Advanced airways and worse outcomes in cardiac arrest
A new study demonstrates an association between advanced prehospital airway management and worse clinical outcomes in patients with cardiac arrest. Done in Japan, the numbers of patients included are...
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New Sepsis Guidelines
The latest update of the Surviving Sepsis Campaign Guidelines has been released. There’s too much interesting stuff to easily summarise, but luckily the full text article is available at the link...
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Ketamine & cardiovascular stability
I ‘jumped ship’ from etomidate to ketamine for rapid sequence intubation (RSI) in sick patients about seven years ago. Good thing too, since I later moved to Australia where we don’t have etomidate....
View ArticleEndovascular stroke treatment
Two randomised controlled trials have been published which compare endovascular stroke treatments with intravenous tPA. Both the American Interventional Management of Stroke (IMS) III trial (1) and the...
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Updated Difficult Airway Guidelines
The American Society of Anesthesiologists has published an update to its Practice Guidelines for Management of the Difficult Airway. You can get the full PDF for free. I’m linking to it for interest,...
View ArticleAlternative ‘universal’ plasma donor
The group usually considered the universal donor for fresh frozen plasma because it contains no anti-A or anti-B antibodies is Type AB. Due to its limited availability the trauma service of the Mayo...
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The importance of first pass success
A large single-centre study in an academic tertiary care center emergency department (where residents perform most of the intubations) examined 1,828 orotracheal intubations, of which 1,333 were...
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On chicken bombs and muppets
I want to clarify some terminology I use on a day-to-day basis, which is now so ingrained in my vocabulary that I forget that its meaning may not be obvious to all. “You go in there and it looks like a...
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Traumatic cardiac arrest outcomes
Ever heard anyone spout dogma along the lines of: “it’s a traumatic cardiac arrest – resuscitation is futile as the outcome is hopeless: survival is close to zero per cent”? I have. Less frequently in...
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Save a life by watching telly?
If you’re in the United Kingdom on Thursday 21st March please consider watching BBC’s Horizon program at 9pm on BBC2. I’m in Australia so I’ll miss it, but I’m moved by the whole background to this...
View ArticleLateral chest thrusts for choking
An interesting animal study examined the techniques recommended in basic choking management algorithms for foreign body airway obstruction (chest and abdominal thrusts). In terms of the pressures...
View ArticleHigh flow nasal cannula oxygen
Where I work high flow humidified nasal cannula oxygen (HFNC) is used for infants with bronchiolitis and our ICU also employs it for selected adult patients. This is a relatively recent addition to our...
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Beherrschen die Reanimation
The whole purpose behind my career and this blog is to save life. Like most emergency physicians I don’t see a huge number of resuscitation patients myself in a given week, so my best hope in making a...
View ArticleHypothermia as an inotrope
This small study supports the hypothesis that therapeutic hypothermia can have positive inotropic effects in patients with cardiogenic shock of ischaemic or non-ischaemic origin. Cooling resulted in a...
View ArticleIdentifying the febrile kid who’s too tachypnoeic
Body temperature raises heart rate and respiratory rate in kids, potentially affecting our interpretation of these clinical signs. Dutch investigators developed centile charts of respiratory rates for...
View ArticleSwallow a camera in GI bleed
Two recent studies evaluate the use of a novel ingestable camera to diagnose upper gastrointestinal bleeding in emergency department patients. The potential advantages of video capsule endoscopy over...
View ArticleCricoid can worsen VL View
It is known that cricoid pressure can hinder laryngoscopic view of the cords during direct laryngoscopy. Using a Pentax-AWS Video laryngoscope, these authors have demonstrated that cricoid pressure can...
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Another argument for ED thoracotomy
A team from Los Angeles (including the great Kenji Inaba) has published a study on penetrating cardiac wounds in the pediatric population[1]. This is one of the largest studies on this thankfully rare...
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Upstairs vs Downstairs: an EPIC Conundrum
A new breed, and new terminology Scott Weingart MD and colleagues have published a discussion paper [1] outlining the role of emergency physicians who have completed additional critical care training –...
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Predicting volume responsiveness
One of the current Holy Grails of ED critical care is to find a reliable measure of fluid responsiveness in those patients with impaired organ perfusion, such as those with severe sepsis. This would...
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