Howie shows us the tools in his toolkit:

  • Tourniquets save lives and do not cause limb ischaemia. The aorta is clamped for many hours in cardiac surgery. Data from the battlefield showed that in >800 cases where tourniquets were applied, there were 3 adverse outcomes (loss of sensation in the distal fingertips).
  • Haemorrhage control (Israeli) bandages are tourniquets with a haemostatic agent that can be applied to a bleeding wound
  • QuickClot (haemostatic powder) can be used for abdominal wounds but may draw the ire of surgeons because they cause an exothermic reaction that burns surrounding tissue.

Howie emphasises that not all bleeding have to be stopped - if it’s not pouring out, it can wait. He teaches us to quantify blood loss in the field - three 335 mL cans of soda worth is when to start worrying.

The talk ends with an interesting mini Q&A session as trauma surgeons and paediatricians also weigh into the debate.

Direct download: How_to_Stop_Bleeding_Without_a_Hospital_Howie_Mell.mp3
Category:general -- posted at: 4:30am AEST

Airway management induces stress and fear in the heart of many Critical Care practitioners. In a high pressure situation, it’s easy to falter on the see-saw of demand vs. ability. Rich argues that in difficult airway management, we are hindered by: complex algorithms, anecdotal expertise and the negative perception of the task as ‘undoable’ and the downplaying of our abilities. In crisis, we need simple!

Rich discusses the need to redefine the priorities of the airway (away from ‘find the vocal cords/cricothyroid membrane’), incrementalisation and consensus of method. Rich also briefly discusses the future of airway management - nasal oxygenation and the need to move past the surgical airway as a failed airway.

Direct download: Day_3_C27_Rich_Levitan.mp3
Category:general -- posted at: 3:00pm AEST