. And it includes an interesting and rather controversial take on cervical collars and spinal immobilisation that’s similar to what we have been propagating for some years now. They say: “The routine application of a cervical collar by a first aid provider is not recommended”, and comment on limitations of the current view of cervical collars as a good routine device in trauma. Read the out-take. More>>

Posted in Emergency Medicine, Trauma | 2 Comments