Category Archives: Video


Humeral Intraosseous – Stay In & Stay Straight

This video shows the mechanism for dislodgement and deformation of humeral intraosseous needles and how to avoid this.

In summary, if you need to abduct the arm (eg. for thoracostomy), keep the thumbs down (ie. have the arm internally rotated at the shoulder). Otherwise the IO catheter may bend or fall out.

References:
1. Pasley J, Miller CHT, DuBose JJ, Shackelford SA, Fang R, Boswell K, et al. Intraosseous infusion rates under high pressure. Journal of Trauma and Acute Care Surgery. 2015 Feb;78(2):295–9.
2. Paxton JH, Knuth TE, Klausner HA. Proximal Humerus Intraosseous Infusion: A Preferred Emergency Venous Access. The Journal of Trauma: Injury, Infection, and Critical Care. 2009 Sep;67(3):606–11.
3. Cho Y, You Y, Park JS, Min JH, Yoo I, Jeong W, et al. Comparison of right and left ventricular enhancement times using a microbubble contrast agent between proximal humeral intraosseous access and brachial intravenous access during cardiopulmonary resuscitation in adults. Resuscitation. 2018 Aug;129:90–3.
4. Knuth TE, Paxton JH, Myers D. Intraosseous Injection of Iodinated Computed Tomography Contrast Agent in an Adult Blunt Trauma Patient. Ann Emerg Med. 2011 Apr;57(4):382–6.
5. Mitra B, Fitzgerald MC, Olaussen A, Thaveenthiran P, Bade-Boon J, Martin K, et al. Cruciform position for trauma resuscitation. Emerg Med Australas. 2017 Apr;29(2):252–3.
6. Reid C, Healy G, Burns B, Habig K. Potential complication of the cruciform trauma  position. Emergency Medicine Australasia. 2017 Apr 27;29:252.
7. Reid C, Fogg T, Healy G. Deformation of a humeral intraosseous catheter due to positioning for thoracostomy. Clin Exp Emerg Med. 2018 Sep;5(3):208–9.

Understanding Elevated Lactate

I find clinicians are quick to consider sepsis and hypoperfusion/ischaemia as causes of a raised lactate, but slow to include other causes in their differential.

Although an elevated lactate has been shown to be associated with worse outcomes in numerous studies, not all causes of a raised lactate are sinister. It’s therefore important to diagnose the cause both to allow the right treatment and to avoid assuming an inappropriately poor prognosis.

This 12 minute video offers an approach to diagnosing the cause of elevated lactate based on an understanding of lactate physiology using a simple visual aid – a ‘lactate map’ and a memorable acronym.

Reference
1. Reid C, Rees V, Collyer-Merritt H. Non-septic hyperlactataemia in the emergency department. Emerg Med J. 2010 May;27(5):411–2

Advice To A Young Resuscitationist

Advice-to-Young-Resuscitationist

This talk was the opening plenary given at smacc Chicago. The title they gave me was ‘Advice To A Young Resuscitationist. It’s Up To Us To Save The World‘ but I ditched the last half because, as I point out later in the talk, I don’t think it is up to us to save the whole World. Some AV muppetry at the conference centre prevented the smacc team from being able to include the slides, so I’ll post those too at some point. You can hear the talk as a podcast at the ICN or on iTunes

The references for the talk are here