Build Your Own Escharotomy Man!

To make your own escharotomy training model, you will need:

1. A thick foam yoga mat (red or pink). This one was $10 from K-Mart.

Yoga Mat

2. A roll of Cling Film (Glad Wrap). Glad wrap

3. A roll of thin packing foam — the sort of stuff your new TV comes wrapped in.

Foam padding

4. Some elastic bands.

Elastic Bands

5. Around 4-5 rolls of white Cloth Tape (similar to Gaffer tape but much cheaper).

Cloth tape

6. A pair of trauma shears

trauma shears

7. A resuscitation mannequin.

mannequins

 

Assembly Instructions

1. Cut the yoga mat into sections and wrap circumferentially around the torso and limbs of your mannequin. Wrap cling film firmly over the top to secure it in place. This red/pink layer represents the viable tissue beneath the eschar — i.e. the end-point of the escharotomy procedure.

red layer 1 red layer 2

2. Next, simulate subcutaneous tissue by adding 2-3 circumferential layers of packing foam to the torso and limbs. Elastic bands can be applied to the limbs to simulate constrictor bands.

fatty layer

3. Now for the most important part! Wrap white cloth tape circumferentially around the limbs and torso to simulate  eschar.

Wrapping 1

The tighter you can apply this layer, the better! The springy foam layers are now compressed by the restrictive tape and will spring apart when incised.

wrapping 2 wrapped

4. Your escharotomy man is now ready to use! For additional realism you can apply make-up or charcoal to simulate charring, or even lightly burn the top layer to produce an unpleasant burned smell.

burned man

5. The mannequin can now be used for simulation or practical skills teaching.

Tutees can be instructed to:

  • Draw their proposed escharotomy lines on the mannequin with a marker pen (e.g. Sharpie) to assess knowledge of correct escharotomy sites.
  • Cut with a scalpel down to viable tissue (the red / pink layer). The incision should spring open once the eschar is divided.
  • Run their fingers along the length of the wound to detect and individually divide any constrictor bands.
  • Dress the wounds (e.g. with cling film) post escharotomy.
escharotomy

Escharotomy Incision Sites

This model was trialled for the first time at our Sydney HEMS team induction and performed very well!

2014-08-06 16.02.26

2014-08-06 16.00.47

Of course, in real life the procedure is a little bloodier…

 

If anybody has a clever way to simulate active bleeding without completely destroying the mannequin then please let me know!

Escharotomy Man designed by Dr Ed Burns. Thanks to Dr Fergal McCourt for the escharotomy video. 

Further Reading

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CGD Flyer – Weds 27th August 2014

Here is the flyer for next week’s Clinical Governance Day. 

CGD Flyer (1)

Please note that as the training building is currently being refurbished, the CGD will instead be held in the conference room in the main office building (“The Castle”). 

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Is lamotrigine ketamine’s black swan?

black-swan-8288_1920.jpgThe black swan theory describes rare events beyond the realm of normal expectation. We use ketamine on a daily basis, but are there any circumstances in which ketamine simply will NOT work?

This interesting case report by an Ex-Sydney HEMS physician Daniel Kornhall describes how ketamine failed completely as an anaesthetic agent in a psychiatric patient with a toxic lamotrigine overdose.

***SCIENCE ALERT***

Lamotrigine, as we all obviously know, exerts its antiepileptic effect by inhibiting presynaptic sodium channels thus reducing the release of the excitatory glutamate and stabilising excitable neuronal membranes. Ketamine’s dissociative anaesthetic effects are a bit more of a mystery and diverse, but they are thought to involve increasing glutamate release through non-NMDA receptor pathways. It therefore follows, that if one drug prevents the release of glutamate and second drugs effects depend on its release, the second drug will not work.

With our high volume of ketamine use, incidents such as this are worth bearing in mind the next time you see a patient with a mixed polypharmacy overdose.

Lamotrigine is therefore ketamine’s black swan.


Kornhall D, Nielsen EW. Failure of ketamine anesthesia in a patient with lamotrigine overdose. Case Rep Crit Care. 2014;2014:916360. Full Text Article

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Selective Aortic Arch Perfusion

Fascinating talk on the development of this resuscitative technology by Dr Jim Manning who appeared in person at our Clinical Governance Day.

 

For further information check out EMCrit Podcast Episode 123

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Developing EM in Brazil is coming soon

DevEM2014
Several of our consultants are presenting at the Developing EM conference in Brazil.  If you’d like to hear more, organising emergency physicians and prehospital & retrieval medicine consultants Mark Newcombe and Lee Fineberg describe it and also discuss the highly successful Developing EM conference they ran last year in Cuba:

 

Check out the program and register here

 

The project is a not-for-profit venture and no SydneyHEMS specialist receives financial remuneration for involvement in the DevelopingEM conference.

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NSW Ambulance Radio Codes

With new team members about to join us, it’s worth revisiting some of the radio terminology used.

The most important one to know is Code 1 – “Officer in trouble requires Police”.

Here are some others we commonly hear, both on the radio and in conversation at the base. Read the sentences and see if you can guess what they mean. Answers at foot of post.

“What is the ETA for the helicopter? The patient is now Code 2″

“Helicopter can stand down, patient is code 4″

“What’s his GCS now? I’ll put in a code 3″

“They’re sending us to an adult female code 9″

For a full list check out the New South Wales paragraph on the Wikipedia page

 

 

 

 

 

 

Answers – turn your computer upside down to read.

codes

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Clinical Governance Day 30th July 2014

 
CGD Flyer (5)
 

See here for directions

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