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This presentation by retrievalist/anaesthetist/intensivist Dr Clare Hayes-Bradley summarises recent Sydney HEMS research into optimal preoxygenation techniques prior to rapid sequence induction.
1. Hayes-Bradley C, Lewis A, Burns B, Miller M. Efficacy of Nasal Cannula Oxygen as a Preoxygenation Adjunct in Emergency Airway Management. Ann Emerg Med. 2016 Aug;68(2):174–80.
2. Hayes-Bradley C, McQuade D, Miller M. Preoxygenation via a non-rebreather mask comparing a standard oxygen flowmeter rate of 15 Lpm to maximally open. Emerg Med Australas. 2017 Jun;29(3):372.
3. McQuade D, Miller MR, Hayes-Bradley C. Addition of Nasal Cannula Can Either Impair or Enhance Preoxygenation With a Bag Valve Mask: A Randomized Crossover Design Study Comparing Oxygen Flow Rates. Anesth Analg. 2017 Jul 26.
Lin Hu gave an excellent review of the above article. Key points from his talk are:
Echocardiography was used to identify parameters that may correlate with poor patient outcome – namely mortality within 30 days or the need for rescue thrombolytic therapy. It was found a TAPSE (tricuspid valve systolic plane excursion) of <16mm, and a RV/LV end-diastolic diameter ratio of >0.9 correlated with increased risk of death or requiring thrombolysis.
In summary – a TAPSE is an easy to attain parameter, that may hold value in stratification and prognostication for haemodynamically stable patients presenting with acute PE, and guide consideration of early thrombolytic therapy.
Phil Holker gave a hair raising presentation on snake bites. The most venomous snakes in the world reside in Australia. Venom generally exerts its effect through either neurotoxicity, myotoxicity or coagulopathy.
Pre-hospital management involves keeping the patient calm and still. The injured limb must be splinted and a Pressure Immobilisation Bandage (PIB) applied to compress the lymphatic system and prevent systemic spread of the venom. The idea is not to restrict circulation. Rapid transport to an ICU equipped hospital is essential.
Significant signs of envenomation include clinical signs of paralysis or bleeding or significant coagulopathy (INR >1.3). This would indicate treatment with antivenin following discussion with a clinical toxicologist, as well as resuscitative and supportive measures (such as intubation). Antivenin (particularly polyvalent) carries significant risk of anaphylaxis. Identification of the snake from photographs or VDK testing in hospital may allow univalent antivenin to be used instead, with reduced risks. Do NOT attempt to catch or transport a snake, dead or alive.
Chris Partyka, Jimmy Bliss, and Carrie McQuarrie supervised ultrasound scans on volunteers with real pathology to review techniques for eFAST and advanced cardiac scanning. Afterwards Chris presented a series of ultrasound cases to review advanced scan image interpretation.
Intra-aortic Balloon Pump Training
Fergal McCourt reviewed the use of the Mcquet for transfers of patients on intra-aortic balloon pumps. All of the learning materials are available in video format on the VLE. There is also a link on paramedic ipad for easy review on route to the patient.