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Archive for March 2010

Basic life support and resuscitation

Basic Life Support from resustv.com on Vimeo.

Basic Life Support from resustv.com on Vimeo.

This is a little video we did a while ago for the medical students and gives them a practical approach to an arrest scenario. Bad acting aside, it does the job.(As many should notice, the only thing we don’t do first is give the initial 2 breaths).
The video takes a few seconds to start.

Basic Life Support is a key skill for all of us. I mean for ALL of us. In Emergency medicine we resuscitate often and so we almost take it for granted that we know this material. If you are a General Practitioner, a healthcare practitioner of any sort, be it surgeon or physician, you need to know this. If you are a nurse, you need to know this. Those of you who are not medical practitioners, but may be dental practitioners or even that subgroup that undertakes sedation of patients, you need to know this!

In medicine, whether you see oncology patients every day, take out gallbladders, or provide family medicine, it is expected of all of us and we must expect it of ourselves, that we know this stuff backwards. We must know the basics of resuscitation.

Just when you were getting it, ILCOR will bring out something new this year. Odds are that the number of compressions to breaths will again increase, highlighting the importance of chest compression and maintenance of coronary perfusion pressure. In fact, I’ll stick my neck out and say that airway will take […]

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Designing the perfect emergency department

screen-shot-2010-03-20-at-60903-pmDesigning Emergency Departments is challenging. This is purely because emergency medicine is a young specialty and still in a state of flux. We are trying new things all the time to improve performance and efficiency. We add paediatric waiting rooms and short stay units and ‘fast track’ areas and streaming. When all is said and done, is there such a thing as the perfect emergency department? Probably not, but we can get very close.

I’ve had the privilege of designing emergency departments now for some 15 years and in more than one country. You can’t keep doing something for that long and not notice what works. There are patterns. As they say ‘success leaves clues’. I’ve noticed that there are some essential aspects[…]

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The LEMON approach for predicting the difficult airway

The 3:3:2 Rule for predicting The Difficult Airway from resustv.com on Vimeo.

www.resustv.com is coming in late APRIL 2010- videos of lectures on all of acute medicine

The L.E.M.O.N. approach is just that, an approach to predicting the potentially difficult airway. It is a way of adding some measurable parameters to what should become a ‘gestault’ approach, where you know, or have a ‘vibe’, a feeling, call it what you will, about the relative ease or difficulty of any airway.

This gestault is usually gained following years of experience. BUT it can be taught.

The LEMON rule allows us to remember to look externally and to look at those parameters that will make the intubation simple or difficult.

LEMON stands for:[…]

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The BURP, the Sellick and the bimanual – which is better?



Which is better? BURP or Bimanual. Is Cricoid Pressure of any use?

Sellick described cricoid pressure in 1961. How useful is it? Well its purpose is to minimise the passive movement of gastric contents into the oropharynx and the potential aspiration of those contents, during rapid sequence intubation. How good is it? I was recently asked this at an Airway Workshop and I had to say for what we have, it’s pretty good. BUT the evidence is not that great!

In fact some of the newer evidence now says, it may be detrimental a […]

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Advanced Airway Course at Albury Wodonga


Thanks to Alex Swain Director of Wodonga Emergency for inviting us up to Albury Wodonga to give an Advanced Airway Workshop. It was a great day and everyone played all out. It was a real treat to see the layered approach of teaching kick in and by the end of the day everyone could tube every manikin repeatedly…..even the famous manikin(dubbed this over several workshops) ‘Mr Evil’.[…]

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Syncope

This is one of my favourite areas, as patients present very frequently with this symptom. That very fact makes syncope a challenge. It is a symptom, not a condition in itself. We have to find the cause of the syncope. We need to be experts in this area as syncope presents some 5% of all emergency department visits and comprises 6-10% of admissions[…]

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