THE DOPPLER EFFECT
We are both incredibly busy at the moment but will hopefully soon be back with posts and replies to comments.
Category Archives: 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
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
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
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
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
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
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
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
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
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
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
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
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
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!
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
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
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
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
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
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
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
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
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
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
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
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.
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
DEFINE THE MOMENT…..
There is a lot to learn about emergency medicine from movies about sport. Tin Cup, the best sports movie ever made, is a treasure trove of wisdom. The first quote speaks for itself. The second…is probably true too. Anaesthesia can … Continue reading
YOU SAY GURNEY, THEY SAY TROLLEY, I SAY BÅRHELVETE
I didn´t know what a gurney was (I do now), but I did know that performing effective CPR while transporting a patient, through a hospital or in a road ambulance, is hard. I didn´t know it was this bad though. … Continue reading