Monthly Archives: October 2010

Evidence refutes ATLS shock classification

Posted on October 18, 2010 by Cliff Reid

I have always had a problem with the ATLS classification of hypovolaemic shock, and omit it from teaching as any clinical applicability and reproducibility seem to be entirely lost on me. I was therefore reassured to read that real physiological … Continue reading →

Posted in General PH&RM | Tagged ATLS, monitoring, shock, Trauma | Leave a comment

In-flight cooling after out-of-hospital cardiac arrest

Posted on October 17, 2010 by Cliff Reid

Aeromedical retrieval specialists in Scotland developed a simple, cheap, effective in-flight cooling protocol using intravenous (IV) cold Hartmann’s solution and chemical cooling packs. Fluids cooled in a fridge (4°C) were transported in an insulated cool box; the patient was sedated, … Continue reading →

Posted in General PH&RM | Tagged ALS, arrest, critical care, hypothermia, neuroprotection, retrieval | Leave a comment

Burr holes by emergency physicians

Posted on October 15, 2010 by Cliff Reid

Emergency physicians at Hennepin County Medical Centre (HCMC) are trained in skull trephination (drilling a burr hole) for patients with coma, anisocoria and epidural (extradural) haematoma (EDH) who have not responded to osmotic agents and hyperventilation. This may be particularly … Continue reading →

Posted in General PH&RM | Tagged CNS, neuroprotection, procedures, surgical, TBI, Trauma | 1 Comment

RCT of 7.5% saline in head injury

Posted on October 7, 2010 by Cliff Reid

Over a thousand patients in North America with blunt traumatic head injury and coma who did not have hypovolaemic shock were randomised to different fluids pre-hospital. 250 ml Hypertonic (7.5%) saline was compared with normal (0.9%) saline and hypertonic saline … Continue reading →

Posted in General PH&RM | Tagged fluid, neurology, neuroprotection, outcome, TBI, Trauma | 1 Comment

Two smaller lines may be quicker

Posted on October 5, 2010 by Cliff Reid

Using Poiseuille’s law and standardized gauge sizes, an 18-gauge (g) intravenous catheter (IV) should be 2.5 times faster than a 20-g IV, but this is not borne out by observation, in vitro testing, and manufacturer’s data. A nice simple study … Continue reading →

Posted in General PH&RM | Tagged fluid, vascular access | Leave a comment

Scoop minimises cervical movement

Posted on October 4, 2010 by Cliff Reid

A cadaveric study using a 3-dimensional electromagnetic tracking device to asses cervical motion compared the application of a scoop stretcher with two other manual transfer techniques, including log rolling onto an extrication (spine) board. The scoop method restricted cervical spine … Continue reading →

Posted in General PH&RM | Tagged pre-hospital, spine, splintage | Leave a comment

Pre-hospital cooling post arrest

Posted on October 1, 2010 by Cliff Reid

An Australian randomised controlled trial assessed the effect of pre-hospital cooling (using 2 litres ice cold Hartmann’s) of post-cardiac arrest patients on functional status at hospital discharge. The intervention group were marginally cooler on arrival but did not have improved … Continue reading →

Posted in General PH&RM | Tagged ACLS, arrest, critical care, hypothermia, outcome, pre-hospital | Leave a comment