Dr Brian Burns, Dr Karel Habig & Dr Cliff Reid of GSA HEMS, NSW Ambulance. What are they looking at so seriously?

Dr Peter Sherren and SCAT Paramedics from the GSA HEMS team, first up in the inaugural Aeromedical Simulation Cup 2012

The winning team ( Dr Andrew Pearce with flight nurses) from MedSTAR, Adelaide in 2012. Come and see them defend their crown in August 2013, Melbourne!

AIR SUPPORT- THE VITAL LINK, CONFERENCE WEBSITE

Jim DuCanto demonstrates how he intubates via the AirQ SGA using the AirVu optical stylet. This is done using gaseous and local anaesthesia alone WITHOUT RECOURSE TO PARALYTICS OR IV INDUCTION AGENTS

Cliff Reid and colleagues presented this poster at the Aeromedical Society of Australasia and Flight Nurses Australasia 2012 meeting in Cairns

Scientific poster on the intubation technique developed by Cliff Reid and colleagues

Here is the paper that Cliff and colleagues published

Chatterjee J,Reid C , Lewis A.  A potential technique for flexible scope-assisted intubation using an Ambu aScope2 inserted via a supraglottic airway device. Anaesth Intensive Care. 2012 Jul;40(4):724.

Mike and Matt of the awesome ULTRASOUNDPODCAST have released Volume 2 of their brilliant Introduction to Ultrasound iBook.

Whats in it? There is prehospital section by none other than Cliff Reid

There is section by Casey Parker of BROOMEDOCS and James Rippey of the ULTRASOUNDVILLAGE
on using ultrasound in the secondary trauma survey

Okay its not free but hey not everything in life is free. I highly recommend both volumes. I have used Volume 1 as a teaching aid whilst flying out to a prehospital patient with a colleague to help supervise him doing a nerve block and reducing a dislocation.

GO AND FOLLOW THIS BLOGSITE NOW THEN SHARE WITH YOUR NETWORKS!
ClinicalCred

This excellent FOAMEd blogsite is the genius work of Dr Nicholas Chrimes, Dr Peter Fritz and Dr Anoushka Perera.
It has great stuff for anaesthesia and emergency doctors but really anyone interested in resuscitation and critical care will get valuable insights and information from this high quality free educational site. The authors are keen educators and it shows.

THis is the birth place of the VORTEX

There are always great insights into areas of emergency and elective anaesthesia, airway management and education.

Get Some Cred now!
Follow em on Facebook and Twitter too!

You know him already but I had to give yet another plug for Dr Tim Leeuwenburg’s excellent FOAMEd new site
RURALDOCTORSNET

It has a ripping hard podcast with short and sweet interviews of rural doctors, retrieval professionals, anaesthetists, animals…ok maybe not animals.;-)

And the clinical practice and training resources are of the highest quality! look at the sections and whats in them! Anaesthesia, obstetrics, emergency …more good stuff under each menu.

So go to RURALDOCTORSNET, follow and enjoy.

Tim has a cracking sense of satire and clean family friendly humour ( NOT!)
Be educated but also be entertained.

This article is by no means an official endorsement of his jokes! and there are plenty of them!

THis month from the Journal of Palliative Medicine ( yes you should add this to your reading list!)
a case report from New Zealand, of the long term treatment of a woman with metastatic ovarian cancer and pre-existing major depressive disorder, weekly IMI ketamine 1mg/kg for her affective symptoms. The authors report good response to this treatment for 8 months!

Here is the link to the article
Long term mood response to repeat dose IMI ketamine

In the awesome Open access section of the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine this month is this article on a case series of prehospital intranasal ketamine analgesia.

Here is the article link ( full text free!)
Prehospital intranasal S Ketamine analgesia case series

This adds to previous case reports like this one from Cliff Reid and colleagues
Case report: prehospital use of intranasal ketamine for paediatric burn injury

And a recent Victorian ED study of intranasal ketamine for paediatric limb injuries, reported here on ResusMe
Intranasal ketamine for kids – 1mg/kg?

Here is the article

“Use of rapid sequence intubation predicts improved survival among patients intubated after out of hospital cardiac arrest”

What was the objective of the authors ? : To examine the relationship between advanced airway management and survival in a prehospital care system with RSI capability. Their hypothesis was that those patients who required RSI for prehospital intubation would be more likely to survive than those intubated without RSI drugs because of an underlying better prognosis.

How did they do this ? : Retrospective cohort analysis of a single large metropolitan EMS system in Seattle, between 2007-2011 using cardiac arrest registry and a separate advanced airway registry.

What did they find ?:  Those who did not get intubated had the best survival rates (71% left hospital). Those who got intubated with prehospital RSI did next best (48% left hospital). Those who got intubated without RSI did worse ( 11% left hospital)

What on earth does this all mean? :

Why do you need RSI to intubate a clinically dead person you ask? Good question..well this paper found that sometimes..in fact not infrequently you DO need RSI drugs to intubate someone in cardiac arrest! Why? Well think about it…it all depends on how long a person is in cardiac arrest for. Its not like the heart suddenly stops flow and everything stops working right? The paper notes that in almost half of arrest victims, there is still agonal gasping  soon after collapse as a result of ongoing brainstem activity. And if you start CPR immediately and restore some flow to the brainstem, then its not inconceivable that airway reflexes can be maintained even in full cardiac arrest. And here is where this paper makes sense…immediate CPR, restored brain perfusion..these are all things that likely contribute to better outcomes in cardiac arrest. So paradoxically the need to use RSI drugs to intubate is an associated factor that predicts those who are going to do better.

Now why does anyone care about this at all….well there have been prior prehospital studies ( notably this one by Hasegawa et al) to suggest that intubation was making things worse for cardiac arrest patients..not better as we all thought for years!

This paper refutes that assertion, saying that its not the intubation itself that is causing the worse outcomes, its the fact that if you can intubated a dead person without RSI drugs, they are of course going to do badly regardless!

Limitations of study : No supraglottic airway use employed during study period. Self reported airway registry data. Not easily extrapolated to other prehospital/EMS systems who do not have RSI capability.

THE LINK IS HERE

6 MINUTE VIDEO FEATURING BROOMEDOCS!

Australia is a big place…huge. Training doctors in rural and remote locations is tricky

Enter remote education..enter Remote Vocational Training Scheme..remote training of rural doctors using cutting edge technology and web based delivery.

Riding the FOAM!

http://www.onqconferences.com.au/rmec13/index.html

RMEC Website (http://www.onqconferences.com.au/rmec13/index.html)

http://www.facebook.com/RMEConference?fref=ts

Facebook (http://www.facebook.com/RMEConference?fref=ts)

https://twitter.com/RMEConference

Twitter (https://twitter.com/RMEConference)

Conference Powered By:

http://www.rvts.org.au/

NEXT REMOTE MEDICAL EDUCATION CONFERENCE 28-29TH JUNE 2013, SOFITEL, BRISBANE, QUEENSLAND!

REGISTRATIONS OPEN

PROGRAM AVAILABLE

SEE YOU THERE!

hi folks. Today’s podcast is taken from a G+ Hangout I did with Dr Yen Chow(Canada), Paramedics Matt Fults and JD Graziano (Iowa, US). Lets be honest the audio quality is not great! But it was a great discussion despite not being able to record it satisfactorily!

Folks, if you ever try to do this at home…use microphones!

What did we discuss?

1. Prehospital airway training for doctors vs paramedics..does your professional background make a difference?
2. How to stay current in emergency airway skills
3. EMS Standing orders blog and podcast
4. Yen’s vimeo channel and collaborative work with Jim Du Canto
5. We demonstrate how a short Youtube video of a difficult intubation can be used to teach simple but important technique points

Here is the video of the hangout. But be prepared for poor audio quality in parts!

Show note references:

1. EMSSTANDING ORDERS BLOG AND PODCAST
2. YEN CHOW VIMEO CHANNEL
3. AIRWAYNAUTICS VIMEO CHANNEL

Below is the difficult intubation video I play during the hangout 

Now on to the Podcast

Right Click and Choose Save-as to Download the Podcast.

Stay calm and use your scalpel

Hi folks! Meet Dr Keith Greenland, a senior consultant anaesthetist at Royal Brisbane and Women’s Hospital.

This is a great 23 minute lecture on dealing with the ” Cannot Intubate Cannot Oxygenate” situation. Well worth your study time!

The awesome welcome from Dr Oli Flower and Dr Roger Harris of the Intensive Care Network site
RIGHT HERE!

Hi folks, on this episode we study 3 intubation videos which involved failed first pass attempts. We study each in some detail to try to learn what we can to improve our intubation technique ( VL or DL) and tactics. Thankyou to Dr Larry Mellick from Georgia, USA for making the video and allowing it to be posted to YouTube by Jo Paul Valles.

FIRST WATCH THE ORIGINAL VIDEO HERE

NOW WATCH THE VIDEO WITH A VOICE OVER OF MYSELF COMMENTING ON KEY LEARNING POINTS

ETT loaded “d” grip bougie first intubation by direct laryngoscopy from Yen Chow on Vimeo.

Thanks Fayaz!

Frova Bougie in D Grip configuration

Dr James Du Canto ( Wisconsin, USA) and Dr Yen Chow ( Ontario, Canada) have been collaborating via FOAMEd ( Twitter and email and Google +) in the last 2-3 weeks on the concept of modifying the Kiwi and Pistol Grips.

What they have come up with is called the D Grip.

Jim was generous to donate his time to record a quick hangout to further elaborate on the modification. Please excuse some missing sound..I think you will get the idea. Along the way Jim discussed the mechanics behind his Paleo grip modification as well to holding the laryngoscope

Now Yen also recorded a demo video of the D Grip so here it is!

Try it out on a mannikin first. I think you will like it!

Advantages:

1. Single operator technique
2. Bougie already preloaded with ETT – faster, smoother
3. still retain advantage of using bougie tip to intubate trachea
4. no extra cost
5. works with VL and DL

Disadvantages:

1. May damage Murphy eye of ETT
2. ??

First we brought you Burr holes in the Bush, from master FOAMEd director , Dr Tim Leeuwenberg & Dt Mark Wilson.

Now from Twitter (@StephenHearns1)

,Dr Stephen Hearns giving the shout out to this awesome FOAMEd article

ENJOY AND BE AMAZED …

CHEWING GUM FOR EXTRADURAL HAEMORRHAGE

Stay calm and use your scalpel

[View the story "Permissive hypotension : a Twitter story" on Storify]

Hi folks

Got this in the email bag last week. Lets see if the PHARM community out there can help out our Peruvian colleague!

Name: Jose Portugal
Email: jportugal18@hotmail.com
Comment: Hi, my name is Jose, and I am a 2nd year emergency medicine resident in Lima Peru. I work at a III-1 level hospital (high complexity), located in a poor county in Lima. It is the only high complexity hospital in a 6 county area, with a total population of a little over 2 million people. We in the emergency department are trying to organize a system to allow us triage the patient before it arrives, so only the sickest patients arrive to our ED (as of right now we receive every single patient that crosses the hospital doors, for example minor cuts, contusion, a flu, mild dehydration). A you can see there is no filter, to direct this not so ill patients to other centers with the capacity to solve this patients problems. The problem we are having with this is, there is no communication whatsoever between the hospital, and the EMS service (the EMS service in Peru is provided by the fire department. Fire fighters in Peru are volunteers with different professions, with little or no knowledge on healthcare). So I was wondering if you could provide some inside on how your pre-hospital system is organized, if you could provide with any documents that could help us set this system we are trying to put in place (in the local area) how hospital manage patients brought in by EMS services, is there any form of registration. who handles the communication between the field EMS providers and the hospital. Anything that you could consider important for us to set this up please send it to me, I’m sure it will be of enormous help. Thank you so much, and keep up the good work with the blog.

Folks, they said it could not be done. Then Dr Yen Chow showed them it could be. And now JD Ggraziano and his paramedic buddies show you too..it can be done. And for those wondering..thats a MAC4 bladed laryngoscope JD is wielding in the video

What’s that? Endotracheal intubation with a great big Supraglottic airway in situ.

Thank these folks here!

Standing Orders Contributors: JD Graziano, BA, NREMT-P, FP-C Matt Fults, NREMT-P, CCEMT-P Brad Buck, NREMT-P, CCEMT-P

http://emsstandingorders.com

 http://roguemedic.emsstandingorders.com

Intubation over SGA in Situ (IOSIS or ISIS) simulation from Yen Chow on Vimeo.

Okay without further ado, results of the PHARM reader survey on blade choice in direct laryngoscopy. 68 of you responded. THANKYOU

ITS THE OVERWHELMING MAJORITY CHOICE OF PHARM READERS FOR INTUBATION WITH DIRECT LARYNGOSCOPY

MACINTOSH 4 BLADE – ACCEPT NO SUBSTITUTES!

>
(picture attributed to Dr Seth Trueger )

FOLKS WHO INTUBATE, PHARM NEEDS YOUR HELP!

TAKE THE POLL AND HELP SETTLE A TWITTER DEBATE
Click here to take survey

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Dr Alasdair Corfield (image from EMRS official website)

hi folks.

I interview Dr Alasdair Corfield, a consultant emergency physician and retrieval doctor with Emergency medical Retrieval Service of Scotland.

Him and his colleagues in Scotland, such as Dr Stephen Hearns, put on an annual Retrieval medicine conference.

I chat to him about the 2013 highlights and the promise of 2014 conference!

Now on to the Podcast

Right Click and Choose Save-as to Download the Podcast.