Videolarygoscopy (VL). Brave new world. VL makes any intubation easy, and solves airway managment problems. Well, it can be a life-saver, but it also brings its own set of problems. Two new RCTs comparing VL and DL are just out. One study looks at using VL as the primary intubation tool in the pre-hospital setting, and next to the old laryngoscope it pales in comparison. Bit there might be more to the story. Let’s have a look.
We’ve held on to our strict fasting regimes for decades. Gastric ultrasound is here to help us individualise our fasting rules a bit more. Gastric ultrasound has lots of uses, and lately it’s become fashionable to use it for evaluating surgical patients immediately pre-op to see if they’re fasted.
There´s a nice Best BET mini review in EMJ April 2016. The authors ask if it is safe and beneficial to control hypertension in the acute/hyperacute phase (~<6h from presentation) in patients with acute intracerebral haemorrhage. More>>
This was one of my favourite SMACC CHICAGO debates: “Predicting Fluid Responsiveness is a Waste of Time” on fluid management, Rob MacSweeney pokes at the fluid response hero/enfant terrible Paul Marik. Great points by both, and Rob’s cartoon is epic! Watch, learn and enjoy!
Thanks to Scott Weingart for editing this video – and letting us share it! See his post at EMCRIT, and the full post on this debate at Intensive Care Network for the original audio and Marik’s slides. Can’t wait for SMACC DUB!
Propofol is a great anaesthetic – but it can cause pain on injection. This is one of the tricks of the trade: mix in some lidocaine in your propofol syringe, and the patient is pain free. Sounds like magic. Especially as there’s no way lidocaine can work its usual local anaesthetic effect that quickly. But it works. There’s been a lot of studies on the subject, and now there’s a Cochrane review too. More>>
There’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>>
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:
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.
The 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>>
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>>