Mistakes that Kill during Cardiopulmonary Resuscitation
Too Slow or Too Fast Chest Compressions
Too Shallow or Too Deep Chest Compressions
Too Many or Too Slow Breaths
Leaning on the Chest
Too Many Interruptions
Giving Up Too Soon
Too Slow Adaptation
Oxygen Bubble Bottles or Bacteria Swimming Pools?
Humidified oxygen is widely administered in hospitals and EMS vehicles and this is presumed to alleviate nasal and oral discomfort in the non-intubated patient. Humidification of supplemental oxygen is commonly delivered by bubbling oxygen through either cold or warm sterile water before it reaches the patient. However, the effect on patient comfort is negligible. Bubble humidifiers may, however, represent an infection hazard and should not be used.
Anaesthesia, Trauma & Critical Care
WHO Emergency and Trauma Care e-Learning Training Course
A modular e-learning course that can easily be accessed by medical providers in an effort to improve emergency trauma care. Give it a try.
Guillain Barré Syndrome (GBS)
Surviving Sepsis Guidelines 2016: Recommendations and Best Practice Statements
Treatment of Helicobacter pylori Infection
2017 American Diabetes Association Standards of Medical Care in Diabetes
I am an Emergency Department doctor…I make mistakes
The Health Act 2017 – Emergency Care
Thank you for all the support in 2017. We look forward to providing you with even greater emergency care content in 2018. From all of us at the Emergency Medicine Kenya Foundation, HAPPY NEW YEAR!
7. Sepsis Six in 60 Minutes: World Sepsis Day – September 13th
NEW SEPSIS PATHWAY
…for every hour you delay, the patient has a 33% increased risk of death!
6. Did you know about the RULE OF TENS for Fluid Resuscitation in Burns?
Burns Rule of TENS:
1. Estimate burn size (TBSA) to the nearest 10%.
2. Multiply %TBSA x 10 = Initial fluid rate in mL/hr (for adult patients weighing 40 kg to 80 kg).
3. For every 10 kg above 80 kg add 100 mL/hr to the rate.
5. New 2015 Resuscitation Guidelines Compedium
4. LFTs explained
LFTs = ‘hepatocellular’ or ‘cholestatic’ arrangement based on the pattern of elevation.
Hepatocellular pattern = transaminases > ALK
ALT is generally considered to be more specific to liver damage
Magnitude of aminotransferase elevation => guide initial diagnosis: mild (<5x), moderate (5-10x), or marked elevation (>10x)
Mild = NAFLD, Drug Induced Liver Injury, Alcohol-Induced Liver Injury
Severe = Acute Viral Hepatitis, Ischemic Injury, Acetaminophen Toxicity
3. The GCS is out-of-stock
Contrary to common belief, The Glasgow Coma Scale (GCS) is NEVER out-of-stock and the lowest score possible is 3.
An intubated patient still gets 1 point for verbal meaning they score 3T…there is nothing like a 2T score (at least not in human beings)
The phrase ‘GCS of 11’ is essentially meaningless, and it is important to break the figure down into its components, such as E3V3M5 = GCS 11.
The Scale was described in 1974 by Graham Teasdale and Bryan Jennett (Assessment of coma and impaired consciousness. A practical scale. Lancet 1974; 2:81-4.) and is the most reference paper in medical literature
2. Nairobi Accident Hotspots
The most dangerous time to walk on Nairobi’s streets is on a Friday, around 7am, particularly along Mombasa Road.
1. Salter-Harris Fracture (remember the mnemonic SALTR)
Slipped (i.e., through growth plate and not involving bone) / Type I
Above growth plate (i.e., through metaphysis) / Type II (most common)
Lower growth plate (i.e., through epiphysis) / Type III
Through (i.e., through metaphysis growth plate and epiphysis) / Type IV
Rammed (i.e., Crush injury) / Type V (worst prognosis)
When you’re rushed to an emergency room, the doctors immediately order a battery of tests to figure out what’s wrong. But while scans and blood draws can tell them an incredible amount about what’s ailing you and the best treatment you should get, study after study shows that all of this testing isn’t actually leading to better care.
The most important step in managing a bleeding trauma patient is surgical source control – most patients with massive hemorrhage need an operation to stay the hemorrhage. The state in which a patient arrives to the operating room or the intensive care unit – alive or near death, cold and coagulopathic or warm and well perfused – is up to you.
Excessive crystalloid administration is associated with hypothermia, coagulopathy and death in bleeding patients. If you think your patient is bleeding and you have ready access to blood products, you can skip crystalloid all together and go straight for the good stuff.
Trauma patients don’t just bleed red blood cells. They lose plasma, platelets and clotting factors, too. Give blood products (red cells, plasma, platelets) in a balanced 1:1:1 ratio (to mimic whole blood) or give whole blood.
Tranexamic acid (TXA) is an anti-fibrinolytic agent that can/should be used early in the resuscitation of bleeding trauma patients. 1gm of TXA given as an early bolus followed by an infusion of 1gm over the ensuing 8 hours has been associated with an absolute risk reduction of 1.5%.
If you resuscitate based a trauma patient based on vital signs alone, you will under-resuscitate about 50% of trauma patients. The foley catheter is an essential adjunct during massive resuscitation. If your patient is making urine at a rate of > 50ml/h, your resuscitative efforts are probably adequate.