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Posts from the ‘Uncategorized’ Category

EZDrugID: International campaign to improve the distinctiveness of medication packaging

Originally posted on MEDEST:

“Look-alike Drugs”is a present concern for all the emergency medicine professionals. EZDrugID Campaign address this topic with a petition a survey and suggesting strategies to prevent medication errors.

Go to the website http://ezdrugid.org/EZDrugID/About_EZDrugID.html and sign the petition, take the survey but most importantly introduce in your working place the awareness of “Look-alike drugs” danger for medication errors.

NMBDOne of these thingsPregnancySuxPancWheresWally_1

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Sandpits, Better Eyes and New Monitors – Can NIRS work for prehospital medicine?

Originally posted on The Collective:

This is part 2 of a series (part 1 is here) on trying to study near-infrared spectroscopy in the prehospital setting by Dr Andrew Weatherall (@AndyDW_). Can NIRS work? No one can be sure but here’s one approach to getting some data we can actually use. 

A while back I did a post where I pointed out that when you get sold technology, there’s a whole history behind the machine that goes beep that means it’s probably not what you’re told. And the example I used was near-infrared spectroscopy tissue oximetry.

That was partly because I’m involved in research on NIRS monitoring and I’ve spent a lot of time looking at it.  Like every time I look carefully in the mirror, there’s a lot of blemishes that I miss on a casual glance. I also don’t mind pointing out those blemishes.

So that post was about all the things that…

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Studies in Blood from Iran – A Quick Review

Originally posted on The Collective:

We all want to stop bleeding. Here’s a quick review from Dr Alan Garner of a paper coming out of Iran that looks at haemostatic dressings. 

Hatamabadi HR et al. Celox-Coated Gauze for the Treatment of Civilian Penetrating Trauma: A Randomized Clinical Trial. Trauma Monthly. 2014;20:e23862. dii: 10.5812/traumamon.23862

There is not a lot of data on haemostatic dressings in the civilian context and human data from the military context is not randomised for obvious reasons. It is therefore nice to see a RCT on this subject in humans. In the study they compare the time to haemorrhage control and amount of haemorrhage in stab wounds to the limbs between 80 patients treated with Celox gauze versus 80 patients treated with normal gauze.

The study is from an emergency department in Tehran and is pragmatic in design. There are some limitations of the study worth mentioning. It was open label, and…

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Eco-ALS and mechanical chest compressions: that’s the way I like to run a code!

Originally posted on MEDEST:

47 ysr old male collapsed on the field. First ALS unit found him arrested in VF.
Shocked 3 times he regained a palpable central pulse.
When we arrived the patient arrested again. VF on the monitor. Shocked 4 times. Mechanical chest compression and tracheal intubation on board. He received Epi, Amio (300+150), Calcium Gluconate and Bicarb (suspected iper K in kidney insufficiency) before the ROSC.
15 minutes passed from the collapse to ROSC,  7 of wich were of “no flow” (no chest compressions, no AED from bystanders).
PMH: Hypertension, kidney insufficiency, heavy smokers. Medication history unknown.
He had chest pain before collapsing, as referred from bystanders.

Vitals at ROSC: GCS 3 T, RR 10 MV, SaO2 100%, EtCO2 35,  HR 70 bpm. NIBP 100/70 12 lead EKG at ROSC is shown below

ROSC IMA

An echo of the heart performed on the field (in the ambulance running to the ED, so I…

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Working with Standards that are Forgetful – Australian NSQHS Standards and Retrieval Medicine

Originally posted on The Collective:

In times where external standards are increasingly applied to health services, where does retrieval medicine fit in? Dr Alan Garner shares his insights after wrestling with the Australian National Safety and Quality Health Service Standards process. 

In Australia, national reform processes for health services began in the years following the 2007 election. Many of the proposed funding reforms did not survive negotiation with the States/Territories but other aspects went on to become part of the Health landscape in Australia.

Components which made it through were things like a national registration framework for health professionals. Although the intent of this was to stop dodgy practitioners moving between jurisdictions, the result for an organisation like CareFlight was that we did not have to organise registration for our doctors and nurses in 2, 3 or even more jurisdictions as they moved across bases all over the country. Other components that made it through were…

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Why Chest Tube and Surgical Airway are the same

Credit to Dr Tor Ecleve for art work and Dr Natasha Pirie-Burley for original design concept. Special mention to Dr Scott Weingart for inspiration. This logo design is distributed under Creative Commons Licence. FOAM to improve surgical airway training!

Credit to Dr Tor Ecleve for art work and Dr Natasha Pirie-Burley for original design concept. Special mention to Dr Scott Weingart for inspiration. This logo design is distributed under Creative Commons Licence.
FOAM to improve surgical airway training!

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HEMS vs GEMS. By ground or by air: which is the best way to take care of traumatized patients

Originally posted on MEDEST:

Amb vs HEMS22 years old male hit from a car on the roadside of an urban area.
The ground EMS ambulance (physician, nurse staffed), dispatched on scene, find the patient alert, oriented and spontaneously breathing. His vitals are:
GCS 15 , RR 20, SaO2 95, HR 85, SBP 110
No mention of head trauma.
Chest no sign of trauma, bilateral and equal expansion and air entry.
Pulse is strong.
He has a profound laceration with loss of substance but not evisceration on left flank and no external bleeding from the wound.
The abdomen is painful and resistant to palpation in left flank.
There is an open fracture to left tibia (VNS 9).
The ground team, after the primary survey, activates the local medical helicopter.
The place is 10 k from a level 1 Trauma Center on a local road in an urban area and the helicopter is at 10 minutes flight distance…

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Pick a Number! – The Enemy at the Gate

Rapid Sequence Intubation beim Kind Martin Jöhr, Luzern, CH - KATZ'08

Rapid Sequence Intubation beim Kind
Martin Jöhr, Luzern, CH – KATZ’08

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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.

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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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