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Flights - A Stab in the Dark
You are working overnight as the H2 doc based at Butler County Regional Airport. It’s bitter cold out (for Ohio that is). Its only 11 PM and already the temperature has dropped to 9 degrees fahrenheit on its way to a low of 0. You are in the lounge refamiliarizing yourself with the contents of the critical care cells when the tones go off: “Scene: stab wound – Hamilton Ohio”
You and the nurse grab your equipment, the blood cooler, and head to the helicopter. You put the critical care cells back in their spot in the rear of the helicopter and then buckle in for the short flight to the scene.
Your patient is a 23 year-old female who was in an argument with her boyfriend earlier in the evening. The verbal argument quickly escalated, her boyfrienf pulling a knife and stabbing her multiple times in the right arm and right chest. He fled the scene and she managed to call 911. The first responders found the patient with significant active bleeding from her arm as well as chest. She was initially responsive, but is now only awake to painful stimuli.
You meet the EMS crew in the back of the squad truck and assess the patient from the head of the bed.
Flights - One Road too Far
You are working as the UH-doc. Driving into your shift with the windows down and music playing, you figured the first warm day of the year would result in a busy day for you and the rest of the Air Care 1 crew. You arrive for your shift, grabbing the radio from the Pod doc when the tones go off for your first flight of the day. You grab the blood cooler head to helipad, checking your pager you find you’ll be responding to Southeastern Indiana for a “MVC rollover, entraped.”
You strap into the helicopter and fly over the city and to the rolling hills of Southeastern Indiana. Landing on the 4 lane divided state road, you unstrap and head to your patient who is waiting with the BLS squad.
You open the side door of the EMS truck and head to the head of the bed to assess your patient...
Ketamine Fight Club: Ketamine in TBI
There has long been a concern for increases in ICP with administration of ketamine primarily stemming from reports of increased ICP in the Neurosurgery and Neuroanesthesia literature. These increases were described primarily in patients usually with CSF outflow obstruction undergoing elective neurosurgical procedures. In the time since these articles were published, the use of ketamine in a wide variety of patients with neurologic compromise has been reported. In fact, there have been a couple of recent systematic reviews and meta-analyses on this topic. These systematic reviews and meta-analyses have essentially analyzing all the same existing literature (which is generally poor in quality).