#18HoursFilm

18 Hours is a Kenyan fictional film written & directed by Njue Kevin, produced by Ruguru Phoebe with Bill Jones Afwani. The film stars Nick Ndeda, Brian Ogola and Sue Wanjiru and follows a rookie paramedic who spends 18 hours in an ambulance for the life of a road crash victim who struggles to get admission into hospital.  Rocque Pictures partnered with Emergency Medicine Kenya Foundation and Chapter One on this project.

Management of Crush Injury/Syndrome

Crush syndrome is a life and limb-threatening condition that can occur as a result of entrapment of the extremities accompanied by extensive damage of a large muscle mass. It can develop following as little as 1 hour of entrapment. Effective medical care is required to reduce the risk of kidney damage, cardiac arrhythmia, and death. Management includes;

  • Fluids: IV fluid to provide 1L/h for 24 to 48 hours (depending on evacuation availability)
  • Equipment: ECG, laboratory tests for serum potassium and urine myoglobin, Foley catheter with graduated collection system, tourniquets
  • Medications: hyperkalemia
  • Manage Pain
  • Give Antibiotics
  • Continuous monitor with portable monitor; 15-minute to hourly vital signs, examination, urine output documented on flow sheet

 

Spinal Immobilization in Trauma Patients – The Facts

  • There is no high-level evidence that prehospital spinal immobilization positively impacts patient-oriented outcomes
    • Spinal Immobilization Does NOT Help Immobilize the Cervical Spine
    • Spinal Immobilization Does NOT Decrease Rates of Spinal Cord Injury
    • Spinal Immobilization Increases the Difficulty of Airway Management
    • Spinal Immobilization Can Cause Pressure Ulcers
    • Spinal Immobilization Changes the Physical Exam
    • Spinal Immobilization Worsens Pulmonary Function
    • Spinal Immobilization Increases Intracranial Pressure
  • There is no evidence that immobilizing awake, alert patients without deficits/complaints provides benefit
  • Selective spinal immobilization protocols can help identify patients at low risk for injury and avoid immobilization

 

Intraosseous Access 101

  • IO access provides rapid vascular access in a variety of emergency situations.
  • There are several types of IO devices that can be used.
  • The humeral site is generally the least painful and quickest to access
  • All resuscitation and anaesthetic drugs can be given via the IO route.
  • Fluids need to be administered under pressure.
  • All devices need to be monitored and a clear handover given.

 

9 Laws of Trauma

  1. “Any anomaly in your trauma patient is due to trauma, no matter how unlikely it may seem.”
  2. “Your trauma patient is bleeding to death until you prove otherwise. “
  3. “The only place an unstable trauma patient can go is to the OR.”
  4. “Even awake, alert, and stable patients die. And it hurts that much more when they do.”
  5. “A previously healthy child who is in arrest, or nearly so, is a victim of child abuse until proven otherwise.”
  6. “Always look at the image yourself.”
  7. “Your patient is at their healthiest as they roll in through the emergency department door”
  8. “Read the entire paper!”
  9. “Question everything!”