Tuesday, 24 November 2015

Sepsis SMACC-down panel.

This is a long one but worth it for broad concepts which are not discussed everyday. This panel comprises of the leading minds in sepsis research and information dissemination. It also demonstrates that we don't know as much as we think we know and are far from consensus on the subject even in 2015. 
Thanks to the SMACC team for the plenary panel vid.

Tuesday, 17 November 2015

TXA denial SMACC-down

SMACC 2015 videos will be coming fast and enlightening as they continue their valuable trend in post conference broadcasting. Long may it continue.
Prof Karim Brohi enthralled at our local conference a few years ago and he is at his whimsical best here. He lays the "SMACCdown" on deniers of a novel therapy using science.
SPOILER ALERT - be prepared for a heavy dose of sarcasm.

Prof Brohi's other talks in 2014 are here and here.

Wednesday, 11 November 2015

Oh shoulder reduction...let me count the ways I love thee.

Shoulder reductions are one of my favourite procedures to do and we have seen it evolve from medieval "leg in the armpit" method to the "no drug" massage nowadays. How many ways can you recall? Here's a delightful compendium.

Get more of Prof Larry Mellick's videos here.

Tuesday, 3 November 2015

Webucation 3/11/15

Web wisdom this episode distills some thoughts about kidney stones, updates our facts in paeds and even challenges dogma about CTs in trauma - heavens no....
All credit to the original posters and do visit their sites for more content.
The last link is essential for anyone treating kids these days. Have to keep up to date as the parents surely are!

Wednesday, 21 October 2015

EHR rapped

As usual, ZDogg captures most of our thoughts and emotions and portrays it well into rap and melody with a hilarious vid to boot. Worldwide this is becoming a bane for most EDs.
A potent combination of "old-school" administrators/heads making allied to profit driven IT companies with a few lawyers thrown into the stew. What you get is almost negative patient satisfaction when staff are so unhappy and frustrated. Actual patient contact time is down to fractions.
But there is hope. The new generation of tech savvy docs will save us...
Rant over, enjoy Zdogg.

Wednesday, 14 October 2015

Are we (EPs) the weakest link in cardiac arrest?

A recent publication in Intensive Care summarises the strategies involved in improving cardiac arrest outcomes, as can be seen in this infographic:

We have many of the elements in place to improve cardiac arrest outcomes. There is an agency with lots of funding looking into increasing pre-hospital cardiac arrest care; this includes - improving bystander CPR, a lot of this involves teaching CPR skills in the schools. CPR instructions over phone are also given to the public who reports a cardiac arrest. There are more and more AEDs available in public places, and instructions to their use are increased as well.

Our pre-hospital services provide reasonably good ACLS, with mechanical CPR available, intravenous and intra-osseous access when needed, and ability to administer adrenaline. Most of our hospitals have incorporated therapeutic hypothermia for post-cardiac arrest victims, and cardiologists nowadays are more willing to bring more of these patients to the cath lab. We have a Pan-Asian cardiac arrest registry, and there is fairly robust cardiac arrest research ongoing in Singapore.

That leaves the final piece of the puzzle - that of monitoring - and this happens in the ED when the cardiac arrest victims arrive. Therein lies the weakest link - ourselves. How often, when we receive cardiac arrest victims, do actually think about, monitor, or make subtle changes to improve the quality of CPR? Do we check that the mechanical CPR on the patient is actually providing adequate flow? Or when manual CPR is performed, do we check on its quality? Do we aggressively check compression timing, depth, adequate recoil and minimal hands-off time? Do we routinely use end-tidal CO2 monitoring to guide CPR and assess cardiac output?

The answer is no - we are not consistent in any of the above. It is telling, if one observes the current resuscitation process in our ED, there is a lot of room for improvement. Therefore, if we seek to improve cardiac arrest outcomes, one simple thing might be, to look inward, and see if we are actually performing good quality CPR.

Cariou et al. Ten strategies to increase survival of cardiac arrest patients. Intensive Care Med (2015) 41:1820–1823

Tuesday, 6 October 2015

"Entry level" exit block

The UK CEM has been active recently in promoting their opinions and more importantly their solutions to access block. Here's another great video for the uninitiated.