Episode 13: The Ventilator

12/02/16 • 30 min

PHEMCAST

https://phemcast.co.uk/wp-content/uploads/2016/12/vent-final.mp3

Ventilation – a dark art. Difficult to be a master, easy to be average (or terrible)!

This is “part 1”, which includes some of the basic (and not very basic) concepts behind ventilation.

We recorded over 60 minutes of excellent content with George – we will post more below as soon as it is edited. .

Check out Georges powerpoint – its excellent!

introduction-to-mechanical-ventilation-11nov2016-podcast

https://phemcast.co.uk/wp-content/uploads/2016/12/vent-final.mp3

Ventilation – a dark art. Difficult to be a master, easy to be average (or terrible)!

This is “part 1”, which includes some of the basic (and not very basic) concepts behind ventilation.

We recorded over 60 minutes of excellent content with George – we will post more below as soon as it is edited. .

Check out Georges powerpoint – its excellent!

introduction-to-mechanical-ventilation-11nov2016-podcast

Previous Episode

Episode 12: Breaking Bad News

https://phemcast.co.uk/wp-content/uploads/2016/09/breaking-bad-final.mp3

YouTube videos:

From the police officer’s perspective: https://www.youtube.com/watch?v=toaA_TNwcxg

From the mother’s perspective: https://www.youtube.com/watch?v=0KJZXOKStao

The paper about watching resuscitation is this one:

http://www.nejm.org/doi/full/10.1056/NEJMoa1203366#t=article

This is a section taken from the London Ambulance Service clinical bulletin, from 2011, which includes the SPIKES mnemonic:

The alternative mnemonic mentioned in the podcast is GRIEV_ING, which has been developed for use in the ED.

References

Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP. Spikes – a six-step protocol for delivering bad news: Application to the patient with cancer. The Oncologist. 2000; 5: 302-311.

Hobgood C, Harward D, Newton K, Davis W. The educational intervention “GRIEV_ING” improves the death notification skills of residents. Journal of Academic Emergency Medicine. 2005; 12: 296-301.

Jabre P, Belpomme V, Azoulay E et al. Fanily presence during cardiopulmonary resuscitation. The New England Journal of Medicine. 2013: 368 (11): 1008-1018.

Next Episode

Episode 14: Thoracotomy

https://phemcast.co.uk/wp-content/uploads/2016/12/final-thora.mp3

Details of the surgical skills course mentioned in the podcast can be found here:

https://wmstc.co.uk/portfolio/phem-ess/

The Sydney HEMS Traumatic Cardiac arrest operating procedure can be viewed on their website, and there are a number of useful references within the document:

Policies and Procedures

An excellent ‘how to do it’ paper, published in 2005, by the London HEMS team, can be accessed via the link below:

Click to access v022p00022.pdf

Equipment required for resuscitative thoracotomy:

Surface anatomy:

Appearance of pericardial clot

A foley catheter being used to fill a cardiac wound – note how easily this could be pulled out.

An open chest with aortic compression

Simulation of resuscitative thoracotomy by London HEMS team.

For an entertaining and insightful discussion about the impact of undertaking thoracotomy, listen to Dr John Hinds talk from SMACC 2015. Highly recommended.

HINDS: Crack the Chest. Get Crucified.

And for a summary of the evidence and recommendations, have a look at the St Emlyns blog:

http://stemlynsblog.org/jc-east-lets-be-blunt-about-ed-thoracotomy/

References

Smith JE, Rikard A, Wise D. Traumatic Cardiac Arrest. Journal of the Royal Society of Medicine 2015. 108(1): 11-16.
Wise et al. Emergency thoracotomy: “how to do it”. EMJ; 2005: 22-24.
Hunt et al. Emergency thoracotomy in thoracic trauma: a review. Injury; 2006 (37): 1-19.
Clay et al. Emergency Department thoracotomy for the critically injured patient: Objectives, indications, and outcomes. World Journal of Emergency Surgery; 2006: 1:4.
Rhee et al. Survival after Emergency Department thoracotomy: review of published data for last 25 years. J Am Coll Surg; 2000. 190(3): 288-298
ACS Committee on Trauma Working Group. Practice Management guidelines for ED Thoracotomy. J Am Coll Surg. 2001, 193 (3): 303-309.
Editorial. When should we stop resuscitative efforts after blunt traumatic arrest. Injury; 2008 (39): 967-969.
Joint Position Statement of Nat Assoc EMS Physicians and ACS Committee on Trauma. Guidelines for withholding or termination of resuscitation in prehospital cardiopulmonary arrest. J Am Coll Surg; 2003 (1): 106-111.
Tarney et al.Outcomes following military traumatic cardiorespiratory arrest: A prospective observational study. Resuscitation; 2011: 1194-1197