Profound hypothermia and no ECMO?

Patients in cardiac arrest due to severe hypothermia benefit from extracorporeal rewarming, and it is often recommended that they are treated at centres capable of providing cardiopulmonary bypass or extracorporeal membrane oxygenation (ECMO). But what if they’re brought to a centre that doesn’t have those facilities? If you work in such a centre do you […]

Down with “down” time!

A man in his 40s has a witnessed collapse and CPR is immediately started. Paramedics are on scene within 5 minutes and initiate advanced cardiac life support. He has refractory ventricular fibrillation which degenerates to asystole. He arrives in an emergency department where, with good ongoing CPR, he appears reasonably well perfused and even demonstrates […]

Emergency Medicine – A Great Job

I was asked to speak at the Australasian Conference for Emergency Medicine‘s Annual Scientific Conference in Adelaide in November 2013. The title they gave me was ‘What a great job’. It was a great opportunity for me to explore some of the literature around what makes people happy, and whether emergency medicine has the ingredients […]

Time to change thinking on ‘cricoid pressure’

I don’t like cricoid pressure. Some people do. There is insufficient evidence that it is of any benefit. There is some consistent evidence that it worsens laryngoscopic view. In my clinical practice of critical care in and out of hospital, I can’t afford to risk delaying the securing of my patients’ airways with a procedure […]

Time to change thinking on ‘cricoid pressure’

Here’s my take on the role of ‘cricoid pressure’ in critical care intubation. Cautionary notice: This post represents my opinion on a topic about which airway practitioners seem to be divided. It is deliberately provocative in order to stimulate thinking and to challenge assumptions. It is not meant to offend or to divide professions or […]