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>>
ScanCrit is currently having a mini-symposium in Zermatt, and it includes leisure-time skiing. The conditions have been less than favourable, windy with low cloud cover and bad visibility – but also lots of fresh snow. This creates a high risk setting, as the conditions are avalanche prone – but are also very tempting for off-piste skiing. So, it was time to revisit our article on avalanches published in Journal of Royal Army Med Corps in 2016. More>>
ECMO at the Louvre, two art forms meet. We first tweeted this photo back in 2014, and now the case report behind the image has just been published. The case report highlights both the possibilities of new frontiers in medicine, as well as their shortcomings. These high-tech interventions come at a cost, and could end up just complicating things without saving lives. Classic sexy way of wasting money. Or, with the right patient selection, it could save lives. More>>
The Norwegian guidelines for spinal immobilisation were recently published in SJTREM. (Open Access)
Our involvement with the development of these started back in 2013 and 2014, when we published some posts that were highly critical of the dominating doctrine of extremely liberal immobilisation and especially of the rigid cervical collar. Much to our surprise, those posts exploded in the FOAMed community and, even more so, beyond. As of today, they have been accessed hundreds of thousands of times. More>>
Cooling in cardiac arrest has had its ups and downs. First, it was cool with 32-34 degrees, then TTM said 36 degrees was fine. So, what’s the optimal brain temperature post arrest? One of the problems with the TTM study was the time from ROSC to target temperature: 8 hours after randomisation. You won’t get any difference between 33 and 36 degrees if you reach 33 degrees after 8 hours. Could there be a hidden benefit with lower temperatures in the long cooling times? More>>
Experimental. On a goat. But still, 151 days on ECMO without any heparinisation is very impressive and promising. One big draw-back of ECMO treatment has been the need for full heparinisation to avoid clotting of the ECMO circuit. Heparin coated circuits have lessened the need for heparinisation, and it’s become routine to run heparin-free for shorter periods if the patient’s bleeding risk demands it. More>>
ECMO in multitrauma patients sounds like asking for complexity and lots of oozing blood – but it seems to have potential for actually stabilising the patient’s systems and get better outcome. The short version: ECMO restores normal physiology and unloads the venous system. More>>
SonoScandinavia is the melting of the successful SonoSweden/SonoSTHML and SonoNorway, bringing together the best of Scandinavian ultrasound teachers – and a bunch of ultrasound folks from the land of the Trump, like Matt Dawson of the excellent ultrasoundpodcast.com, as well as Bret Nelson (who’s also written a great textbook on EM ultrasound with Vicky Noble), Jacob Avila of 5minsono.com and Joe Wood of the Mayo clinic as well as other top quality teachers from around the globe.