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Posts from the ‘Uncategorized’ Category

The Death of the Cervical Collar?


let the debate begin!

Originally posted on AmboFOAM:

Those fantastic Vikings over at one of my favourite FOAMed sites, ScanCrit have been rampaging through the dogma of cervical collars for some time, and now it seems the campaign is coming to a head:

Bergen EMS will no longer apply c-collars to patients

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Winch bag. Can it be a FOAMED experience?

Originally posted on MEDEST:

We are tryng to assemble a special bag dedicated to winch operations.

This need came from many of us who found very difficult to be winched on the scene with the actual rescue bag, cause of his weight and size.

So we decided to assemble a smaller bag, less heavy with just the essentials to supply the team for a short period of time  in order to stabilize the patients before winching him on board.

We have to choose what is important and what is not in the actual bag.

Analyzing the majority of our missions, found that mostly of the procedures we perform where linked to some specific situations:

  • Traumatic cardiac arrest
  • Advanced airway management/RSI
  • Traumatic Emo/pneumo
  • Brain trauma
  • Traumatic shock (hemorragic, obstructive, spinal)
  • Anaphylaxis
  • Non traumatic shock

On this basis we decided to allocate a limited amount of drugs and equipment specifically targeted for this emergency situations.


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Trauma Junkie? Have I got the course for you!

Originally posted on AmboFOAM:

For all you trauma junkies out there (and let’s face it, that’s most of us at some stage) there is a new way to get your fix of top-notch, innovative, interactive and exciting education….

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Auckland HEMS – the first two years

Originally posted on Auckland HEMS:

This slideshow, assembled by Dr Chris Denny, shows the ARHT & Auckland HEMS team during the first two years of the HEMS initiative. It was presented at a recent strategic planning meeting to plot the future course of the service. The gentleman whose photo is shown at the start is the late Dr Robin Mitchell, a UK-trained emergency physician who was instrumental in laying the groundwork for Auckland HEMS.


(and rest assured no mannequins were harmed in the making of this slideshow… sort of…)

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tPA for Stroke. Again. Sorry about that.

Originally posted on AmboFOAM:

Sorry to carry on about this, but I can’t help myself…

The other night SBS television in Australia aired a special on stroke (found online here)  It brought together some stroke survivors, neurologists, emergency doctors and so on to discuss stroke and stroke treatment.  Of course the issue of tPA for stroke reared it’s ugly head again and it is clear that the debate over this has not been settled. 

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To thump or not thump?

Originally posted on rain0021:

I wonder if the authors of the October 4th’s NEJM Journal Watch Alert saw the irony?

Firstly a review of a paper which examined the utility of the precordial thump for out of hospital cardiac events.

Nehme Z, Andrew E, Bernard SA, Smith K.  Treatment of monitored out-of-hospital ventricular fibrillation and pulseless ventricular tachycardia utilising the precordial thump. Resuscitation 2013 Aug 29

The author’s abstract (I’m too stingy to buy the complete paper) suggests that few studies have described the value of the precordial thump as first-line treatment of monitored out-of-hospital cardiac arrest from ventricular fibrillation and pulseless ventricular tachycardia.

Using data from the Victorian Ambulance Cardiac Arrest Registry  out-of-hospital cardiac arres witnessed by paramedics between 2003 and 2011. The study outcomes were: impact of first shock/thump on return of spontaneous circulation and more importantly, survival to hospital discharge.  434 cases met the eligibility criteria. Seventeen patients (16.5%) observed a precordial thump induced rhythm…

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Nepean Difficult Airway Course

Originally posted on expensivecare:

DAC Poster for 16.10.13

This course is pretty soon but it looks like it will be great fun! the good folks at Nepean hospital in Western Sydney really know how to lay on a good course. So if you’ve got a day free and need to keep your accountant busy with tax deductions you should head along. I have no financial interest in the course, but a good friend of mine is on the faculty so I can vouch for it!

Nepean Difficult Airway Course

The Nepean Difficult Airway Course is a one day course aimed at
trainees in anaesthesia, emergency medicine and intensive care medicine,
who already have reasonable airway experience but wish to upgrade their
skills in the manage of difficult airways and airway crisis management,
including tracheostomy emergencies. All tutors are specialists
experienced in advanced airway management.

There are vacancies available on the next course on Wednesday October
16th, 2013. Enquiries…

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Infectious diseases physician owns the airway with a steak knife and pen

Karel Habig: To air is human

Originally posted on Auckland HEMS:

From The Intensive Care Network – another podcast from the SMACC 2013 conference. This is Dr Karel Habig, Medical Director of the Greater Sydney Area HEMS, discussing how experience from aeromedical retrieval can improve medical practice.

Click HERE for the audio (right click to open it in a new tab), accompanying slides are below:


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Prehospital tranexamic acid use in primary and secondary air medical evacuation

Originally posted on Auckland HEMS:

BC_AmbulanceIn the latest edition of Air Medical Journal the British Columbia Ambulance Service’s AirEvac And Critical Care Operations has published a case series detailing the use of tranexamic aid by flight paramedics.

The abstract for the paper can be found HERE. The paper details 13 patients who recieved TXA over a 4 month period, with 9 patients from MVAs, 3 patients who had fallen, and one industrial accident. The average time to administration of TXA from first patient contact was 32 minutes. No complications were reported.

The authors make the point that while tranexamic acid in theory has more benefit in major trauma the earlier it is administered, the importance of it should not be overplayed. Its use occurs in their protocol after a primary survey has occurred, critical interventions have been done, and transport has been initiated. They also mention several cases where the patient met the criteria…

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Originally posted on expensivecare:

Here are the slides and references for the talk I’m giving on Acute Liver Failure (ALF) at the Bedside Critical Care meeting in Cairns, QLD on Thursday 26th September 2013.

Lee WM, Stravitz RT, Larson AM. Introduction to the revised American Association for the Study of Liver Diseases position paper on acute liver failure 2011. Hepatology. 2012 Feb. 23;55(3):965–967.
The most up-to-date guidelines from the American Association for the Study of Liver Disease. Freely available here.

Patton H, Misel M, Gish RG. Acute liver failure in adults: an evidence-based management protocol for clinicians. Gastroenterol Hepatol (N Y). 2012 Mar.;8(3):161–212.
Another recent and easy to read review of ICU management of ALF. Also freely available here.

Bernal W, Auzinger G, Dhawan A, Wendon J. Acute liver failure. The Lancet. 2010 Jul. 17;376(9736):190–201.
Slightly older but still pretty good review from the Lancet.


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A Rant about Paramedic Intubation

Originally posted on AmboFOAM:

A relatively brief and evidence free opinion piece about intubation. As always, feedback is welcomed.

Play in player below, or right click file at bottom of page and select “Save As”

AmboFOAM Intubation Rant Podcast

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The Importance of a Solid Foundation

Originally posted on AmboFOAM:

Here is another guest post by my colleague James. This is an excellent piece on the importance of approaching scenarios in a cohesive, standardised manner that still allows some flexibility. Emergency medicine is actually based on some pretty simple concepts as James discusses.

As an ALS clinical instructor who also dabbles in teaching at university, the one single concept I harangue all my students with is the idea of having a good clinical approach. Teaching many students in one form or another has shown me that this is the single most useful thing that anyone can learn in paramedicine. Unfortunately it’s one of the most unevenly applied and its importance is poorly understood. So today I want to try to get across why it’s critical that the student paramedic gets this straight in their head.

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Originally posted on Rural Doctors Net:

OK, thanks to all who answered CASE#6 ‘Find the bleeding, stop the bleeding’

Plenty of good ideas, although some of the options are more realistic than others given the inevitable constraints of rurality. Glad that none followed the EMST mantra to the letter and killed him…

The setting of rural Australia poses a challenge, especially for those used to working in larger centres. James and Casey are used to this kind of stuff (although Casey’s mostly in-hospital and has even got a CT scanner…James is used to working out of a tent wearing just rabbit skins). Credit to Derek & Hildy for having a bash with spot on answers – but with kit we just don’t have!

You can read the case and initial comments here


Case discussions like these can be useful to reinforce what we already know and perhaps look at things from a new perspective. I chose…

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