A 68 year old female present with altered mental state, shock and hypothermia Continue reading
An 80 year old women with severe anaemia secondary to GI bleed Continue reading
An 85 year old female with bowel obstruction is in your Emergency department for the past 12 hours waiting for a bed. She has been seen by the general surgical team and accepted for admission. She has been having increasing pain and abdominal distension requiring opiate analgesics. The nurse has interrupted you on multiple occasions because the patient is becoming increasingly tired and breathless with some mild confusion. You are slightly annoyed by this and finally decide to see the patient. You find the patient looking unwell, on 4 litres oxygen in you short stay ward. You decide to move the patient to the resuscitation area and do “blood tests”
Her ABG shows: Continue reading
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
The End of Therapeutic Hypothermia?
HOT OF THE PRESS: this new article in NEJM, the Targeted Temperature Management (TTM) trial, that I came across initially courtesy of @CHsu1012 (and then from just about every FOAM resource on the planet due to the significance of these findings) found no benefit of cooling to 33 degrees v 36 degrees. That’s right – no benefit!
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