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Posts from the ‘Uncategorized’ Category

Bougie aided video assisted intubation through King Laryngeal Tube

Originally posted on MEDEST:

If you have a patient with a King LT in place and want to intubate him use the Bougie and the videolaryngoscope. It works perfectly.

Here is the video tutorial.

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The Bind About Pelvic Binders (Part 2)

Originally posted on The Collective:

This is part 2 in Dr Alan Garner’s series on pelvic fractures and the approach to binders. You can find part 1 here

In part one we had a look at the evidence for benefit from pelvic binders. In short there is no study yet published showing a significant improvement in mortality. Not even a cohort study.

Of course, it still might be OK to use them if they possibly help as long as there is no evidence of harm either (and they don’t cost too much). The probability of good has to outweigh the probability of evil. It is the potential for evil that I want to examine now so we can see where the balance lies.

Before we can do that though we need to have a quick look at the types of pelvic ring fractures (no one is suggesting that non-pelvic ring fractures of the pelvis…

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The Bind When it Comes to Using a Binder

Originally posted on The Collective:

This post by Dr Alan Garner is the first of a trio on the topic of pelvic fractures and the evidence for what to do. Alan is an emergency physician at Nepean Hospital in Sydney and the Medical Director of CareFlight, having started in prehospital medicine in 1996. He has a bunch of other interests but there’s not enough space for that here.

Unfortunately I am old enough to remember when MAST suits were considered standard of care. In many states of the US it was law that ambulances had to carry them – that is how convinced everyone was that the things were doing good, not evil. We were all misled by measuring surrogates of outcome such as blood pressure rather than the outcomes that really matter, morbidity and mortality. Of course when good studies evaluating mortality were eventually done we discovered the evil side of the device and…

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Mechanical CPR: Three CHEERS or a big thumbs down?

Originally posted on AmboFOAM:

There has been a fair bit about mechanical CPR devices floating around the FOAMasphere lately, so I thought I should probably do a post.

These devices are not exactly new (check out the Thumper, in use in Victoria in the 70s) However, there seems to be a surge in interest in these devices, and I must say there seems to me to have been a largely positive buzz about them in spite of the evidence for their effectiveness being somewhat lacking to say the least.

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Auckland HEMS Checklist Reference Manual

Originally posted on Auckland HEMS:

Dear colleagues,

In June of this year our Canadian HEMS Fellow Dr. Robert Gooch shared one of our emergency checklists with the Prehospital and Retrieval Medicine (PHARM) community. Thank you to those of you who provided feedback on this initiative. We continue to draw inspiration from the work of Dr. Atul Gawande. http://atulgawande.com/

Now, in the spirit of Free Open Access Medicine, we are keen to share our complete Auckland HEMS Checklist Reference Manual with the PHARM community. At the start of September we made this manual operational within our service.

Innovation is one element of success; implementation is another core element.  http://www.sjtrem.com/content/19/1/53/abstract This article emphasizes the importance of end-users ‘the sharp end’ being involved throughout the checklist development process. We are fortunate to have input into this checklist from our pilots, crewmen, paramedics and doctors. Even our CEO (who is also a pilot) has shared his experience.

We see…

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Why the VideoLarygoscopy don’t gonna kill the DirectLaryngoscopy (at least in the near future)

Originally posted on MEDEST:

A novel publication goes to enrich the long-living debate on direct laryngoscopy (DL) vs video laryngoscopy (VL) efficacy in emergency intubation.

The recent article, pubblished on JEMS and titled  “Deploying the Video Laryngoscope into a Ground EMS System” ,compares the success rate beetwen DL vs VL in a ground EMS Service. The device used was the King Vision with channeled blade. The partecipants had a prior training on the divide, consisting in didactic orientation and practical skills on manikins.

The result of the study shown that “Within the first 100 days of the study, the video laryngoscope utilizing the channeled blade has shown to be at least as effective as DL in relation to first-attempt success” and considering that “the mean experience in our group with DL is nine years, yet the success rate remains unacceptable” “It’s time to consider transition from a skill that’s difficult to obtain and maintain…

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GSA HEMS Airway training – a recipe for success

SCAT Paramedic Martin Pearce tubing like a boss!

SCAT Paramedic Martin Pearce tubing like a boss!

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Hymn to Simulation Team Training/ Inno alla Simulazione

Originally posted on MEDEST:

Blessed the emergency systems who train their professionals with simulation

Blessed the emergency professionals who challenge themselfs day by day in simulation

Facing their fears to win their weakness

Improving the quality of their work for the good of all patients

They are the future of emergency medicine

Shame on emergency systems who don’t train with simulation

Shame on emergency professionals who don’t have the umility to challenge themselfs

Running from their fears and weakness

Compromising the quality of their work and the health of the patients

They will disappear from emergency medicine panorama

Beati i sistemi d’emergenza che allenano i loro professionisiti con la simulazione.
Beati i professionisti che giorno per giorno si mettono in gioco allenandosi con la simulazione,
Affrontando le loro paure per vincere le proprie debolezze
Migliorando la qualità del proprio lavoro per il bene dei pazienti
Di loro sarà il futuro dell’emergenza sanitaria
Poveri i…

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PEEP zero. Is this the answer?

Originally posted on MEDEST:

Inspiring discussion on Twitter (Minh Le Cong@rfdsdoc, Karim Brohi @karimbrohi and Peter Sherren@PBSherren)
The topic:
Your hypotensive blunt/penetrating trauma patient with associated severe TBI needs a vent. How do you set it and how you achive your physiological goals?
Is it possible to mantain eucapnia, avoiding hypercapnic insult to the brain, using low minute ventilation strategy and not depressing stroke volume with high intrathoracic pressure?
“Permissive hypoventilation” in a swine model of hemorrhagic shock.

Conclusions: Although permissive hypoventilation leads to respiratory acidosis, it results in less hemodynamic suppression and better perfusion of vital organs. In severely injured penetrating trauma patients, consideration should be given to immediate transportation without PPV.

But what if we have concomitant severe TBI? How can we avoid respiratory acidosis and hypercapnia (due to hypoventilation) and conseguent insult to the brain?
Is PEEP…

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The occasional intubator needs a plan. I got one! Do You?

Originally posted on MEDEST:

want you

Following some discussion on who owns the airway (see the comments at the post Paralytic is the answer on EMPills Blog)

Have to admit: I’m an occasional intubator.

I manage something like 10 airways per month, all of them are “non conventional”, (no operating room, no chance to wake the patient, no chance to call an expert), and usually I have no time to evalute any of common indicators to predict difficult airway (time is often a rare issue in ground or air prehospital scenarios).

Half of the airway I manage are CRASH, half needs an RSI, so, shame on me, I’m also an occasional “paralytic agents user”.

So I desperatley need a plan

But lissen, I got one!

Dear collegue, wathever intubator you are, occasional or regular,  feel free to submit any comment on the plan and also fell free, if you think it’s useful, to use and…

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A ballad for Minh

ketaminh:

My mate Rob can carry a tune !

Originally posted on AmboFOAM:

My friend Minh from the PHARM blog has been hit hard by the news of a ketamine shortage.  I haven’t the wherewithal to set up a benefit concert for Minh, but the least I could do was record this number to help ease his pain (although in a way that ketamine never could)

Hang in there brother!

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The Death of the Cervical Collar?

ketaminh:

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.

The…

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EMERGENCY TRAUMA MANAGEMENT COURSE MANUAL – FREE SAMPLE CHAPTERS FOR DOWNLOAD!

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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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