Tag Archives: Critical Care

FOAM Eye-Catchers 13: Mental Training for Resuscitaiton

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Despite resuscitation teams operating in extremely high stress environments and such stress being known to substantially impair optimal performance, historically very little attention has been paid to preparing these teams to mentally function at their best. Recently strategies taken from other high stress environments such as armed “special forces” teams and high performance athletes have been applied to critical care with some impressive demonstrated and potential benefits.

Several excellent critical care podcasts (links provided below at the end) by Jason Brooks, Chris Hicks, Mike Mallin & Scott Weingart provide an excellent insight into how we can specifically train our minds for the rigours of the resuscitation room, using psychological techniques from “stress inoculation training” or “stress exposure training”. Note, while this post focuses on the resus room, these techniques could be applied to other stressful situations at work or in your personal life. Continue reading →

FOAM Eye-Catchers 10: Apnoeic Oxygenation – new trial questions value of NODESAT

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A new RCT called the FELLOW trial examining the benefits of NODESAT (Nasal Oxygenation During Attempts at Larngoscopy) has been published online and Emcrit has just released a podcast interviewing the leader author. There is also a brief review of this paper at emlitofnote.

This is a RCT in a single medical ICU randomising patients to NODESAT or usual care. Surprisingly it found no benefit in the primary outcome – the lowest measured arterial oxygen saturation.

However there was some key aspects of this trial that seriously affect its generalisability to ED and operating room patients: Continue reading →

FOAM Eye-Catchers 9: Early Goal Directed Therapy is Dead

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Apologies for the recent hiatus in FOAM Eye-Catchers – have had my head down in fellowship exam study.

The big news of late is that the 3rd episode in the trilogy of multi-centre trials evaluating Early Goal Directed Therapy (EGDT) for septic shock has been released.

First we had PROCESS from the US, then came ARISE from Australia/NZ and now we have PROMISE from the UK.

Continue reading →

FOAM Eye-Catchers 7: SMACC GOLD Highlights

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Having recently returned from the FOAM-ite mecca, SMACC GOLD, in this edition I take a look at just a few of the many highlights.  Given there were frequently 3 speakers on at the same time, there were many talks that I missed so this is not an all inclusive list by any means. Continue reading →

FOAM Eye-Catchers 5: ACEP says fasting is not required for procedural sedation in ED

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HOT OFF THE PRESS: ACEP has just published a new Clinical Policy: Procedural Sedation and Analgesia in the Emergency Department, in the February edition of Annals of Emergency Medicine. After reviewing the relevant literature they have made several important recommendations including:

1. Do not delay procedural sedation in adults or pediatrics in the ED based on fasting time. Pre procedural fasting for any duration has not demonstrated a reduction in the risk of emesis or aspiration when administering procedural sedation and analgesia [Level B]

Continue reading →

FOAM Eye-Catchers 4

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Time for a Rethink on IV Fluids in Sepsis?

Earlier this year in March, I was fortunate enough to pilgrimage to the inaugural FOAMite mecca – SMACC (Social Media And Critical Care) Conference in Sydney. Quite frankly, it was the best conference I’ve ever attended. Some of the highlights included talks by Prof John Myburgh, in particular one on IV fluids in Sepsis, available for free via SMACC talk archive.

Recently Emcrit released a paradigm shifting lecture by Dr Paul Marik on fluids in sepsis that builds on some of the theme’s of Prof Myburgh’s talk. Not long after, Scott Weingart released his response to Dr Marik’s lecture.

All 3 talks are well worth listening to in full. However I’ve summarised some of the key concepts below as well as the FEAST study which is a landmark study discussed in both talks: Continue reading →

Bite-Sized Basics: Urgent Endotracheal Intubation

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The Urgent Endotracheal Intubation (UEI) describes the primary intubation scenario that occurs in the ED where intubation must proceed in a semi-rapid or rapid fashion due to the patient’s clinical state.

We discuss the Rapid Sequence Intubation, the mainstay of the UEI with the longest history and firmest evidence base.

In Beyond the Basics we look at alternatives to RSI including:

– Modified RSI

– Rapid Sequence Airway (RSA)

– Delayed Sequence Intubation (DSI)

– Awake Intubation

– Inevitable Surgical Airway

Read more…

Bite-Sized Basics: Preoxygenation

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This is our very first Bite-Sized Basics post and the topic is Preoxygenation.

Preoxygenation (PreOx) is a critical step performed prior to intubation or sedation to extend the period of safe apnoea. We take a look at:

– how best to perform it and the choice of Preox devices in the ED

– what to do when we run into problems achieving PreOx

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