Happy New Year. It’s been a while, but I’m hoping to up my post count in 2013.
I try and reserve my posts for issues that are significant in prehospital care, not necessarily tidbits here and there. As such, my posts will be less frequent than other blogs, so keep checking back in.
This is a great lecture on RSI from Dr Karel Habig of GSA-HEMS. Check it out:
I like Karel’s lecture style. His points are almost universally applicable. The only point I have I guess is the continuing reference to US prehospital RSI data. Unfortunately due to the paucity of prehospital RSI data in Australia, there is a reliance on the US data (which shows mostly poor outcomes). Most of it is paramedic-based research, but I don’t believe that the data is transferrable to the Australasian environment where paramedic education (particularly in regards to prehospital RSI) is of a very high standard, supported by an high level of clinical scrutiny (no offence to US readers). Hopefully, with time, there will be an increasing amount of Australasian prehospital data, and Karel and his team are at the forefront of prehospital critical care research, specifically airway management.
Check this presentation out from Cliff Reid over at Resus.me.
I have always hated the term “scoop and run”. In my mind, it invokes images of this:
Check out this excellent piece from Cliff Reid over at Resus.me
If you’re good at your job, you should deliver the best care you can, albeit in a timely fashion. Cliff’s message isn’t that you can set the picnic table up at the scene.
The next time someone says “He needs a bit of diesel therapy”, ask them for the data on diesel versus a high standard of clinical care.
Cliff’s Stay and Play
An article from EMJ looking at Ontario paramedics who intubated trauma patients with a GCS<9 without drugs. This would be the only option for many prehospital services around the world, where RSI is not practiced/authorised.
Not surprisingly, it showed that “cold-tubing” these patients was associated with an “heightened risk of mortality”.
Cold tubes in trauma
A great article, especially for those who are new to the use of devices such as EZ-IO (MICA Road Paramedics in VIC are finally about to start using this device).
Putting an IO in in an awake patient, as the article suggests, it a completely different kettle of fish.
IO in the somewhat conscious patient
Incredible range of uses if they can pull this one off. If it’s cheap and effective, potentially save a lot of lives.
Here’s an interesting paper on the use of a small-bore catheter for initial decompression of pneumothorax, versus a standard chest tube.
Small-bore pneumothorax decompression