All posts by Chris Nickson

smaccGOLD is all the RAGE

The entire RAGE team were at smaccGOLD, and we loved every minute of it.

Of course, Cliff Reid stole the show as per usual with his talk on ‘When should resuscitation stop?” (look out for it on the SMACC podcast in the coming months) but all the RAGE team made huge contributions to the critical care conference of the millennium.

Photo courtesy of SMACC
Photo courtesy of SMACC

This was the first time the entire RAGE team were in one place at the same time – rather than connected via Skype over the Internet – so we took the chance to record some audio. We managed to include a few friends too… Though, as always, the best bits will probably have to be edited out ;-)

Look out for the next RAGE podcast featuring these SMACCers:

RAGE at smaccGOLD
Photo via @markhwilson

From left to right:

Unfortunately Oli Flower (@oliflower) is missing from the photo, but he’ll be in the next podcast too.

PS. Hat tip to @alittlemedic for inspiring the post title

RAGE SESSION THREE

Just in time for smaccGOLD, RAGE Session Three is here!

It is 67 min 53 sec long and includes:

  • Introduction, including an ERCAST shout out and apologies from Haney… (starts 00:00 min)
  • ‘What’s bubbling up?’ (starts 01:30 min) — shout outs and interesting discoveries from the world of FOAM and elsewhere featuring pre-hospital spinal immobilisation, astronaut Chris Hadfield, ‘Mistakes were made’, EMA’s 25th anniversary edition and the need to tailor blood pressure targets to the individual.
  • the RAGE team discussing acute  life-threatening asthma (starts 15:52  min)
  • the RAGE team discussing ‘Medical Reversal’ (starts 52:52 min)
  • ‘A blast from the past’ by Karel Habig on ‘Ether Day’ and the origins of general anaesthesia (starts 63:42 min)
  • ‘Words of Wisdom’ featuring a quote from Cliff Reid’s role model, and some other guy (starts 66:32 min)

The RAGE podcast is on  iTunes here and the RAGE podcast audio feed is available here. Here are the show notes for RAGE Session Three:

Introduction

What’s bubbling up?

Life-threatening severe asthma

Medical reversal

  • Medical Reversal (LITFL CCC)
  • Mac Sweeney’s Top Ten Critical Care Papers for 2013 (LITFL)
  • Prasad V, et al. A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices. Mayo Clin Proc. 2013 Jul 12. doi:pii: S0025-6196(13)00405-9. 10.1016/j.mayocp.2013.05.012. [Epub ahead of print] PubMed PMID: 23871230. [Free Full Text] (includes a video commentary by the lead author)
  • Walters BC, Hadley MN, Hurlbert RJ, Aarabi B, Dhall SS, Gelb DE, Harrigan MR, Rozelle CJ, Ryken TC, Theodore N. Guidelines for the management of acute cervical spine and spinal cord injuries: 2013 update. Neurosurgery. 2013 Aug;60 Suppl 1:82-91. doi: 10.1227/01.neu.0000430319.32247.7f. PubMed PMID: 23839357. [Free Full Text articles]
  • The Nobel Prize in Physiology or Medicine 2005 — Barry J. Marshall, J. Robin Warren (NobelPrize.org)
  • Chesnut RM,  et al; Global Neurotrauma Research Group. A trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med. 2012 Dec 27;367(26):2471-81. doi: 10.1056/NEJMoa1207363. Epub 2012 Dec 12. Erratum in: N Engl J Med. 2013 Dec 19;369(25):2465. PubMed PMID: 23234472; PubMed Central PMCID: PMC3565432.
  • Bellomo R, Chapman M, Finfer S, Hickling K, Myburgh J. Low-dose dopamine in patients with early renal dysfunction: a placebo-controlled randomised trial. Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group. Lancet. 2000 Dec 23-30;356(9248):2139-43. PubMed PMID: 11191541.
  • Jacobs IG, Finn JC, Jelinek GA, Oxer HF, Thompson PL. Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomised double-blind placebo-controlled trial. Resuscitation. 2011 Sep;82(9):1138-43. doi: 10.1016/j.resuscitation.2011.06.029. Epub 2011 Jul 2. PubMed PMID: 21745533.
  • Finfer S, Bellomo R, Boyce N, French J, Myburgh J, Norton R; SAFE Study Investigators. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med. 2004 May 27;350(22):2247-56. PubMed PMID: 15163774.
  • Stroke Thrombolysis (LITFL CCC)

Blast from the Past

Words of Wisdom

Dreams save us

Addendum 30 March 2014:

Thanks again for listening to the RAGE!

How we train is how we fight

The RAGE team’s sphincters are progressively tightening as the pressure to perform at smaccGOLD mounts… the conference is just a couple of weeks away.

Sydney HEMS submitted a fantastic SimWars GOLD video entry — featuring quotations from HEMS speakers at the first SMACC conference, including RAGE’s Karel Habig and Cliff Reid.

Watch and be inspired…

Be inspired to train harder…

Be inspired to fight harder to save lives.

RAGEback: Minh Le Cong, Verapamil and SVT

The discussion of verapamil as an option for the treatment of supraventricular tachycardia (SVT) in RAGE Session Two went off like a fire cracker in the FOAM world.

In this RAGEback, Minh Le Cong from the PHARM podcast explains why the RAGE discussion is not going to change his practice, which is to use adenosine as a first line agent.

This is followed by a response by RAGErs Karel and Cliff.

You — the listener — are left to make up your own mind about which patients (if any) you’ll consider verapamil as an option.

References and Links

Minh cites these references (in the order they were mentioned):

  • Leitner RP, Hawker RE, Celermajer JM. Intravenous verapamil in the treatment of paroxysmal supraventricular tachycardia in children. Aust Paediatr J. 1983 Mar;19(1):40-4. PubMed PMID: 6870700.
  • Delaney B, Loy J, Kelly AM. The relative efficacy of adenosine versus verapamil for the treatment of stable paroxysmal supraventricular tachycardia in adults: a meta-analysis. Eur J Emerg Med. 2011 Jun;18(3):148-52. doi: 10.1097/MEJ.0b013e3283400ba2. Review. PubMed PMID: 20926952.
  • Hood MA, Smith WM. Adenosine versus verapamil in the treatment of supraventricular tachycardia: a randomized double-crossover trial. Am Heart J. 1992 Jun;123(6):1543-9. PubMed PMID: 1595533.
  • Anugwom C, Sulangi S, Dachs R. Adenosine vs. calcium channel blockers for supraventricular tachycardia. Am Fam Physician. 2007 Jun 1;75(11):1653-4. Review. PubMed PMID: 17575655. [Free Full Text]
  • Brady WJ Jr, DeBehnke DJ, Wickman LL, Lindbeck G. Treatment of out-of-hospital supraventricular tachycardia: adenosine vs verapamil. Acad Emerg Med. 1996 Jun;3(6):574-85. PubMed PMID: 8727628.

Karel and Cliff added these to the mix:

  • Holdgate A, Foo A. WITHDRAWN: Adenosine versus intravenous calcium channel antagonists for the treatment of supraventricular tachycardia in adults. Cochrane Database Syst Rev. 2012 Feb 15;2:CD005154. doi: 10.1002/14651858.CD005154.pub3. Review. PubMed PMID: 22336809. [Free Full Text] (note: withdrawn by the author due to lack of time and resources to update)
  • Miyagawa K, Dohi Y, Ogihara M, Sato K. Administration of intravenous calcium before verapamil to prevent hypotension in elderly patients with paroxysmal supraventricular tachycardia. J Cardiovasc Pharmacol. 1993 Aug;22(2):273-9. PubMed PMID: 7692169.
  • Riaz R, Mishra J, Hussain S, Sinha LM. Adenosine Versus Verapamil for the Treatment of Supra-ventricular Tachycardia: Randomized Comparative Trial. Pakistan J Med & Health Sci. 2012 Jul-Sept [Free Full Text]
  • Lapage MJ, Bradley DJ, Dick M 2nd. Verapamil in infants: an exaggerated fear? Pediatr Cardiol. 2013 Oct;34(7):1532-4. doi: 10.1007/s00246-013-0739-8. Epub 2013 Jun 26. PubMed PMID: 23800976.

Roie Tal’s Prezi journal club presentation on the Lapage et al 2013 article:

The links mentioned at the end are:

Thanks again for listening to the RAGE! 

RAGEback: Andy, Amit and the ETM Twitter Fiasco

As promised in RAGE Session Two, Andy Buck and Amit Maini from the Emergency Trauma Management (ETM) course are here to give their side of the story of what happened when a slide from their course was tweeted out of context leading to an unexpected backlash.

Be sure to check out:

Thanks again for listening to the RAGE! 

RAGE Session Two

The wait is over, RAGE Session Two is here!

RAGE Session Two is 80 min 19 sec long and includes:

  • Introduction, including some bad news… (starts 00:00 min)
  • ‘What’s bubbling up?’ (starts 00:58 min) — shout outs and interesting discoveries from the world of FOAM and elsewhere featuring codeine in kids, post-intubation sedation, adenosine versus verapamil for SVT and how to do a good vagal manoeuvre, the ETM Twitter fiasco, the FOAMcc Google Plus Community and smaccGOLD.
  • the RAGE team discussing a case of submassive pulmonary embolism and the role of thrombolysis (starts 22:14  min)
  • the RAGE team’s discussion on ‘Humans in the resus room: ‘when your back-up gets your back up’’ (starts 51:50 min)
  • ‘A blast from the past’ on WW2 hero and chain-smoking legend Edgar Patz, the only man to complete an entire Masters degree unconscious!  (starts 73:00 min)
  • ‘Wise Words’ featuring the art of observation, the immortal John Hunter and the infinitely wise Sir William Osler (starts 77.55 min)

The RAGE podcast is on  iTunes here and the RAGE podcast audio feed is available here.

Here are the show notes for RAGE Session Two:

What’s bubbling up?

 Submassive Pulmonary Embolus and Thrombolysis

FOAM:

Journal articles:

  • Dresden S,et al. Right ventricular dilatation on bedside echocardiography performed by emergency physicians AIDS in the diagnosis of pulmonary embolism.  Ann Emerg Med. 2014 Jan;63(1):16-24. doi: 10.1016/j.annemergmed.2013.08.016. Epub 2013 Sep 27. PubMed PMID: 24075286.
  • Kline JA, Steuerwald MT, Marchick MR, Hernandez-Nino J, Rose GA. Prospective evaluation of right ventricular function and functional status 6 months after acute submassive pulmonary embolism: frequency of persistent or subsequent elevation in estimated pulmonary artery pressure. Chest. 2009 Nov;136(5):1202-10. doi: 10.1378/chest.08-2988. Epub 2009 Jun 19. PubMed PMID: 19542256; PubMed Central PMCID: PMC2818852.
  • Howard LS. Thrombolytic therapy for submassive pulmonary embolus? PRO viewpoint. Thorax. 2014 Feb;69(2):103-5. doi: 10.1136/thoraxjnl-2013-203413. Epub 2013 Apr 26. PubMed PMID: 23624534.
  • Konstantinides S, Geibel A, Heusel G, Heinrich F, Kasper W; Management Strategies and Prognosis of Pulmonary Embolism-3 Trial (MAPPET-3) Investigators. Heparin plus alteplase compared with heparin alone in patients with submassive pulmonary embolism. N Engl J Med. 2002 Oct 10;347(15):1143-50. PubMed PMID: 12374874. [Free Full Text]
  • Sharifi M, et al; “MOPETT” Investigators. Moderate pulmonary embolism treated with thrombolysis (from the “MOPETT” Trial). Am J Cardiol. 2013 Jan 15;111(2):273-7. doi: 10.1016/j.amjcard.2012.09.027. Epub 2012 Oct 24. PubMed PMID: 23102885.
  • Simpson AJ. Thrombolysis for acute submassive pulmonary embolism: CON viewpoint. Thorax. 2014 Feb;69(2):105-7. doi: 10.1136/thoraxjnl-2013-204193. Epub 2013 Sep 17. PubMed PMID:24046127.

Humans in the Resus Room: ‘When your Back-Up gets your Back Up’

Blast from the Past

Words of Wisdom

Thanks again for listening to the RAGE!

Top Ten ICU trials for 2013

Wondering what to do while you’re waiting for RAGE Session Two to be released?

Here’s an option.

Check out Mac Sweeney’s Top Ten Critical Care Papers for 2013 (includes links for further reading). I  talked to Rob from Critical Care Reviews about his picks for the ten best trials in the intensive care literature for 2013. It is a fast paced and in depth discussion. I’m still suffering from the cortical burn!

Rob, along with all the RAGE team, will be at smaccGOLD in March 2014. See you there!