Never remove a central line from an upright patient - only supine.
Estimates of 1 air embolism death / day worldwide from this
Tell everyone who you think might not know this
Excellent video from @patientsafe3 on how safety challenges can be addressed.
Save the date!
Our next Resuscitology Course will be on the 15th-16th November 2018 in Sydney, at a coastal venue.
We'll allow a few more registrations on the Resuscitology course in the Blue Mountains before we hit the 'Closed' button.
And some good news - we're extending the early bird discount so you can finish your Easter eggs!
Resuscitology – The Art and Science of Resuscitation course is accredited for 14.5 ACEM CPD hours.
But even if it wasn't - you'd want to be there
@resuscitology @Paul_Wischmeyer In fact in LMICs the best option for ALL is simple adrenaline. No evidence on recent RCTs that it is any worse than NA and far superior to Dobut or Dop. We use only that and don't see patients dying at a rate of knots.
How do you select the right vasoactive drug for shock patients in the ED?
Would you use noradrenaline (norepinephrine) first line in cardiogenic shock?
There are evidence based guidelines...
Participants in the 9-10 May 2018 Resuscitology Course have already started submitting their tough resus cases for discussion. Powerful learning points in clinical, human factors, and systems domains. It’s going to be an empowering and educational two days
@resuscitology @HawkmoonHEMS @RAGEpodcast @_NMay @precordialthump @karelhabig A serious collection of brain power, clinical experience and teaching talent! Very tempting!!
Are you using arterial lines during CPR?
Targeting coronary perfusion pressure (or diastolic BP) is supported by animal and human data and an AHA consensus.
Aim for DBP >25 mmHg
Traditional teaching was that atropine doses < 100 mcg causes bradycardia in young infants. This had no evidence base and has seen been rebutted
A quick way to consider causes of PEA arrest (or severe hypotension) is to consider: Volume - Pump - Obstruction, and then 3 causes of obstruction (tamponade, tension pneumothorax, massive PE). This is the '3 plus 3 rule'.
Although fever in patients with other acute brain pathologies (eg stroke, traumatic brain injury) should be avoided, it might be beneficial in CNS infection, & aggressive temperature reduction might be harmful
Description of the type of cases we'll analyse on the Resuscitology Course, by @cliffreid
Course info at https://t.co/1R51NE43ub
Traumatic cardiac arrest should not be seen as universally fatal or treated with nihilism. Civilian studies show survival rates of around 7-8%, and in some military studies >10%
Our earlier Tweet linked to an article that referred to central venous gases vs ABGs
Most of the work on peripheral VBGs is by @kellyam_jec
See https://t.co/4GO1zmVm0S… (thanks @broomedocs ) and https://t.co/5RHSZjKHlz
In life-threatening postpartum haemorrhage consider intrauterine balloon tamponade as an adjunct to other measures.
In the Emergency Department without dedicated uterine balloon devices, a Sengstaken–Blakemore tube or even condom catheter can be used.
Even in hypotensive patients, venous blood gases provide pH, bicarb, base excess & lactate levels that are close enough to arterial values to be clinically useful.
No need to puncture an artery acutely other than for invasive blood pressure monitoring.