Top 10 C+C Snippets from the last month: 

1. Time for re-attachment of a limb is longer than you might expect! The severed limb can be viable for up to 12 hours. 

2. Guidance for amputated parts: 

– Rinse with saline and cover with saline-soaked dressing 

– Place in an airtight bag and place this bag in a 1:3 ice:water slurry 

– Avoid direct contact with ice 

3. Don’t forget to register to be a GoodSAM responder. Sign-up page can be found here. 

4. Record cine loop during cardiac arrest to review echo images. The COACHRED protocol for incorporating focused echo into the rhythm check can be found here. 

5. In low perfusion states expect to wait more than 60 seconds for paralysis to work. 

6. Penetrating neck injury with hard signs (e.g. arterial/brisk bleed, massive surgical emphysema, air bubbling through wound) – Prehospital RSI almost certainly required. Hard and soft signs of penetrating neck injury can be found here. 

7. Penetrating neck injury is one of the few trauma scenarios where femoral CVC placement is appropriate. 

8. Nasendoscopy for prognosticating airway burns: 

– Topicalise nose and throat with co-phenylcaine spray 

– Use NPA for scope passage 

– Can leave NPA in (if tolerated) for subsequent scopes 

9. Morbidly obese patient with challenging IV access? Consider subclavian CVC option. 

10. Neonatal life support – the heart rate of a newborn baby is best judged by listening with a stethoscope. 

C+C Update 

• Robbie has done an incredible job developing the C+C QI project over the last year. He has recently headed back to the UK / Spain for the next adventure so Tom will be taking on the role of C+C lead registrar. 

• Check out the Sydney HEMS blog to read all about how the C+C project started and how far we’ve come. And listen to the HEMS Debrief podcast with Robbie and Sam to hear about the project. 

 Thanks for another great month of C+C! 

Dr Tom Brown, on behalf of the C+C team