Top 10 Coffee and Cases Snippets from April 2023

  1. In infants, a blood pressure cuff can be used as an effective pelvic splint.

  2. Post-RSI sedation in paediatrics is cognitively challenging. Take the time to sense-check the dosing strategy you are using. The NETS calculator might be a useful resource if you are looking for one…but get familiar prior to using it on a job.

  3. Suspension trauma leads to orthostatic cardiac arrest – lots of case reports of patients dying after climbing accidents where they are suspended, but without apparent injury. Check out this paper.

  4. Grade IV view on DL/VL? Remember the option to insert blade deeply and slowly withdraw to see if the anatomy becomes clearer.

  5. In aneurysmal SAH patients, nimodipine reduces risk of delayed cerebral ischaemia. In general, this should not be withheld in the context of hypotension. It is safer to give the nimodipine and up-titrate vasopressors.

  6. Faced with a post-op patient with jaw wires requiring intubation? The wires can easily be removed with forceps. Grasp the wire and rotate twice. Watch this video.

  7. There are two approaches for retrieving the patient with an EVD in situ:
    – Keep the EVD open throughout the retrieval except during the immediate patient bed/stretcher transfers.
    – If turbulence/rough journey anticipated, consider leaving EVD closed and intermittently open (every three to five minutes).
    (**Might be worth re-reading the Neuroprotection Clinical Practice Standard)

  8. Movement of arms into crucifix position to facilitate thoracostomies may dislodge humeral intraosseous lines. Keeping the patient’s thumbs down (which internally rotates arm at the shoulder) may mitigate this. Watch this video.

  9. Agitated patient? Remember to use non-pharmacological strategies in the first instance:
    – Removing sources of confrontation (including police)
    – Treating the patient with respect
    – Managing pain
    – Taking the time to explain intentions and reasoning

  10. Don’t be completely reassured by the suspected inhalational burn patient who is asymptomatic. In this study 30% had pathologic findings on fibreoptic laryngoscopy despite no symptoms. However, we are probably intubating too many of these patients, even if symptomatic (also worth checking out this study).

Thanks for a great month of case discussion!
The C+C QI project team

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