BushyFromOz

Oh yeah, the days when Dusty would cut you a new one for saying something stupid. EDIT Goddam, its been a long time...profile way out of date! Last time I posted was Dec 2014!

I'm not sure triemal. this has been going for a few years obviously. We used to have these weird little 02 regulators that had a fixed 8l/min flow. they were kind of a legacy item I guess, and it wasn't an issue until the hyperoxia = bad really started to get investigated, so it could be an equipment limitation from a few years back when "high flow and go" was the standard

Wouldn't you know, came into work today and there is a press release about the AVOID trial. Enrollments have obviously ceased and they are awaiting publication, but O2 in MI appears to be .....wait for it.....bad..... http://www.ambulance.vic.gov.au/About-Us/Media-Centre/News/20141120-Oxygen-causes-harm-says-landmark-heart-attack-study.html

Its being trialled here (either soon or about to start) prehospitally. I think the issue with it is that CRASH-2 (i tihnk that was the trial) less than 400 patients were from 1st world trauma systems, with most ebing 3rd world. So there may no be a significant difference for patients in 1st world systems provided they have a relatively short time to hospital, having said that, Australia is a big country, im sure it has use in the more remote areas of australia https://www.mja.com.au/journal/2013/199/5/trauma-and-tranexamic-acid som info, and some of these guys are involved in the upcoming PATCH trial here

I dunno, we get an email about it every few months through work about how far along they are in enrollment etc, and i think we had one recently. If i remember, ill have a look tomorrow. I have no idea of the methodology, but i do remember seeing its methodology in a register of trials somewhere, that was ages ago though

Mike, been a while, my employer just inserted this into our ETT guideline. http://www.annemergmed.com/article/S0196-0644%2811%2901667-2/fulltext

http://www.bmj.com/content/341/bmj.c5462 Thats the one i could think of off the top of my head Personanally, im looking forward to the AVOID (Air Versus Oxygen In myocarDial infarction) trial to release its resulst But theres a bit out there

We had lecture about this few weeks ago and when asked if the RIvers study had made a significant difference to the Management of sepsis patients in our states largest hospital the answer came back that despite the Rivers being interesting time the survival rate in this hospital was already slightly lower than the Rivers EGDT group. The doc then followed his up with something like "we didn't know a lot about sepsis then, what we did now is that the patient was hypovolaemic, so we filled them up and used pressors if that didn't work." gotta run, bbl...

Here's some non sensicle annecdotal evidence form someone who does not intubate, though i do work with people who have that skill set and assist with the procedure from time to time. A lot of guys here incorporated this into their practie when Weingart put that on his podcast and from my many conversations with them they have had very very few desaturations and when they do they desaturate a lot slower than pre-oxygenation with BVM alone. I dunno what its work but from what I've seen I'm pretty much sold on it for the future.

I know man, ive been coming across articles and examples in the last few weeks that have been used to justify the introduction of one piece of equipment / drug procedure in one EMS system, and then used to no introduce the same piece of equipment / drug / procedure in another area. Very interesting stuff!

We just covered this last week in class, basically we do not have the stats to make the argument for video over direct laryngoscopy as our success rates equal those of emergency department physicians already. The other thing is the cost, we would need 130 something units.

Thanks mate, very much appreciated.

Thanks system for you interrupted post and triemal. I have submitted the assessment an elected to forgo sux and go sedation only for intubation with doses adjusted accordingly accordingly. I wont go into our dosages etc for my service because its not that relevant to here but conceptually i have reduced the sedation dose. All this however comes after concerted efforts at perfusion management with fluid and adrenaline, and pretty much in the same vein that you guys have posted here so im happy with that, its nice to know your on the right track Ive read enough literature this past 2 weeks to begin to understand a few things about where i practice, in that we have good practice as far as the procedure is concerned but not best practice in terms of pharmacology (even though the outcomes are still favorable), but Ketamine sounds awesome. It was also nice to read that the concerns about ketamine in TBI have been largely debunked so i look forward to a more simplified intubation procedure when i get to that stage Cheers

**sigh** Is this going to be another one of those "lets measure our dick" things?

When Mark Fitzgerald and a Steve Bernard come in next week for the RSI lectures ill tell em you you dispute their expertise

Rock shoes: for some reason we only have adrenaline as a pressor, though im told Norad is getting another look in. Thanks for the rest of the advice. Kiwi : Fentanyl / midazolam / sux / tube pancuronium for RSI Fentanyl / MIdaz / tube / Panc = IFS Ketamine for induction in the next few months, but the fent / midaz will remain for TBI kiwi. Mike: Are you saying your getting old? See, that's what i needed, the simple answer instead of all this other complicated crap clouding my judgement. Medical standards says IFS ok for select patients, who am i to argue with The Alfred hospital kiwi =D

thanks for the replies. What i would really like to say is fluid load him cautiously and oxygenate him for 10 minutes and see where we are at with his CVS signs, but i only get one set of obs to work with. I had forgotten about those podcast's from weingart, so im going to listen to them again. thanks chbare Mike, i think the whole point of this one is entirely because it is a dammed if you do / dammed if you dont, They put a transport time of 1+ hours in and no air support. I do not believe that i ever thought doing ICP would be easy, but im still shocked at how much more complicated and difficult the decision making is. If i ever hear someone say that its just some extra drugs, guidelines and skills i think im going to slap someone!

Cool thread title eh? Okay, now, i realise im shairing homework and its usually frowned upon (yeah, im looking at you paramedicmike =D) but rest assured this is not about trying to get free answers, im just interested in what other peoples thought on this would be. Basically its a 30 y/o M, heroine OD who has aspirated and been in a feotal posion up against a cupboard for several hours. HR170, B/P 60/40, GCS 5, Temp 37.9, RR 18 with fine exp. crackles, SP02 of 88% despite being oxygenated with 100% 02 and an ECG showing sinus tach with triplets of VEB's. You have not seen anything that indicates hyperkalaemia or rhabdomyolysis either ECG or physical finding but you lecturer is a sadist who likes to arm you with a bunch of readings about the association of drug overdose and rhabomyolysis to complicate your thinking before cooking up a scenario like this to test you out. Now i have already elected to go softly softly on the fluid because of the aspiration possibly neurogenic APO?? and unless there is a significant change in theri heart rate with 02 and fluid adrenaline is pretty much out of the question, but i still need to intubate him. The question is, would using suxamethonium with its hyperkalaemia contrindication be too much of a risk, considering you cant find a physical or ECG finding to back up your suspicion, other than the fact the patient has been hypotensive and immobile for several hours placing him at risk of rhabdo? I'll finish this off by saying that i also have sedate to intubate at my disposal (and it is what i have elected to proceed with)

Interesting, this question never bothered me until a couple of years ago. In fact, i used to borrow a line from "bringing out the dead" where cage's character answers "Lima beans on a pizza", so i changed it to "baked beans on a pizza" and they usually get the hint that i don't want to share it. If they don't get the hint, the next answer is "I don't want to talk about it" Some things are just for me.

In undergrad i was never able to find a method of study that worked very well for me, and now im in postgraduate study, i still cannot find a method that is repeatable, it annoys me to no end

Gets told by a friend that rosters rang the wife of a colleague who died 2 years ago and asked her if he is available for overtime puts in a stick of dynamite...

Yes you did, but i read islands post when i hit the reply button before i saw your post doc =) And its "vagina and hymen" =D

What about dirty little pneumonics to remember cranial nerves? Only pneumonic i ever remembered =D

I sued to remember which one was decorticate was because the posture was similar to catching a football as in decorticate = "caught it"

no mate, i wasnt a twinkle in dads eye until 83