R main stem intubation

The crashing intubated patient: DOTTS

Whenever a patient you have just intubated deteriorates, or a patient on a ventilator deteriorates quickly: DOTTS Disconnect and let them exhale: This gets the ventilator out of the equation and simplifies things / reduces our cognitive load: we understand BVMs (bag-valve-mask), ventilators and circuits confuse and scare us.  It also stops ventilation for a […]

theo-mustache2-mar-3

Diving sats? Check your oxygen supply

    A cautionary tale from the not so distant past: To cut a long and messy story short – a 6 month old child needed to be intubated for deteriorating bronchiolitis with pneumonia. The infant was preoxygenated with a paediatric Bag-Valve-Mask (BVM) and the sats rose to 97%. Then the sats dropped to 30% […]

8894920-panic-emoticon

Obstetric Emergency Communication and Teamwork

  Audio   Obstetric emergency communication and teamwork from chricres Phone image from http://mobilephones.pk/reviews/emergency-calls-now-free-from-all-networks-%E2%80%9Cthe-number-allocation-and-administration-regulations-2011%E2%80%9D-issued-by-pta/ Panic face image from http://tamlynn75random.blogspot.co.nz/2012/02/panic-face.html Music: Mr Wendle. Arrested Development.

Rethinking_ETI_2

Rapid Sequence Intubation

Audio:   Rapid sequence intubation (RSI) is the rapid anaesthetising and paralysing of a patient to facilitate tracheal intubation. RSI is the cornerstone of emergency airway management. There are many variations and nuances.  This post will only cover simple, standard RSI. RSI is one of the most complex and dangerous procedures in emergency medicine.  Passing […]

coldsnaps

Accidental Hypothermia

From Dr Doug Brown, lead author from the NEJM 2012 article on accidental hypothermia (Free full text article here: N Engl J Med 2012;367:1930-8). (Dr Brown was interviewed on EM:RAP Jan 2013) This is the key flow chart from this article: His website includes the original article and an audio summary and a video summary […]

Etomidine

Sedation Only Intubation. Etomid-ine

Etomidate and Ketamine for intubation without a muscle relaxant   There was an interesting section on EMRAP last month about sedation only intubation. This is not for junior doctors to be playing with unsupervised on night shifts.  And it is not for Australians as some how etomidate has passed them by. We occasionally get a […]

Courses

Australasian Emergency Medicine Courses

Some Australasian Courses Advanced Course in Toxicological Emergencies roz.jaworski@uwa.edu.au Airway Skills (Auckland) http://www.airwayskills.co.nz/page.php?3 ALSO: Advanced Life Support in Obstetrics http://www.also.co.nz/ APLS: Advanced Paediatric Life Support http://www.apls.org.nz/      http://www.apls.org.au/ BASIC: ICU skills for House Officers and above http://www.hawkesbay.health.nz/page/pageid/2145874837/BASIC_Course EMST: Early Management of Severe Trauma http://www.surgeons.org/for-health-professionals/register-courses-events/skills-training-courses/emst/ NB there is a very long waiting list for this course. Unless […]

ED Thoractomy

ED Thoracotomy for Asthma?

  After my last post on a patient with asthma who arrested in our ED,  Prof Simon Carley (@EMManchester, St Emlyns, BestBETs and all round EM guru (but doesn’t know much about snake bites)) posted a comment suggesting ED thoracotomy for asthmatic arrest. I’d never even thought of this as an intervention. He linked to […]

lungs in chains

Life Threatening Asthma

Here is an excellent asthma talk from EM:RAP 2012 (paid subscription required): The following is adapted from EM:RAP’s written summary from that talk [with NIV and Vent settings, Australasian drug doses, comments re nebulised adrenaline / epinephrine and ketamine sedation added]: Treatments Oxygen. Inhaled beta-2 selective agonists. eg back-to-back salbutamol 5mg via nebuliser for severe […]

Ca Gluconate

Calcium Gluconate works as quickly as Calcium Chloride

See http://academiclifeinem.com/calcium-gluconate-vs-calcium-chloride-myth-busted/       Music: She’s Not There by The Zombies:  https://itunes.apple.com/nz/album/shes-not-there-time-season/id362966890 Download audio here (right-click and save or save as) or