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Cutting Edge Resuscitation Medical Education



Last Build Date: Tue, 26 Sep 2017 06:12:08 +0000

 



Comment on The Area Under The Suffering Curve by Andrew Coggins

Tue, 26 Sep 2017 06:12:08 +0000

Great concept, thanks for sharing



Comment on The Area Under The Suffering Curve by Tim Leeuwenburg

Mon, 04 Sep 2017 04:24:26 +0000

Just think how effective it might be to have a GP in the hospital....holistic overview expert communicator with patients and relatives, bridge the gap between teams and facilitate patient journey through the hospital and back to primary care So long as not a muppet....



Comment on The Myth of Error-Free by Michele Guthrie

Fri, 25 Aug 2017 04:24:29 +0000

As clinicians it is important to be able share with each other and learn from our errors. Humility is key and we should welcome support from one another. I agree that errors don't define us, we tend to impose that on ourselves and that is when self care needs to come into place.



Comment on The Myth of Error-Free by Brian

Thu, 24 Aug 2017 14:58:01 +0000

This is an excellent and much needed piece.



Comment on The Myth of Error-Free by Simon Carley

Thu, 24 Aug 2017 06:44:30 +0000

I'm sure this story will chime with many of us. There is some inevitability that when we work in time critical and information light settings that errors will happen over the course of our career. It's up to us to support each other when they happen. Yes, we must learn, but we cannot allow our colleagues (and ourselves) to suffer through that learning . Thanks for sharing. S



Comment on The Myth of Error-Free by Toby

Thu, 24 Aug 2017 05:07:21 +0000

Spot. On. Having the fortitude to talk about a mistake is impressive. Our system and culture is generally set against it. Those not yet experienced shudder at their near misses and move on quietly. Regardless of new models of care, the clinician who is there with the patient providing treatment is weighed by the responsibility. Our system and culture should encourage openness and support, but does not. Personal experience. Thank you for an excellent article.



Comment on Head Rotation for Mask Ventilation by M U Haider

Wed, 14 Jun 2017 02:06:38 +0000

It is not a new idea. It has been forgotten. Having trained before the days of propofol, LMA, CO2 and pulse oximeter, we were always trying and finding head positions for a good chest rise while holding the mask with one hand. Any degree of Head rotation combined with different neck extentions was the mainstay while using guedels airway with mask being held by harness and a chin support. Any one remembers that ?? I stringly believe that training must start with one person bag mask handheld. Similarly, Standard laryngoscope will be forgotten after glidoscope. Anatomical landmark based Central lines will be forgotten after US guided technique. My position is to master basics then advance techniques. As if and when met with adverse circumstances this training will be life saving. Many disagree and maintain old fashion methods have no place. I wonder.



Comment on Head Rotation for Mask Ventilation by Thor

Sun, 11 Jun 2017 05:36:14 +0000

I was taught this doing anaesthetics in Norway, where it appeared to be common practice for tricky BVM patients. I find it useful in the Ozzie ED for procedural sedation as well. Often a "sedated snorer" who is already in a sniffing position can be cured by slight head rotation to either side, without supported airway maneuvers chin lift/ jaw thrust etc.



Comment on It’s Tamponade – Now What? by Cliff

Sun, 18 Sep 2016 08:47:56 +0000

I had this comment from Daniel K: Hi Cliff, Excellent summary. Thanks for that. Id like to build on Sven Graumans comment above. Since i started ultrasounding every single crook patient I ever meet I seem to see 1-2 of these very sick, profoundly shocked, haemorrhagic tamponades per year. On several occasions i have performed periocardiocentesis with the hope of stabilising the patient so they will live long enough for retrieval to come and take them to thoracic surgery. (2-3 hours away) On some I cant evacuate any blood despite perfect visualisation of the needle because the haematoma has already clotted. Some have improved after multiple punctures of the pericardium without me being able to aspirate any blood in the syringe. Those cases led me to believe I somehow, through the many puncture sites, created a 'pericardial window', that allowed some clot/gel/goo to seep out. In some I have evacuated 20-30 ml of blood. Often with dramatic improvement of vitals. Unfortunately they all seem to clot eventually. Eventually I cant aspirate any blood whatsoever. ALL of these, very sick, patients delivered to the remote hospitals i work in have arrested before retrieval arrives or long before arrival in OR. So I am starting to wonder if there is any point at all in decompressing these patients unless theres thoracic surgery on site. Are we doing all we can for these patients? Shouldn´t we aim for a more robust solution? Surgically creating a pericardial window via an US-guided scalpel stab? Should we insert wide bore drains that allow effective clearance? Thoracotomy? I know people will suggest that they will only keep bleeding through the dissection, into the pericardium and then into our syringe or onto the floor? Really? Is that necessarily the case? Is there nothing we can do about that?



Comment on It’s Tamponade – Now What? by Sven Grauman

Sat, 17 Sep 2016 13:35:21 +0000

Hi Cliff. Thanks for this rundown. Very clear and sensible. Regarding the pericardiocentesis most of us have been taught for years that in penetrating traumatic tamponade there is no role for that procedure since blood will have been clotted and that thoracotomy is the action of choice. What would be the difference in physiology that makes pericardiocentesis work, without significant clotting in the case of aortic dissection? Obviously making a thoracotomy would complicate the situation a great deal and probably not save the patient. I´m just curious about the clotting issue and what amount you can get out thru a pericardiocentesis if there is a blood only tamponade.