8 years ago I met Dr Levitan and read his seminal book on emergency airway management. It was like a light was turned on in a dark room. Since then, with his teachings I have NEVER failed an intubation/airway to date. A living legend of Emergency medicine and airway management

Filed under: airway, Emergency medicine and critical care, FOAMEd, Interviews of interesting people, Online critical airway training Tagged: airway, levitan, SMACCGOLD

Fluid resuscitation in bleeding trauma patient: are you aware of wich is the right fluid and the right strategy?

Originally posted on MEDEST:

DCR copy

The fluids of choice in prehospital field are, in most cases, cristalloids (Norma Saline or Lactate Ringer).

But what is the physiological impact of saline solutions when administered in large amounts (as the latest ATLS guidelines indicates) to hypotensive trauma patients?

Is aggressive Fluid resuscitation the right strategy to be pursued?

The triad of post-trauma lethal evolution is:

  • Hypotermia
  • Acidosis
  • Coagulopathy

Aggressive fluid resuscitation with cristalloids, and saline solutions in particular, can be detrimental in many ways:

  1. Cristalloids tend to displace the already formed clots and improves bleeding
  2. Normal Saline produce hypercloremic acidosis worsening coagulation and precipitating renal and immune dysfunction
  3. Cristalloids diluts the coagulation factors and precipitate the coagulation system (dilution coagulopathy)
  4. Cristalloids rapidilly shift in intercellular space worsening SIRS process and interstitial edema (brain edema, bowel wall edema) with consequent compartment hypertension

So wich is the perfect fluid to infuse in trauma?

The perfect fluid doesn’t exists.

Balanced saline…

View original 241 more words

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This is the King Air 200 that’s based in Inuvik NT

Hi Folks

On today’s show, I chat to Flight Paramedic Hugh Gilmour.

This is Hugh! It’s cold there so a good warm hat is pretty important!

This is a favourite picture of myself enjoying the northern lights on the highway outside of Inuvik NT last winter.

A colleague doing some charting while flying a late night medevac from Paulatuk NT to Inuvik NT

A colleague doing some some point-of-care lab analysis of a trauma patient with our iStat.

Not every community has a proper ambulance, so we have to ustilize whatever vehicle is available. In this case we are using a large sport utility vehicle to move the patient from the nursing station to the airport.


Show note references:

  1. Advanced Medical Solutions
  2. The Extraordinary Life Of A Flight Paramedic In The Canadian Arctic

  3. Paramedics of Canada

Register for SMACC please!


  1. Now, onto the PODCAST!


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Filed under: Emergency medicine and critical care, FOAMEd, Interviews of interesting people, prehospital and retrieval medicine podcast, Prehospital medicine Tagged: CANADA, itunes, NORTHERN, prehospital