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Foam in review


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My FOAM in Review slides from SMACC2013, highlighting all the big hits from the EMCC podcasting and blogging world in 2012

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Foam in review

  1. 1. FOAM in Review Kane Guthrie
  2. 2. FOAM from 2012• The review: – 189 different EMCC blogs & podcasts
  3. 3. Crowdsourcing
  4. 4. The Big FOAMed Hit’s Of 2012
  5. 5. The Popular OnesEMCrit DSI Best use of the Bougie
  6. 6. Thought Provokers& Game Changers!
  7. 7. LMA in Cardiac Arrest • Does the LMA decrease cerebral blood flow? • Using FOAMed to challenge the science!
  8. 8. LMA in Cardiac Arrest • They didn’t buy it! • Used MRI to show LMA doesn’t impede flow! • Short paper response - rejected to letter form • So they used FOAMed instead! – Blog post, videocast&podcast discussion! • LMA’s are safe in critically ill.
  9. 9. The Man who made Sepsis Sexy! NYC STOP Sepsis Collaborative
  10. 10. Sepsis in the ED Lessons: – Time sensitive disease - High mortality – Needs early recognition – AB’s & fluids within 1 hour – Use lactate to find the cryptic cases – Non invasive approach is effective
  11. 11. Ketamine or KetaMinhWho’s using it more because of Minh?
  12. 12. Ketamine or KetaMinh• What is it good for? – Agitation/Aggression/Analgesia – Procedural sedation – Antidepressant – Hypotensive patients – Chronic pain – The DSI approach
  13. 13. PCAs in the ED• Review of 2 studies!• Provide less-labor intensive analgesia• Better pain scores• Few more adverse events! – Nausea, vomiting, pruritis• Worth it in some painful conditions!
  14. 14. Critical Care Palliation“When we can’t be aggressive with our resuscitation – we need to be aggressive with our palliation!” palliation/
  15. 15. Critical Care Palliation3 things never to say: 1. “Do you want us to do everything?” 2. “Do you want us to resuscitate her?”3. “I am so sorry, there is nothing more we can do” palliation/
  16. 16. Tranexamic AcidThe FOAMed world ask why we aren’t using it? – Its cheap! – Its an old drug! – But it works! – ?prehospital drug
  17. 17. Pressure Poisoning• Lung protective ventilation – Meta Analysis• Not just in ARDS!• Lower tidal volumes = better outcomes
  18. 18. Pressure PoisoningStart with:• 6-8ml/kg by IBW for all intubated ED patients And protect those lungs!
  19. 19. Hypoxic Patient?Needs lots of O2?Not for Intubation? What to do?
  20. 20. High Flow Nasal O2• Give ^60L/02/min• Enable 100% 02, with 5/PEEP• Humidified• Great for NFI pts• More comfortable NIV• Use for DSI! nasal-cannula-in-the-emergency-department/
  21. 21. PPI & Upper GI Bleeder! • Face validity of using PPI’s • 750 million per/yr USA • Systematic R/V -Cochrane • 2000 Pts
  22. 22. PPI & the Upper GI Bleeder! No difference in: • Mortality, rebleeding, need for surgery!
  23. 23. The Best Tricks of the Trade!
  24. 24. Difficulty feeding the NGT tube?• Try the SCANCRIT manoeuvre!
  25. 25. Opioid Induced Constipation = Naloxone = • Give 2mg Naloxone PO • Mix with lactulose/colonlytely • Doesn’t induce opioid withdrawal!
  26. 26. Superglue for CVCs• Need to secure that ART line or CVC during a resus?Forget this: Try this:
  27. 27. Need to Chemically Cardiovert SVT?
  28. 28. Combine Adenosine with the Flush• Use 20ml syringe• Draw up adenosine & flush together• Administer by fast IV push• Doesn’t reduce effectiveness! of-trade-combine-adenosine-and.html
  29. 29. Nebulised Naloxone • Worried about acute withdrawal with IV naloxone? • Still got some respiratory effort? • Feel you need to do something? • Gives “gentle & effective” reversal? Try 2mg naloxone, 3mls saline in a neb!
  30. 30. Stabilising Mandibular Fractures• Splinting mandibular dislocation/fracture • Easy as• Putting them in a stiff neck collar!
  31. 31. A Dose of Dex • Casey been doing it for a while! • Cochrane then decided to agree with him: Benefits: • Reduction of pain • Early onset - 24hours • Same Kids vs Adults • No difference Bactvs Viral
  32. 32. Ruling & Managing the RESUS ROOM
  33. 33. Life, Limb & Sight Saving Procedures• Published in emj & Resus.Me• Questions if we’re ready to perform: – Time Critical InterventionsHighlights metacompetence:• Ability to apply the intervention @ the right time!
  34. 34. The Usual State of Readiness• Being ready to act with life-saving maneuvers• Managing your own catecholaminesBeing ready1. Cognitively2. Materially
  35. 35. The Usual State of Readiness1.Cognitively• Invisible simulation• Develop & prepare plans/scenarios in your mind!• Knowing what you need to know
  36. 36. The Usual State of Readiness2. Materially• Equipment you need• When you need it• Where you need it• Checking your equipment yourself!
  37. 37. Mind of the Resuscitationist• Being at the sharpest end of EM• Making things happen• Controlling your environment• Science of human persuasion• Standing like a leader
  38. 38. Owning the Airway in 2012 Been dominated by: • From DL to VL • To Human Factors & CRM • & Tools and Techniques• Then LMAs, retrogrades, bougies, & airway aids –all through to the surgical airway!
  39. 39. The VortexChanging the way we approach the difficult airway
  40. 40. The Vortex• “High stakes cognitive aid” – Simple enough to be recalled – Flexible enough to be use in any context• Train staff in unanticipated difficult airway• Using single, simple, universally applicable template l
  41. 41. The FOAM Checklists
  42. 42. EMCrit Intubation
  43. 43. EM Updates Intubation Checklist
  44. 44. EMCrit Post-Intubation Package
  45. 45. EM Updates Asthma
  46. 46. In SummaryFOAMed in 2012 was all about:• Airway management/devices• Teaching us to use Checklist• How to Rule the Resus Room FOAMed showing how to practice medicine in the future!
  47. 47. Questions
  48. 48. Thank-youMay the FOAM be with you!