Author Archives: ScanCrit

06.09.13

by ScanCrit

WE NO WHO U R

Just wanted to share this video from norway. The director of medical training at Kristiansand hospital is apparently taking his job seriously and is doing a good job too. This time he and his colleagues in anaesthetics, ED and obstetrics … Continue reading →

06.09.13

by ScanCrit

TRACMAN

The TracMan trial was recently published in JAMA. TracMan is a randomised trial comparing early vs late tracheostomy in ICU patients. Which just happens to be one of the big current controversies in intensive care… Background Since the introduction of … Continue reading →

05.17.13

by ScanCrit

THE DOPPLER EFFECT

We are both incredibly busy at the moment but will hopefully soon be back with posts and replies to comments.

05.08.13

by ScanCrit

RSI AND PERMISSIVE HYPOTENSION

A study in Injury looks at what happens to our patients´ blood pressures when we do rapid sequence inductions for intubation. With all the talk of ´permissive hypotension´  in modern trauma management this could be important. Background Trauma- or shock-RSI, … Continue reading →

05.01.13

by ScanCrit

LUCAS

Here is some (poor…) i-phone footage i shot the OR that demonstrates how effective mechanical compressions can be. The patient is a hypothermic cardiac arrest victim. He was put on LUCAS2 as a bridge to ECMO-cannulation. On this transesophageal echo … Continue reading →

04.27.13

by ScanCrit

DAILY SEDATION INTERRUPTION STILL CONTROVERSIAL

 The average intensive care patient spends 40% of her/his ICU time being weaned from the ventilator. Reduced weaning times means freeing up an enormous amount of floor-space, manpower and resources. Two important causes for prolonged weaning are over-hydration and excessive … Continue reading →

04.25.13

by ScanCrit

HELPING BABIES BREATHE

Every once in a while there’s a different research project, something that actually makes a difference. This is one of them. A great example of how simple interventions can lead to significant results in low resource settings. The “Helping Babies … Continue reading →

04.18.13

by ScanCrit

RINGER’S A LOUSY VOLUME EXPANDER

With colloids being miscredited by Cochrane and synthetic colloids being hammered by RCTs, it might seem we’re left with crystalloids. So how good is our standard crystalloid, Ringer’s Lactate, at volume replacing a volume depleted patient? This study withdrew blood … Continue reading →

04.15.13

by ScanCrit

SAM

Until recently I didn´t really know what SAM was. I do now. Boy am I happy. SAM stands for Systolic Anterior Motion of the Mitral valve and is a not too uncommon complication of hypertrophic cardiomyopathies (HCM), myocardial infarction and … Continue reading →

04.11.13

by ScanCrit

ULTRASOUND FOR SPINALS AND EPIDURALS

This is a well known, but fairly novel use of ultrasound. Certainly not standard in any place I’ve worked. But ultrasound for epidurals and spinals seems to be in vogue. Here’s a meta-analysis on ultrasound for spinal and epidural access. … Continue reading →

04.05.13

by ScanCrit

A LETTER TO THE EDITOR…

Any-one who knows the frustrations of submitting a paper to a review panel of a peer reviewed journal must read this letter to the editor. It quite accurately describes one’s feelings during the review process. As the letter says: “We … Continue reading →

03.22.13

by ScanCrit

INSIDE COMBAT RESCUE

A pretty interesting look inside the US Air Force’s Combat Rescue Choppers in Afghanistan. A five part series on youtube. Having worked in helicopters, I’m impressed with all the procedures they perform in-flight. BONUS: Airway porn in episode 5 (above): … Continue reading →

03.18.13

by ScanCrit

THE GCS STILL DOES NOT BELONG IN EMERGENCY MEDICINE

A while ago we wrote about the Glasgow Coma Scale and how it can´t be relied on for trauma patients or in emergency medicine in the acute phase.  We based it on an excellent editorial written by a Dr Stephen … Continue reading →

03.18.13

by ScanCrit

ARCTIC CPR

Just wanted to share this photo that was on the front page of a norwegian national paper called Verdens Gang. It is from the evacuation of an avalanche victim that tragically passed away a few hours after this photograph was … Continue reading →

03.15.13

by ScanCrit

CODE BROWN: CENTRAL LINE GOES WRONG

This one I got from a colleague of mine at a Scandinavian hospital, and it’s a scary reminder of the dangers of central cannulations. Placement of a large dialysis catheter went wrong – very wrong. Standard procedure? A standard procedure … Continue reading →

03.14.13

by ScanCrit

LOST & FOUND: TRAUMA UPDATE

. I wanted to have a permanent link to this excellent trauma update and review of recent litterature by David Anderson of Greater Sydney HEMS. If you watch this 30 minute talk and look up the references I’ve listed in … Continue reading →

03.07.13

by ScanCrit

REJECTION

Bastards. I wrote a up ground-breaking EM case report.  Here´s the verdict from two of the three referee editors. Well….NOBODY PUTS BABY IN A CORNER!

03.05.13

by ScanCrit

NOREPINEPHRINE AND CO

A small study in Crit Care Med reminds me how it is really hard to anticipate the effects of systemic vasoconstrictors. Norepinephrine/noradrenaline is more likely to reduce cardiac output than maintain it. The study A small study including 16 postoperative … Continue reading →

02.23.13

by ScanCrit

CVC AND US

A meta-analysis in Anesthesiology confirms how central line cannulation is a lot safer when guided by ultrasound. Does that mean we don’t need blind landmark techniques? Background Since a couple of years I am using real time ultrasound more and … Continue reading →

02.19.13

by ScanCrit

THAW SOME BLOOD PLEASE

Cryopreserved blood can last longer, and might have superior RBC function to standard, cooled SAG-Ms. As a bonus, cryo always sounds good in a sci-fi kind of way, even if it does just mean frozen. Pilot study on frozen RBC … Continue reading →

02.17.13

by ScanCrit

TUNNEL CREEK AVALANCHE

In NY times I found this incredible piece about avalanches and avalanche survival. It is a detailed description of what went down (other than heaps and heaps of snow…) when an avalanche hit 16 backcountry skiers in the Cascades. A … Continue reading →

02.16.13

by ScanCrit

BNP AND WEANING

B-type or Brain Natiuretic Peptide (BNP) is secreted by the heart ventricles in response to excessive stretching of the heart. It’s physiologic actions is to decrease vascular resistance and increase natiuresis, thereby off-loading the strained heart ventricle. Recently BNP is finding … Continue reading →

02.11.13

by ScanCrit

ULTRASOUND BEST FOR PNEUMOTHORAX

We know ultrasound is great for detecting pneumothorax, there’s been lots of studies confirming this, and here’s the final meta-analysis from Chest – print it and use it to slap colleagues who still want x-rays over ultrasound scans. The Study … Continue reading →

02.08.13

by ScanCrit

TRAUMA CARE EVOLVING

Sometimes it feels like we’re not really going forward. Trends swing back and forth, new treatments and techniques get hailed one year, then falls out of favour the next. Are we moving forward at all? An article on hepatic trauma … Continue reading →

02.06.13

by ScanCrit

RAPTOR SUITE

So, in our latest Code Brown, I wrote on a crashing trauma patient. Scott Weingart made a comment where he also noted that transfer between OR and angio might come to an end with RAPTOR like operating theatres. RAPTOR is … Continue reading →

02.03.13

by ScanCrit

NASAL PRONG ETCO2

Monitoring sedated patients without airway devices in place is often based on the time machine, the pulse oximeter, showing you what the patient’s oxygen saturation in the lungs were 30 seconds ago. Also, it doesn’t tell you if the patient … Continue reading →

01.31.13

by ScanCrit

CODE BROWN: CRASHING TRAUMA PATIENT

We all know the rules for damage control resuscitation. Often the lines are clear. But sometimes it’s hard to make that call. We received a MVA trauma: a young man trapped in a wrecked vehicle for hours in the Norwegian … Continue reading →

01.30.13

by ScanCrit

FATTIES IN SMALL CARS

 An article in EMJ confirms a very valuable lesson I once learnt from a veteran paramedic. Fat people are more prone to suffering serious injury or death in car accidents. Fat Female Fiesta (Festiva in Australia…) A few years ago, me … Continue reading →

01.29.13

by ScanCrit

IMAGING CASE OF THE MONTH

OK, that’s it! I’m off to Germany! I don’t care if they treat their registrars like shit, as long as I get to drive a Porsche with prehospital ECMO.

01.28.13

by ScanCrit

IVC DIAMETER AND HYPOVOLEMIC SHOCK

AJEM recently printed a meta-analysis of the evidence supporting making blood volume assessments in hypovolemic patients based on the ultrasound diameter of the inferior vena cava. Only five studies met the authors selection criteria. Background As the IVC is a … Continue reading →