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Vortex Approach App available now! 

  

It is available now for free! In spirit of FOAM, the creators committed to never charging payment for the app . If you enjoy using the app to learn, please say thanks to Nicholas Chrimes, Peter Fritz and Tessa Davis if you ever get the opportunity, via Twitter or posting a comment on this blog. The story behind the app development is upcoming as a blog post and podcast here. Stay tuned! Spread the word about the Vortex App

Cricoid Pressure in DAS 2015 Intubation Guidelines: an update.

Originally posted on MEDEST:

Below you can read the answer to my question (Cricoid pressure in new DAS (Difficult Airway Society) Guidelines: still on?) from Chris Frerk, Chair of DAS guidelines group:

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“Mario

Thanks for your thoughtful comments

The website posting is necessarily brief and there will be more detail in the developing paper.

Your point is well made re cricoid pressure vs BURP and external laryngeal manipulation.

The paper is predominantly aimed at anaesthesia for surgery in the UK though we recognise that the existing 2004 guidelines are referred to in ED and ITU settings. Current UK practice does endorse cricoid pressure for RSI (which includes most ED intubations) though we are aware this is not the case in other countries – we’ve taken the stance so far that this paper isn’t the place to debate RSI techniques but we do have a developing section on RSI.

 I think we do…

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Risky Business – Weighing Things Up

Originally posted on The Collective:

The excellent Dr Paul Bailey returns to provide more practical insights from the bit of his work that involves coordination of international medical retrieval. This is the second in (we hope) a recurring series which started here. 

Greetings everyone, it’s a pleasure to be back for the long awaited second edition of this humble blog. Looking back at my first foray into this unfamiliar world I’m pretty happy with how it reads and I think that it worked out well. If any of you have questions, I’m happy to participate in a bit of to and fro in the comments section.

Where to from here? I thought we might talk about risk. It’s hard to know exactly where to start, but it is fair to say that there are clinical risks, aviation risks, environmental and political risks – and there are probably more but I can’t think of them right…

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Cricoid pressure in new DAS (Difficult Airway Society) Guidelines: still on?

Originally posted on MEDEST:

DAS Difficult Airway Society

Background story:

This is the post I wrote about the DAS April 2015 draft on intubation Guidelines:

DAS (Difficult Airway Society) released a draft of its intubating Guidelines for evaluation and comment before definitive update.

Previuos 2007 Guidelines are available here DAS Intubation Guidelines

This is the link to download the Update (April 2015) on DAS intubation guidelines 2015

What’s new on this draft:

Plan A (face mask ventilation and intubation)

  • Preoxygeneation is now included (to mantain even during the intubation, O2 nasal cannula).
  • VL is considered as standard approach (same leve than DL).
  • Cricoid pressure is no longer mentioned and replaced with BURP.
  • BURP has to be released if difficult intubation(laryngoscopy is predicted.

The authors invite all to send suggestions and comments to intubation@das.uk.com.

Last night (Italy time at least) on Twitter a debate about the presence on less of cricoid pressure aroused:

23:06 @MyEmergencyMed: Difficult Airway Society 2015…

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VL tecnique in suspect intracranial bleeding

Originally posted on MEDEST:

62 yrs old male found unconscious GCS 6 (E1,V1, P4). Sign of vomiting and inhalation. Profoundly hypoxic, hypertensive (BP 200 over 110). Pupils were miotic with anisocoria dx>sx.

The team, after aspiration of gastric material from the airway, decided for airway control, before transport. The patient is overweight with a “taurine” neck so VL was chosen as first choice for airway management.

RSI (Fentanyl. Midazolam, Sux) performed. In the video you can see a detailed explanation of the VL technique that is slightly different from DL technique.

 Post-intubation management included ventilation optimization (EtCO2 35-38 mmHg in suspected intracranial hypertension) oxygenation and haemodynamic management.

Logo MEDEST2 

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SMACCFORCE NEEDS YOU! PLANES, HELOS & AMBULANCES!

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Examining the Hairs on the Yak – A Good Chance for More Chat

Originally posted on The Collective:

One of the good things about research that has its own issues, is that there is lots of scope to learn from the things about it that are good, as well as those that aren’t so great. The nice thing about ongoing comment is it gives even more chances to explain why a researcher might make certain choices along the way. Every question in research has more than one way of approaching some answers. Dr Alan Garner returns to provide even more background on this particular study, which has already generated some interesting conversation and a follow-up post

It’s an excellent thing to be able to keep having discussion around the challenges related to both conducting and interpreting a trial.  These things always bring up so many valuable questions, which deserve a response. So this is not going to be quick, but I hope you’ll have a read.

Lots…

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Same, same? Actually different

Originally posted on The Collective:

More of the operational data from the Head Injury Retrieval Trial has just been published. By luck more than anything else this has occurred within 24 hours of the publication of the main trial results which you can find here.

Some operational data about systems used in the trial has already been published. A key part of HIRT was a dispatch system where the operational crew were able to view screens with case information as they were logged to spot patients who may have severe enough injuries to warrant advanced care. They could then use the available information or call the initiating number for further details. If the available information matched the criteria for consideration of an advanced care team, the randomisation process then swung into action. The whole idea was to streamline the process of activation of an advanced care team to severely injured patients.

A study looking…

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HIRT – Studying a Non-Standard System that Ended up as Standard

Originally posted on The Collective:

There’s always a bit of extra reflection you can’t include in the discussion of a research paper. Dr Alan Garner reflects more on some of the challenges of doing research in prehospital medicine. 

The main results of the Head Injury Retrieval Trial have now been published on-line in Emergency Medicine Journal. We have paid the open access fees so that the results are freely available to everyone in the spirit of FOAM. This was an important study that was eagerly awaited by many clinicians around the world.

The summary from my point of view as the chief investigator: an enormous opportunity wasted.

It is now nearly ten years since we commenced recruiting for the trial in May 2005. Significant achievements include obtaining funding for a trial that was ultimately to cost 20 million Australian Dollars to run. I am not aware of another prehospital trial that has come anywhere close to this…

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RSI Basics Podcast with Minh Le Cong (@ketaminh on twitter)

Originally posted on DOWNSTAIRS CARE OUT THERE BLOG:

A Podcast with Minh Le Cong on beginner RSI. Recorded for my own personal reference but its such a great resource for Paramedics, Paramedic Students and a good all round touch up on the subject with a person much more knowledgeable than I.

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If your not listening to Minh I highly suggest you start! His podcast was my first step into #FOAMed, so its an absolute honor to have him on my own.

You can find the Podcast over on I-Tunes:  https://itunes.apple.com/au/podcast/downstairs-care-outthere-podcast/id876296199c (please take time to leave a review or rating!!)

Below you will find some of the papers, trial and websites that we mention throughout, all are a good read. There’s also a number of different checklist ideas.

PHARM Podcast 61:
http://prehospitalmed.com/2013/02/19/pharm-podcast-61-rapid-sequence-intubation/

The Original RSII Article;

http://journals.lww.com/anesthesia-analgesia/Citation/1970/07000/Rapid_Induction_Intubation_for_Prevention_of.27.aspx

The study protocol for the Head Injury Retrieval Trial (HIRT): a single centre randomised controlled trial of physician prehospital management of severe…

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A Bit About Paeds Trauma for Those Who Do A Bit of Trauma

Originally posted on The Collective:

This is a post put together by Dr Andrew Weatherall as background preparation for a talk at the SPANZA Paeds Update from March 14, 2015. This is an update for the occasional paeds anaesthetist. It’s not about covering it all but hopefully there’s a few useful points in there to prompt a little thought and discussion.

For lots of people who do a bit of paediatric care, there’s a bit of nervousness around little people. It’s a bit disproportionate to the numbers of actual cases of course because paeds trauma is not common. In fact, rates are slowly going down.

There is also a common paediatric conundrum to deal with – what do you do with adult evidence? This is because overwhelmingly trauma literature deals in the bigger, smellier version of Homo sapiens.

So the challenge is to provide a refresher on something that is getting less common for…

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Inter Hospital Transfer

Originally posted on DOWNSTAIRS CARE OUT THERE BLOG:

wpid-20150111_130054.jpg

Not much research has been done in this area relating to interhospital transport, but a lot of good practice from the hospital can apply to us. You obviously have fews sedating medications available but the principle remains the same.

Take your safety into account and if your concerned raise it with your partner, the sending and receiving hospitals.

It takes a few minutes to sort out any issues and can prevent a major mishap further down the road.

All view and opinions are my own, always observe local protocols and procedures.

Work Hard and be good to your patients!

What to read;

ABC’s Transfer and Retrieval Medicine; Chapter 42, Acute Behavioural Disturbance M. Le Cong

ABC’s Prehospital Emergency Medicine; Chapter 4, Scene Safety V. Calland & P. Williams

What evidence exists about the safety of physical restraint when used by law enforcement and medical staff to control individuals with acute…

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Let’s be clear! Not all trauma patients must be treated with spinal immobilization during prehospital resuscitation and transport.

Originally posted on MEDEST:

ems-backboardsSpinal immobilization is performed in all trauma patients from the rescuers in EMS systems all over the world, regardless the mechanism of injury and the clinical signs.
This kind of approach is nowadays been rebutted from the recents evidences and the actual guidelines.
ACEP, in Jan 2015, released a policy statement entitled :”EMS Management of Patients with Potential Spinal Injury” clarifying the right indications, and contraindications, for spinal immobilization in prehospital setting.
The lack of evidence of beneficial use of devices such as spinal backboards, cervical collars etc… is in contrast with the demonstrated detrimental effects of such instruments: airway compromise, respiratory impairment, aspiration, tissue ischemia,increased intracranial pressure, and pain, consequent to spinal immobilization tools, can result in increased use of diagnostic imaging and mortality.

Already in 2009 a Cochrane review demonstrated the lack of evidences on use of spinal restriction strategies in trauma.

Recently the out of hospital validation…

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Immediate care at the community level

Originally posted on DOWNSTAIRS CARE OUT THERE BLOG:

I want to talk about getting your community involved in CPR Programs and CPR education. Often I hear people, friend, family, acquaintances, bystanders talking about CPR, often I hear “I couldn’t do CPR I haven’t done a course”

Ambulance Computer aided dispatch has been providing CPR instruction over the phone for years, once a Cardiac or respiratory arrest is identified by information given by the caller a prompt is delivered to the call taker scripting providing  CPR instruction to the caller, after establishing the ability of the person to perform CPR instruction is given for 100 beats per minute with no “rescue breaths”

CPR is an easy skill to provide a passing understanding of to the general public.

I can do the shopping centre version in under two minutes with a short practice.

1; Make a W start at the top and bottom of the sternum

2: Press at the…

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Caring for the ‘invisible wounds': – A former Paramedic’s mission to help build Resilience in the lives of Emergency workers.

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