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

Critical illness is part of the remit of rural doctors, albeit encountered relatively infrequently – which of course makes it all the more challenging! Moreover rural doctors have to deal with such cases with limited staff, no backup and paucity of lab tests and definitive care.

Perhaps one of the most commonly encountered true emergencies in the bush is dealing with major haemorrhage. Our patients work on farms, in heavy industry, or are involved in road crashes.

Let’s consider a hypothetical case and see how FOAMed could help.

THE SCENARIO

It’s Tuesday morning and you are busy working through a routine Primary Care Clinic in anticipation of the afternoon off. The local Rotary are hosting a BBQ at the nearby football oval and you’ve been invited as a guest speaker on the pros & cons of prostate cancer testing.

Clinic is rudely interrupted by a loud “BANG” from the direction…

It’s been a pleasure having former KI Doc, Dr James Doube back on Kangaroo Island for a short locum stint, but also a chance to catch up and talk about various schemes.

Jamie is a rare breed – a former career as paramedic and wildlife conservationist, he’s also a GP-surgeon, recent JCCA-graduate GP-anaesthetist and has carved out a niche career in truly remote & austere medicine with the Australian Antarctic Division & other organisations.

Dr Doube is also a wonderful experimental test subject.

He is WAY to modest to mention his award of the 2012 Australian Antarctica Medal for his services as both expedition medical officer but also conservationist – read more about his exploits here. He’s been involved in eradicating rabbits from Macquarie Island & with TEAM RAT on South Georgia.

In this brief podcast we discuss his work with AAD and particularly the potential for FOAMed…

Recently I had the pleasure of attending a superb AWLS course in Queenstown. The course was run by a group of intrepid clinicians who decided several years ago to import AWLS from the United States. You can read about the group (and more importantly, book a place on the course!) here:

Wilderness medicine is in may ways the ultimate in prehospital care – it involves providing care to patients in an frequently austere environment with often very limited personnel, equipment, and communications. For emergency department doctors like myself, it also separates us from the security of readily accessible diagnostic investigations.

At its core wilderness medicine represents the same pathologies as emergency medicine, although environmental issues are obviously more common than in our urban ED and regional HEMS (check out this article about some recent lightning strike patients treated in Waikato ED!). The challenges encountered by treating clinicians however are…

*Conditions apply: You ARE required to have a medical qualification that was not purchased over the internet, and you WILL occasionally have to share your flight with a patient or patients with varying pathologies. Oh, and you will occasionally have to make an appearance at the hospital too (which fortunately has a top-notch helipad)

Auckland ED Specialist

Auckland ED Fellow

 

From ALiEM:

“CRM and SBT… just another set of acronyms in the world of medical education?  Don’t we already have enough??

Not quite!  Rather, Crisis Resource Management (CRM) is a complementary approach to Simulation Based Training (SBT). It can enhance current ongoing medical simulations or provide foundation for a vigorous curriculum when launching new simulation programs.

WHAT IS IT?

Crisis Resource Management is the ability to translate medical knowledge to real world actions, in the setting of an emergency.

Rather than a separate entity from medical simulation, CRM principles can be looked at as a way to focus and shape medical simulation curriculum and especially the objectives of each case to focus upon development of critical skill-sets that contribute to optimal team function and success during crisis.”

Read the rest HERE…

Comparison of Prasugrel and Ticagrelor Loading Doses in ST-Segment Elevation Myocardial Infarction Patients

RAPID (Rapid Activity of Platelet Inhibitor Drugs) Primary PCI Study

Guido Parodi, MD, PHD, Renato Valenti, MD, Benedetta Bellandi, MD, Angela Migliorini, MD, Rossella Marcucci, MD, Vincenzo Comito, MD, Nazario Carrabba, MD, Alberto Santini, MD, Gian Franco Gensini, MD, Rosanna Abbate, MD, David Antoniucci, MD Florence, Italy

OBJECTIVES: This study sought to compare the action of prasugrel and ticagrelor in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI). BACKGROUND: It has been documented that prasugrel and ticagrelor are able to provide effective platelet inhibition 2 h after a loading dose (LD). However, the pharmacodynamic measurements after prasugrel and ticagrelor LD have been provided by assessing only healthy volunteers or subjects with stable coronary artery disease. METHODS: Fifty patients with STEMI undergoing PPCI with bivalirudin monotherapy were randomized to receive 60 mg…