"Out for blood" by Bill Hinckley 

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Category:general -- posted at: 2:19pm AEDT

Using a 1982 portable unit (ADR-4000), we could define, since 1985, a use of ultrasound devoted to the critically ill, different from the traditional one (radiological & cardiological). This technology was sufficient for making, at the bedside, a whole body approach, although a 1992 technology (Hitachi-405) was better for optic nerve assessment. Search for blood in trauma, inserting subclavian venous lines was a basis. The consideration of the lung (the main vital organ) allowed to change the rules of ultrasound. Lung ultrasound (in the critically ill: LUCI) showed its potential for not only allowing immediate diagnoses (pneumonia, pulmonary edema, pneumothorax and others), but mostly, associated to a simple venous approach, to simplify echocardiography. In the CEURF protocols, the heart analysis can be usually reduced to the right ventricle volume (the pericardium is apart). The potential of LUCI to show infra-clinical subtle signs of interstitial edema is the starting point of the FALLS-protocol for assessing a circulatory failure, providing this direct parameter of clinical volemia. The potential of LUCI to show the A-profile (ruling out pneumothorax) or the A’-profile (highly suggesting pneumothorax) is used in the SESAME-protocol, a very fast protocol in cardiac arrest assessment. The BLUE-protocol is a fast protocol assessing a respiratory failure, where only lungs and veins are on focus (the heart is not included). LUCI makes critical ultrasound a holistic discipline for all these reasons. LUCI shows its multifaceted potential from sophisticated ICUs to austere areas, from the elderly to the neonate, where the signs are the same, including ARDS in bariatric patients, and many less critical disciplines up to family medicine. A single, universal microconvex probe is used for our whole body approach. We do not use Doppler nor harmonics. The LUCIFLR project highly decreases medical irradiation. CEURF trains intensivists to this visual medicine since 1989

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Category:general -- posted at: 3:57pm AEDT

Emotion has a profound effect on decision-making. As scientists and rational beings, we like to believe that we can control our emotions and make good decisions regardless of the context in which those decisions must be executed -- The reality is, that's far from the truth. Furthermore, we rarely take the opportunity to deliberately examine how emotional valence can influence the choices we make, or how we sort and process information as clinicians. Simulation-based training often provokes strong emotions, both positive and negative, whether we intend it to or not. Sim may be an ideal tool for eliciting challenging emotions -- anger, fear, anxiety, joy, prejudice -- and developing skills to manage them in real time. Breathe, make better decisions.

In Day Two of the Learning from Sim series, the story continues as our patient transitions from the pre-hospital to the emergency department.

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Category:general -- posted at: 3:50pm AEDT

What is New York City style resuscitation? Reuben Strayer and Scott Weingart honed their chops in public hospitals in America’s largest city, where patients come from every country, speak every language, and manifest every physiologic derangement on earth. Preferring to ask neither permission nor forgiveness, Reuben and Scott have long challenged emergency medicine and critical care orthodoxy and developed lateral (though sometimes divergent) strategies in their approach to problems that arise in the care of the sometimes unwashed masses who tend to avoid presenting to medical attention until they’ve fallen off the Frank-Starling curve. Topics that may be discussed (or argued) include the use of epinephrine, the use of noninvasive ventilation, the management of recently intubated patients, the use of ketamine as an induction agent with and without a paralytic, and decision-making in badly injured trauma patients. Ad hominem attacks will be defined and probably employed. Though Weingart has a physical and intellectual disadvantage against the bigger, stronger, quicker, younger, and better-looking Strayer, these disparities will be muted by Natalie May’s capable moderation.

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Category:general -- posted at: 12:59am AEDT