All posts by Chris Nickson

miniRAGE: The ProCESS Trial

Relax, we didn’t really delete the discussion of The ProCESS Trial from RAGE Session Four… We just chopped it out to be published separately as a miniRAGE.

This is what we’re talking about:

ProCESS Investigators, Yealy DM, Kellum JA, Huang DT, Barnato AE, Weissfeld LA, Pike F, Terndrup T, Wang HE, Hou PC, LoVecchio F, Filbin MR, Shapiro NI, Angus DC. A randomized trial of protocol-based care for early septic shock. N Engl J Med. 2014 May 1;370(18):1683-93. doi: 10.1056/NEJMoa1401602. Epub 2014 Mar 18. PubMed PMID: 24635773. [Full Text] [Supplement]

So, following on from Haney’s comments on the Surviving Sepsis Campaign response to ProCESS, here is the RAGE team talking about what it all means for the management of septic shock.

Learn more here:

Thanks again for listening to the RAGE!

RAGE Session Four

RAGE Session Four is here! (at last…. you say)

It is 61  min 46 sec long and includes:

  • Introduction, including a welcome to new RAGE team recruit John Hinds and apologies from Cliff… (starts 00:00 min)
  • ‘What’s bubbling up?’ (starts 01:16 min) — shout outs and interesting discoveries from the world of FOAM and elsewhere featuring regional anaesthesia, the GoodSam app, the Surviving Sepsis Campaign response to the ProCESS Trial, Brain Impact Apnoea and the ‘Tamiflu’ debacle.
  • the RAGE team discussing ‘Getting The Right Side Right: RV infarction and RV failure’ (starts 13:39  min)
  • the RAGE team discussing another ‘Humans in the Resus Room’ topic: ‘I Want to Stop, But Someone Else Doesn’t’ (starts 37:03 min)
  • ‘A blast from the past’ by me (Chris Nickson) on ‘Jack Barnes and the Irukandji Enigma’ (starts 55:07 min)
  • ‘Words of Wisdom’ from motorcycle legend Guy Martin via John Hinds (starts 59:14 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 Four:

Introduction

What’s bubbling up?

Regional Anaesthesia

  • Beaudoin FL, Haran JP, Liebmann O. A comparison of ultrasound-guided three-in-one femoral nerve block versus parenteral opioids alone for analgesia in emergency department patients with hip fractures: a randomized controlled trial. Acad Emerg Med. 2013 Jun;20(6):584-91. doi: 10.1111/acem.12154. PubMed PMID: 23758305.
  • Black KJ, Bevan CA, Murphy NG, Howard JJ. Nerve blocks for initial pain management of femoral fractures in children. Cochrane Database Syst Rev. 2013 Dec 17;12:CD009587. doi: 10.1002/14651858.CD009587.pub2. Review. PubMed PMID: 24343768.
  • De Buck F, Devroe S, Missant C, Van de Velde M. Regional anesthesia outside the operating room: indications and techniques. Curr Opin Anaesthesiol. 2012 Aug;25(4):501-7. doi: 10.1097/ACO.0b013e3283556f58. Review. PubMed PMID: 22673788.
  • Gadsen J. Regional Anesthesia in Trauma: A Case-Based Approach. Cambridge University Press; 1 edition (November 12, 2012) (website)
  • Wu JJ, Lollo L, Grabinsky A. Regional anesthesia in trauma medicine. Anesthesiol Res Pract. 2011;2011:713281. doi: 10.1155/2011/713281. Epub 2011 Nov 21. PubMed PMID: 22162684; PubMed Central PMCID: PMC3227428.
  • Mike Stone’s video showing how to perform a fascia iliaca block with ultrasound:

FICB Refresher from Mike Stone on Vimeo.

Other topics ‘bubbling up’:

Getting The Right Side Right: RV Infarction and RV failure

  • The ‘OH CRAP’ mnemonic for optimising oxygen delivery and haemodynamics: Oxygen, Haemoglobin, Contractility, Rate & rhythm, Afterload and Preload (for both the right and the left heart – need to do different things for each!)
  • Inohara T, Kohsaka S, Fukuda K, Menon V. The challenges in the management of right ventricular infarction. Eur Heart J Acute Cardiovasc Care. 2013 Sep;2(3):226-34. doi: 10.1177/2048872613490122. Review. PubMed PMID: 24222834; PubMed Central PMCID: PMC3821821.
  • Vandenheuvel MA, Bouchez S, Wouters PF, De Hert SG. A pathophysiological approach towards right ventricular function and failure. Eur J Anaesthesiol. 2013 Jul;30(7):386-94. doi: 10.1097/EJA.0b013e3283607a2d. Review. PubMed PMID: 23571479.
  • Right ventricular infarction (LITFL ECG Library)
  • Right Ventricular Failure (LITFL CCC)
  • Right Ventricular Function and Haemodynamic Assessment (LITFL CCC)
  • Pulmonary Artery Catheters (LITFL CCC)
  • Pulmonary Hypertension (LITFL CCC)

Humans in the Resus Room: I Want To Stop, But Someone Else Doesn’t

Blast from the Past

Words of Wisdom

Thanks again for listening to the RAGE!

When should resuscitation stop?

RAGE Session Four is fully edited and soon to be released. Unfortunately, as you’ll soon find out, Cliff wasn’t able to make the session.

To make up for it, we’ll be featuring a few different Cliff Reid talks in the next week or two. We’ll start with this controversial and inspiring talk from smaccGOLD which left more than a few resuscitationists feeling conflicted.

Listen to it yourself and make up your own mind.

Cliff was asked to speak on the topic of ‘When should we stop resuscitation?’ instead – as he is wont – he turns the talk on its head and asks ‘When should we NOT stop resuscitation?’

Here is the audio (download the mp3 directly here):

Here is the video:

Cliff Reid – When Should Resuscitation Stop from Social Media and Critical Care on Vimeo.

 

To listen to all the smaccGOLD talks as they are released subscribe to the SMACC podcast on iTunes.

Neurosurgery for Everyone!

You’ll remember Mark Wilson (@markhwilson) from RAGE: The smaccGOLD Edition. Mark is an amazing mix of neurosurgeon and prehospital physician… We’ve already got him to promise to come on RAGE for a neuro-focused RAGE Session in the next few months.

Check out Mark’s talk on ‘Neurosurgery for Everyone!’ from smaccGOLD.

Mark Wilson Neurosurgery for Everyone from Social Media and Critical Care on Vimeo.

To listen to all the smaccGOLD talks as they are released subscribe to the SMACC podcast on iTunes.