Gaining traction

Here's another of Prof Larry Mellick's great videos. Self explanatory with great x-rays and commentary. Love the ketamine adjustment!



For more of his videos, go here.

Smells like team spirit

In times of crises, certain traits are desirable and some, admirable. One of those is situational awareness. What is most desired is knowing your limits and calling for help.

A competent registrar notified me of an impeding airway disaster:

• Semi conscious patient in respiratory distress
• Oro-pharyngeal tumour (undergoing chemo)
• Bleeding acutely from unknown site in oropharynx or lower
• Shocked clinically
• The best description I can give to those who understand is "peri-arrest".

Here's the really good news though:

• A RSI checklist had been commenced prior to my arrival
• The airway team had been called
• Nursing staff were ensuring all the items on afore-mentioned checklist were prepped
• Tranexamic acid given
• Cric kit was opened and location marked (as best we could due to oedema)

The inevitable happened and the soon GCS deteriorated as did BP. Subsequently, this followed:

• Ketamine 
• Unmatched blood as soon as we got it
• Peripheral pressors 
• Paralysis and attempt by Anesthetist
• Continuous suctioning of blood with no view of cords
• Bougie assisted intubation with no desats and good CO2 trace
• Good post intubation care

The whole hospital team successfully oxygenated and ventilated this patient. I did practically nothing. Which is why I am elated. This was a triumph for systemic preparation & team sport...

... but it all started with a keen-eyed doctor with the sense to know they couldn't do it all by themselves. 

Remember:

ACL exam - all you need to know.

Dr Nabil Ebraheim makes some fine videos and this is no exception. It demonstrates the Lachman and Pivot shift tests and explains the pathology, relevant investigations and follow up as well. I'm a biased ACL tear sufferer but this is a common injury and it pays to know the sensitive and specific tests.