5 thoughts on “Resus.ME! Podcast June 2012”

  1. Boys…….. not bad…
    Brillant idea… from the closet.. we all have cases that we will forever remember, and cases that changes our clinical life…
    Sharing that is great… And Karel, a fab case, that emphasises the need for prehospital WELL SKILLED physicians with the RIGHT attitude… ie: achieve CLINICAL EXCELLENCE…
    One way forward is training training and more training….

  2. Excellent stuff guys! I now understand why you have forged GSAHEMS into the most awesome looking training on Earth for prehospital medicine.
    Absolutely driven. love it!

  3. Thanks Cliff and Karel.

    Great and amazingly educational case. Not seen such a severe traumatic asphyxiation/SVC congestion. One I saw (in hospital) was not nearly as dramatic but did have this lovely plethoric look with petechial haemorrhages but chest injuries were his main issue.

    My main question is if I could hypothetically change the scenario and say in fact what you couldn’t see below the chest was a crushed and mangled pelvis and lower limbs. Given you couldn’t easily assess or let’s make it easier and say it was obviously the case. I noticed the concerns regarding excess fluid administration prehospitally. Is this not the exception (along with maybe burns) that proves the rule in regards to restrictive fluid administration and haemostatic resuscitation? Say he didn’t need an immediate surgical airway and you were setting up your kit dump for extrication what would you have ready? RSI, thoracostomies, CACL, HCO3-, fluids or some other good examples of fairy dust? This leads on to should abdo/pelvis/lower limb crush patients be fluid preloaded for extrication ‘crash’ and to avoid later morbidity (rhabdo/AKI)? If so how much is enough in terms of end points prior to extrication? I look forward to your thoughts Cliff.

    Thanks for the podcast and allowing as to learn from other peoples cases. The only tragedy is not that this could happen, but that it could happen again to another person without these kind of frank discussions.

    Pete

  4. Wow. Just got home from driving back from Perth and needed to post.

    Cliff and Karel thank you for your honesty. I got a clinical chill as I drove home.

    As Dr’s and more specifically those who deal with life and death in critical care we learn from death and near misses.

    Listening to Karel recount that unfortunate case highlighted those cases in my closet that have made me more obsessive and thorough when others are saying “she’ll be right mate”. Furthermore I have peripherally been involved in and heard of some clinical disasters which have changed my practice.

    Thanks guys for the encouragement to drive for clinical excellence as a Rural GP.

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