Category Archives: RAGE News

Bubbles in the Wilderness

There have been many discussions and debates about the role of FOAM (free open-access meducation) in medical education, the pros, the cons and whether or not it really is useful.

It may not be for everyone, yet for some individuals – especially those who are remote or isolated – FOAM has transformed how they learn, engage and enjoy medicine. A great example of this — one the RAGE team recommends you read — is Natasha Pirie-Burley’s account, Bubbles in the Wilderness: All about FOAM, published on the Adventure Medic blog.

“In 2007 I struggled to find my passion or heroes within my workplace. I listened to closed minds and wondered why everyone was, “just getting through it”. It was un-inspiring and at times depressing. I resigned from my job in the UK and headed to the wilderness of America, New Zealand, Nepal, and Australia. I was searching for heroes and inspiration relevant to my life. Then last year, by chance, I found that Mawson’s bravery, Shackleton’s leadership, Dean Potter’s composure and the family Robinson’s ingenuity were right here at my fingertips and living in these medical pioneers of FOAM.”
— excerpt from Bubbles in the Wilderness: All about FOAM by Natasha Pirie-Burley

Vive la FOAM!

Submassive PE on EMCrit

Back in RAGE Session Two we discussed ‘Thrombolysis for Submassive Pulmonary Embolus’. This was actually just before the PEITHO trial was published, though we were able to anticipate many of the findings thanks to the wonders of the web.

A great follow up to our discussion is EMCrit Podcast 128 – Pulmonary Embolism Treatment Options and the PEAC Team with Oren Friedman. This discussion reiterates many of the conclusions the RAGE team came to, with additional discussions about catheter-directed thrombolysis and reduced dose thrombolysis.

Meanwhile, the NEJM has just published correspondence in response to the PEITHO trial -it  includes a comment about half-dose thrombolysis by Rory Spiegel, myself and Ryan Radecki.

Cricoid: To Press or Not to Press?

Just in case you still thought cricoid pressure was a good idea, listen to the RAGE team’s newest member John Hinds at smaccGOLD. Hinds is an anaesthetist, intensivist and a motorcycle-riding prehospital resuscitationist based in Northern Ireland. In this debate he will tell you about ‘cricolol’.

What?

John parodies cricoid pressure by encouraging us to imagine that this procedure is a drug… Yep, might as well use it as a suppository.

Would you give it?

RAGE listeners have already heard Scott Weingart in RAGE: smaccGOLD edition call this the ‘most brilliant cutting away at the knees of an opponent…”

Listen to the talk below (John starts about halfway through at 12min 55sec if you’re impatient).

Here are the slides to flick through as you listen:

Or why not go straight to the video:

BTW, big ups to Brent May for valiantly putting forward the case for cricoid pressure… An unenviable task.

Learn more here:

Otherwise check out John’s references:

  1. Sellick BA. Cricoid pressure to control regurgitation of stomach contents during induction of anaesthesia. Lancet 1961;2:404-6.
  2. Koziol CA, Cuddeford JD, Moos DD. Assessing the force generated with application of cricoid pressure. AORN journal 2000;72:1018-28, 30.
  3. Smith KJ, Dobranowski J, Yip G, Dauphin A, Choi PT. Cricoid pressure displaces the esophagus: an observational study using magnetic resonance imaging. Anesthesiology 2003;99:60-4.
  4. Hartsilver EL, Vanner RG. Airway obstruction with cricoid pressure. Anaesthesia 2000;55:208-11.
  5. Allman KG. The effect of cricoid pressure application on airway patency. Journal of clinical anesthesia 1995;7:197-9.
  6. Levitan RM, Kinkle WC, Levin WJ, Everett WW. Laryngeal view during laryngoscopy: a randomized trial comparing cricoid pressure, backward-upward-rightward pressure, and bimanual laryngoscopy. Annals of emergency medicine 2006;47:548-55.
  7. Garrard A, Campbell AE, Turley A, Hall JE. The effect of mechanically-induced cricoid force on lower oesophageal sphincter pressure in anaesthetised patients. Anaesthesia 2004;59:435-9.
  8. Chassard D, Tournadre JP, Berrada KR, Bouletreau P. Cricoid pressure decreases lower oesophageal sphincter tone in anaesthetized pigs. Canadian journal of anaesthesia = Journal canadien d’anesthesie 1996;43:414-7.
  9. Heath KJ, Palmer M, Fletcher SJ. Fracture of the cricoid cartilage after Sellick’s manoeuvre. British journal of anaesthesia 1996;76:877-8.
  10. Ralph SJ, Wareham CA. Rupture of the oesophagus during cricoid pressure. Anaesthesia 1991;46:40-1.

What a great job!

Indispensable RAGE team member Cliff Reid was a keynote speaker at the ACEM Annual Scientific Meeting in 2013.

He was tasked with delivering a talk titled ‘What a great job!’

… and, of course, he well and truly delivered.

httpv://vimeo.com/93460243

Hopefully this tides you over until the next RAGE session and inspires you as much as it inspires us.

Special thanks to ACEM for allowing the audio to be released as FOAM on the RAGE Podcast.

RAGE on…

Thanks again for listening to the RAGE!

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

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.