CPR AND AMIODARONE

cprThere’s a new RCT out in NEJM on amiodarone and lidocaine in cardiac arrest. It’s an interesting study we wrote on, but needed a less categorical take. In the unselected study population, amiodarone and lidocaine did little for the patients. In selected patients, it might help a little more. We’ll look at it in more detail. More>>

Posted in AHLR, Emergency Medicine, Prehospital Medicine | 4 Comments

NEW CPR GUIDELINES

The Norwegian Resuscitation Council has released revised guidelines for CPR, and presented them at the Scandinavian conference for emergency medicine, SAM 16. These recommendations might differ from international recommendations. Click image or “more” for a quick English translation and run-through of the changes listed in the slide:

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ONSD NORMAL VALUES

Optic Nerve Sheath Diameter (ONSD) on ultrasound has been used to identify patients with high intracranial pressure. ONSD threshold measurements for high ICP range from 5 to 6mm. Unfortunately there´s not really been any reference values. A study in Journal of Critical Care measures on ONSD in healthy volunteers,reporting a mean ONSD of 3.68 mm. (95% confidence interval [CI], 2.85-4.40). There wa s a significant difference between men and women at  3.78 mm and  3.60 mm, respectively.

Study lives here.

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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 | 5 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