Specialised chemical burns

Certain chemical burns require a little extra thought than just irrigation and good wound care – which may even be contraindicated. An article in The Journal of Emergency Medicine addresses these, and some of the points are summarised below, with some additional information from Toxbase: Hot tar (bitumen) Immerse contaminated area in cool water until … Continue reading Specialised chemical burns

London Calling – part 2

Notes from Days 2 & 3 of the London Trauma Conference Day 2 of the LTC was really good. There were some cracking speakers who clearly had the ‘gift’ when it comes to entertaining the audience. No death by PowerPoint here (although it seems Keynote is now the presentation software of choice!). The theme of … Continue reading London Calling – part 2

Not just in ARDS

A ‘lung protective’ ventilation strategy that includes low tidal volumes has been shown to improve outcomes in patients with ARDS. Many also advocate it as sensible practice for any ventilated patient as a means of minimising the chances of ventilator-induced lung injury and hopefully improving outcome. A recent meta-analysis provides further evidence to support that … Continue reading Not just in ARDS

What's with all the chloride? An assault on salt

I continue to be bewildered at my ED colleagues’ overwhelming preference for 0.9% saline as a resuscitation fluid regardless of clinical presentation. However, I have to acknowledge a lack of robust high level clinical evidence demonstrating its relative harm compared with more balanced solutions such as Hartmann’s / Ringer’s lactate or one of the more … Continue reading What's with all the chloride? An assault on salt

Treating sepsis – have we got it the wrong way round?

In our understanding of the pathophysiology of sepsis, we often attribute organ damage and death to the excessive host response to infection, including the popular phrase ‘cytokine storm’. This has been nicely described as ‘friendly fire’ by Prof Derek Angus, who points out that this central tenet of sepsis understanding may in some cases be … Continue reading Treating sepsis – have we got it the wrong way round?

Fluids contribute to acid-base disturbance on ICU

I enjoyed a paper from Critical Care Medicine this month which relates to a major bugbear of mine: the prescription of 0.9% saline for critically ill patients and the consequent metabolic acidosis this causes. However it did produce some interesting findings that helped me review my own biases here. In short, an ICU team decided … Continue reading Fluids contribute to acid-base disturbance on ICU

'Cryptic shock' important but not always very cryptic

Patients with severe sepsis and an elevated lactate who appear to be normotensive had a mortality similar to those presenting with hypotension. This is demonstrated in a new study on patients who were recruited to a study I have reported before. The so-called ‘cryptic shock’ group was defined by a systolic BP of at least … Continue reading 'Cryptic shock' important but not always very cryptic

Nasal cooling method

More data on the RhinoChill device from an in-hospital study of post-cardiac arrest patients in Germany. The RhinoChill device (BeneChill Inc., San Diego, USA) allows evaporative cooling by spraying an inert liquid coolant (a perfluorochemical) into the nasal cavity. The liquid evaporates instantaneously, thereby removing heat. It can make your nose discoloured, and in one … Continue reading Nasal cooling method

In-flight cooling after out-of-hospital cardiac arrest

Aeromedical retrieval specialists in Scotland developed a simple, cheap, effective in-flight cooling protocol using intravenous (IV) cold Hartmann’s solution and chemical cooling packs. Fluids cooled in a fridge (4°C) were transported in an insulated cool box; the patient was sedated, paralysed and intubated, and controlled ventilation started. The patient was then cooled by IV infusion … Continue reading In-flight cooling after out-of-hospital cardiac arrest