JUNE 23-26 2015 – SAVE THE DATE!

SMACC GOLD is just over, and the amazing presentations from that conference is starting to get posted. For a taster, watch Haney Mallemat give a SMACC talk on the biggest ICU challenge: The art and science of fluid responsiveness. Also there were top speakers like Karim Brohi, Scott Weingart, Cliff Reid and lots of other great docs. They’re not only great docs, but also great presenters and entertainers. And they will be there for SMACC Chicago. Learning doesn’t have to be boring! This will be a conference to look forward to, not just for the great talks and information, but for the experience. More>>

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ECMO OUTCOMES IN ACCIDENTAL HYPOTHERMIA

iPhoneIcon_BigIn accidental hypothermic cardiac arrest we are to continue CPR until the patient has been rewarmed to around 34. If available, and appropriate, these patients are to be transferred to a hospital with ECMO capability. ECMO is the most efficient means we have for reheating hypothermic patients. Rewarming rates up to 12 C/h are possible with the fastest devices. ECMO will also provide circulatory and respiratory support during resuscitation and after ROSC when these patients are notoriously unstable. A small retrospective study in AJEM looks at outcomes. It is a tiny study but nevertheless interesting as the results are good but also as it comments on the hypothermic cardiac arrest patients with asphyxia as part of their mechanism. More>>

Posted in ECMO, Prehospital Medicine, SAR | 1 Comment

PRIAPISM AFTER SPINAL CORD INJURY

iPhoneIcon_BigWhile the rest of the #FOAMed world went away to fight in the great Cricoid Pressure war, I discreetly retired to my library in order to study the male erection. More>>

Posted in Emergency Medicine, Prehospital Medicine, Trauma, Uncategorized | 7 Comments

ELECTROLARYNX – TALK WHILE INTUBATED

Electrolarynx iconFor awake, intubated patients a great frustration is the inability to speak. A great little report in NEJM shows a novel use of the electrolarynx – that little device some laryngectomised patients hold to their neck to produce robot sounding speech. But here, the authors used the electrolarynx on an awake, intubated patient. More>>

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QUOTE OF THE MONTH

“Damage control resus can help avoid damage control surgery”

- Karim Brohi, smaccGOLD.

Posted in Anesthesia, Emergency Medicine, Trauma | 1 Comment

TO HALVE OR NOT TO HALVE

Hemicraniectomy-iconAn interesting study on outcomes for hemicraniectomies after extensive middle-cerebral-artery stroke. Hemicranectomies in cerebral oedema is not new, and has shown improved survival, but at the cost of severe disability. But what do the patients say? More>>

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THE MOTTLING SCORE

iPhoneIcon_BigSeveral methods have been developed for identifying and quantifying microcirculatory dysfunction in septic shock. We can measure buccal, sublingual and subcutaneous microcirculatory CO2-levels. Near infrared spectroscopy (NIRS) measures microcirculatory hemoglobin saturation. Sidestream dark field (SDF) imaging directly visualises the microcirculation. None of those, or the other existing modalities, are readily available at my hospital and most definitely not in the rural or prehospital settings where I sometimes start resuscitating septic patients. Fortunately, there is a ‘poor man’s version’ of all that technology. The mottling score. More>>

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THAT’S HOW I (WAS) ROLL(ED)

iPhoneIcon_BigWe try to avoid putting personal stuff on this blog, but my personal observations from being a trauma patient fits too well with Thomas D’s righteous rant about logrolls a few days ago. He wrote about how the logroll, as a diagnostic tool, is mostly useless for finding relevant injuries. He told us, with the possible exception of penetrating trauma, it misses most of the injuries it is intended to find. Injuries that are found on the trauma CT scan anyway. More>>

Posted in Emergency Medicine, Prehospital Medicine | 2 Comments

LOG ROLL AND A FINGER UP YOUR BUM – THEN YOU’RE DONE

DREATLS mythbusting time – again. ATLS provides a great structure for talking and working trauma, but many of their procedures have been rethought the last couple of years as our understanding of trauma improves. Now it’s time for rethinking the log roll and digital rectal exam. More>>

Posted in Emergency Medicine, Trauma | 9 Comments

SEPSIS PROGRESS

iPhoneIcon_BigThe PROCESS and SEPSISPAM studies were serious blows to protocol EGD therapy in sepsis. With all the other dead ends we pursued (activated protein C, colloids, intensive insulin therapy, cortisone and what not) it is tempting to think that little progress has been made. That is not the case. Many studies demonstrate decreasing mortality from sepsis in the last decade. Now, in JAMA, a massive Australian-New Zealandite (sic?) database study confirms we are doing something right. More>>

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