Sunday, 23 August 2015

Smells like team spirit

In times of crises, certain traits are desirable and some, admirable. One of those is situational awareness. What is most desired is knowing your limits and calling for help.

A competent registrar notified me of an impeding airway disaster:

  • Semi conscious patient in respiratory distress
  • Oro-pharyngeal tumour (undergoing chemo)
  • Bleeding acutely from unknown site in oropharynx or lower
  • Shocked clinically
  • The best description I can give to those who understand is "peri-arrest".
Here's the really good news though:
  • A RSI checklist had been commenced prior to my arrival
  • The airway team had been called
  • Nursing staff were ensuring all the items on afore-mentioned checklist were prepped
  • Tranexamic acid given
  • Cric kit was opened and location marked (as best we could due to oedema)
The inevitable happened and the soon GCS deteriorated as did BP. Subsequently, this followed:
  • Ketamine 
  • Unmatched blood as soon as we got it
  • Peripheral pressors 
  • Paralysis and attempt by Anesthetist
  • Continuous suctioning of blood with no view of cords
  • Bougie assisted intubation with no desats and good CO2 trace
  • Good post intubation care
The whole hospital team successfully oxygenated and ventilated this patient. I did practically nothing. Which is why I am elated. This was a triumph for systemic preparation & team sport...

... but it all started with a keen-eyed doctor with the sense to know they couldn't do it all by themselves. 


Monday, 10 August 2015

ACL exam - all you need to know.

Dr Nabil Ebraheim makes some fine videos and this is no exception. It demonstrates the Lachman and Pivot shift tests and explains the pathology, relevant investigations and follow up as well. I'm a biased ACL tear sufferer but this is a common injury and it pays to know the sensitive and specific tests.

Sunday, 26 July 2015

Webucation 26/7/15

Web musings from around the globe this round include pointers on trauma, paeds, cardio and a good rundown on the ever challenging asthmatic.
The last link is a notion supported by our group as well. It is essential to know the basics of trauma resuscitation and how teams work in that arena. It just shouldn't be termed "Advanced" in this day and age.

Thursday, 16 July 2015

The amazing story of the man who gave us modern pain relief

Being a history buff and chastiser of oligoanalgesia, I am ashamed not to know of Dr Bonica. This wonderful talk by Latif Nasser is not just enlightening in delivery and fact finding but also has a vivid, powerful ending.

Thursday, 9 July 2015

Blazing admissions with ZDogg MD

Dr Zubin Damania burns up the airwaves as well as airways and hallways in this institutionalised rendition of the R Kelly classic. It all rings true if you can keep up with the lyrics. Keep it up ZDogg!

Thursday, 2 July 2015

Webucation 2/7/15

Web wisdom this edition comes from areas of urology, general surgery, trauma and paeds. As always, give credit to the content creators.

The last link is a gem in mnemonics. It also has a great Rule of 3's for infantile colic. Great site for paeds. Do visit it.

Thursday, 25 June 2015

Facts of A&E (UK)

The following video is from the UK College of Emergency Medicine. It not only details the problems, statistics, evidence and myths surrounding Emergency Medicine practice but also boldly highlights some solutions. They may have a relatively new college but that seems to be their strength as the execution of message delivery is fresh and concise.
The keen observers among you will immediately see the similarities in your own departments and / or countries!