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!

2 thoughts on “RAGE Session Four”

  1. As usual, enjoyed listening to the podcast. Many thanks chris and team. a few comments.

    For an interesting discussion on the right heart circulatory system and the distinction between right heart and right ventricular failure see the recent paper by Mehra MR, Park MH, Landzberg MJ, Lala A, Waxman AB; International Right Heart Failure Foundation Scientific Working Group. Right heart failure: toward a common language. J Heart Lung Transplant. 2014 Feb;33(2):123-6. doi: 10.1016/j.healun.2013.10.015. Epub 2013 Oct 17. PubMed PMID: 24268184

    John Hinds’ words of wisdom, while hilarious after a few beers, left me a little uncomfortable after some further reflection. Slowing down may not increase the size of the gap but then neither does going hell-for-leather. On the other hand, the significance or potential of that gap can change dramatically. In my short experience, crisis situations are frequently complicated by too much speed –the psychology and physiology of stress an important factor. No matter how much confidence we may have in our own abilities, the other crucial players – environment, team and patient – have a habit of surprising us at unexpected moments. To continue the country back road analogy: a blown tyre, a wayward roo, a half blind elderly driver…these await us at any moment. I would think our reaction to these developments and their potential for adverse outcomes can be optimised by a more measured approach. In the narrow alleyway, even if we can’t swap our twenty tonne juggernaut for a push bike we can at the very least slow down (with apologies to Cliff Reid and his propofol assassins rant).

    While mentioning Cliff, can I also comment on the recent dogmalysis post and the debates between Carley and Weingart in the social media. It seems to me, dogma, like thrombus, is not all bad. Not all dogma, again like thrombus, needs lysis. Indeed some amount of dogma is required for us to function and prevent us from the outcome of cerebral haemorrhage. There is a delicate balance in the perpetuation and progress of medical and clinical knowledge, as of science in general, which again is akin to the delicate balance of the coagulation system. To me, the key issue is not on the speed of change but rather whether it is the right thing to do. And how do we decide that? It is interesting therefore that the debate has turned into one of “goodness”. This values approach, this understanding of our beliefs and priorities, and how these interact with new information is the key to understanding change – as I think Carley is trying to highlight. Rarely is the evidence so overwhelming it brings with it its own demand for action – more commonly, like much of our clinical data, it needs placing into context. And it is this ill-defined balancing which makes for the substance of our debates and discussions at journal clubs, on ward rounds, in the media and so on. It is a sign of a healthy culture; as able to change as not to, and importantly, as able to be wrong as to be right.

    Looking forward to rage five. Cheers

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