Prehospital and Retrieval Medicine – THE PHARM dedicated to the memory of Dr John Hinds

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We cover the Taming the SRU podcast, “Ketamine Cagematch” (iTunes), a debate between Dr. Minh Le Cong and Dr. Chris Zammit.

Dogma persists that ketamine may increase intracranial pressure, which would be bad in traumatic brain injury (TBI) given the fixed space in the cranial vault.  These are largely from Yet, these patients often need sedation, for agitation or intubation, and drops in blood pressure are also deleterious (see EMCrit on neuroprotective intubation).

PRO (Le Cong): The literature doesn’t show clinically significant deleterious outcomes from ketamine use in the head injured patient.  Review in Annals on ketamine and ICP.  Deleterious effects of apnea may result from other sedative agents.

CON (Zammit): Studies showing that ketamine does not increase ICP confounded by the presence of other sedatives on board.  As…

Dr Andrew Weatherall returns to stuff about paediatric airways, a bit of a companion to an earlier post with some practical tips. 

There are some things you’re taught from a very young age to believe in. Then it turns out it’s just plain wrong. Santa Claus. The Tooth Fairy. The Public Holiday Numbat. (Well, the last one might be specific to my upbringing.)

And in medicine there are plenty of examples those too. Oxygen is always good. You can’t manage trauma without a cervical collar. Then of course there’s pretty much everything about the paediatric airway. As if managing kids didn’t come with challenges anyway, we all get to work with information that is just plain wrong.

And there’s no mistaking that clinicians find paediatric airways difficult. The staff from Royal Children’s Hospital Melbourne have recently published a sizeable prospective study of emergency department intubations. This is from a big, clinically…

Helicopter Emergency Medicine Service (HEMS)

Fellow position – 6 month fixed term (ACEM accredited special skill term in Air Ambulance)

June 2015 – December 2015

Auckland City Hospital is the largest public Hospital in New Zealand and one of the best trauma centres in the country .The Emergency department is a modern purpose built, world class facility that opened in 2003. We have an enthusiastic team of clinicians who have expertise in resuscitation, ultrasound, simulation, toxicology and retrieval medicine. The closely knit team consists of  FACEM’s, Medical officers and Resident Medical Officers. The department sees about 60,000 adult patients annually with a high patient acuity.

The department in conjunction with the Auckland Rescue Helicopter trust run the Helicopter Emergency Medical service (HEMS) which has been successful in providing fully integrated care for trauma patients. The department is also active in research and is currently involved…