During simulated cardiac arrest resuscitations, a comparision was made between those run by teams that had had time to form before the arrest, and those that had to be assembled ad hoc after the arrest occurred. 99 teams of three doctors, including GPs and hospital physicians were studied. ACLS algorithms were less closely followed in the ad hoc formed teams, with more delays to therapies such as defibrillation. Analysis of voice recordings revealed the ad hoc teams to make fewer leadership utterances (eg. ‘we should defibrillate’ or ‘the next countershock will be 360J’) and more reflective utterances (eg. ‘what should we do next?’). The authors suggest that team building is therefore to be regarded as an additional task imposed on teams formed ad hoc during CPR that may substantially impact on outcome. No surprise to those of us who banned ‘cardiac arrest teams’ from our emergency department resuscitation rooms many years ago!
Hands-on time during cardiopulmonary resuscitation is affected by the process of teambuilding: a prospective randomised simulator-based trial
BMC Emerg Med. 2009 Feb 14;9:3
http://www.ncbi.nlm.nih.gov/pubmed/19216796
Full text at http://www.biomedcentral.com/1471-227X/9/3
Category Archives: PHARM
Prehospital and Retrieval Medicine
Population density & use of ambulance services
Does ambulance use differ between geographic areas? A survey of ambulance use in sparsely and densely populated areas
A lower use of emergency department health care services by rural residents as compared with urban residents has previously been described. This Swedish study examined the use of ambulance services in relation to geography, showing that patients from sparsely populated areas were sicker. required more treatment, and were assessed as not needing prehospital care less than half as often as their urban counterparts (16% vs 39%). Take home message is that population density is related to inappropriate use of ambulance services.
Am J Emerg Med. 2009 Feb;27(2):202-11
http://www.ncbi.nlm.nih.gov/pubmed/19371529
72000 retrievals by Flying Doctors
Over twelve years in Queensland the RFDS undertook over 72000 fixed wing retrievals, including over 4000 critically ill patients. Trauma was the commonest diagnostic category. There were only 90 primary retrievals, from locations without healthcare facilities – less than one per month on average. This fascinating service covers vast distances, low population density, and a high number of indigenous people.
Aeromedical retrieval for critical clinical conditions: 12 years of experience with the Royal Flying Doctor Service, Queensland, Australia
J Emerg Med. 2009 May;36(4):363-8
http://www.ncbi.nlm.nih.gov/pubmed/18814993
Tibial vs humeral intraosseous approaches
An observational, prospective study comparing tibial and humeral intraosseous access using the EZ-IO
Emergency physicians at Singapore General Hospital found flow rates to be similar when comparing the tibia with the humerus as sites for adult IO access. The EZ-IO had a very high insertion success rate. It took about 12 minutes to infuse a litre of saline, which drops to about 6 minutes if a pressure bag is used.
Am J Emerg Med. 2009 Jan;27(1):8-15
http://www.ncbi.nlm.nih.gov/pubmed/19041528
Prehospital airway equipment on UK HEMS
Prehospital airway management on rescue helicopters in the United Kingdom
26 of 27 identified UK rescue helicopter bases responded to a questionnaire sent by German anaesthesiologists on the airway equipment they carried. The take home message is that there were some important gaps: not all carried equipment for establishing a surgical airway and not all had a means of capnometry. Pull your socks up guys the Germans are watching.
Anaesthesia. 2009 Jun;64(6):625-31
http://www.ncbi.nlm.nih.gov/pubmed/19453316
Trauma scissors vs the Rescue Hook
Trauma scissors vs the Rescue Hook, exposing a simulated patient: a pilot study
American military investigators compared traditional trauma scissors with the ‘rescue hook’ (a hooked knife with the cutting edge on the inside of the hook) in rapidly removing the clothes from a simulated casualty. An army desert combat uniform and boots were removed more quickly with the rescue hook, which was favoured by the combat medics employed in the study. We don’t have data on how it would work on denim, leather, or belts, but it looks pretty good. I just want to know if it’ll go through a sternum before I trade in my trauma scissors.
J Emerg Med. 2009 Apr;36(3):232-5
http://www.ncbi.nlm.nih.gov/pubmed/18155382
Fluid Flow Through Intravenous Cannulae
Published flow rates for cannulae are derived from a test in which fluid runs through a perfectly straight cannula into an open receptacle. Laminar flow is expected in such a model in which the Hagen-Poisseuille formula tells us that flow is proportional to the fourth power of the radius. In this study manufacturers’ published flow rates were compared with an artifical vein model. Hartmann’s flowed faster than Gelofusine. For all cannulas flow was less than the manufacturers’ published rates. Although the radius was the biggest determinant of flow rate, the fourth power could not be used, suggesting a mixture of laminar and turbulent flow. The addition of pressurised infusions increased the flow rate with increasing pressure. Although the vein model used has limitations, and many other factors may influence flow rate in the clinical setting, the authors’ conclusions are helpful:
While the effect of radius is less than commonly believed, it is still important. However, clinicians should be aware of the limitations of increasing radius and use other strategies to increase flow when needed. These could include use of pressure, choice of fluid to be infused, and using multiple cannulae in parallel.
Fluid flow through intravenous cannulae in a clinical model
Anesth Analg. 2009 Apr;108(4):1198-202
High BMI and frontal crashes
In adult patients injured in front impact motor vehicle collisions, the outcomes of obese patients with a Body Mass Index greater than 30 kg/m2 was compared with those less than 30 kg/m2. Obese patients were more likely to suffer a severe head injury from a frontal collision.
J Trauma. 2009 Mar;66(3):727-9
Traumatic Brain Injury After Frontal Crashes: Relationship With Body Mass Index
ETCO2 all over the place in trauma
In 180 intubated trauma patients in the ED, there was little correlation between arterial carbon dioxide tension (PaCO2) and end-tidal carbon dioxide levels (ETCO2) (R2 = 0.277). In fact, in those patients ventilated to the ‘normal range’ of 35-40 mmHg (4.6-5.2 kPa), PaCO2 was over 50 mmHg 30% of the time. Slightly reassuring that in isolated brain injury the correlation was better (r2 = 0.52)
The Utility of Early End-Tidal Capnography in Monitoring Ventilation Status After Severe Injury
J Trauma. 2009 Jan;66(1):26-31
Passenger Compartment Intrusion and Kids
The presence and degree of compartment intrusion (from crash investigation data) was correlated with the likelihood of serious injury in 880 children from age 0-15 years, and odds for presence of serious injury increased for each centimetre of compartment intrusion.
Passenger Compartment Intrusion as a Predictor of Significant Injury for Children in Motor Vehicle Crashes
J Trauma. 2009 Feb;66(2):504-7