We know that alterations in hemodynamics do not only occur in hemorrhagic shock. Both obstructive (such as from tension pneumothorax) and neurogenic shock (for example, from a spinal cord transection), can result in hemodynamic compromise that would not be corrected by blood product administration. There have been some studies that have shown isolated traumatic brain injury (TBI) can also cause hemodynamic derangements. This article looks at a paper which attempts to examine the incidence of cardiovascular instability in patients with TBI.Read More
Severely burned patients can be intimidating for even the most seasoned critical care transport providers. These patients often require aggressive resuscitation and multiple procedures in a relatively short period of time. It is often easy for providers to become overwhelmed, necessitating an algorithmic approach to the patient, similar to traumatically injured patients, is crucial. By advancing through the primary survey and stabilizing the patient while starting aggressive but goal directed crystalloid resuscitation, critical care transport providers can bring ICU level care to one of the sickest pre-hospital patient populations.Read More
We train for it, we have a healthy fear of it, and we realize that having to perform one is not an admission of failure on our part. But, how often is a cricothyrotomy performed on HEMS. Dr. Andrew Cathers of University of Wisconsin Med Flight walks through a recently published paper on the topic.Read More
May brought the fourth case of our Air Care Flight Physician Orientation Case Series with the goal of preparing our first year residents for their roles as Flight Physicians. This is a monthly series that will continue through the R1’s Flight Physician Orientation Day in June. First year residents discuss the case and its associated questions on our internal asynchronous learning forum, Slack. This month, a case of sepsis. Should we just transfer the patient as quickly as possible, or are there other things we should do first? Read on to find out!Read More
This month's AirCare Series post is the first podcast in the series! In this podcast one of our current interns, Adam Gottula, interviews a graduate of our program, Andrew Latimer. Dr. Latimer is currently a Senior EMS Fellow at the University of Washington. In this interview, Dr. Latimer discusses how they use pre-hospital ultrasound at his flight program as well as his thoughts on the future applications of this technology.Read More
April brought the third case of our Air Care Flight Physician Orientation Case Series with the goal of preparing our first year residents for their roles as Flight Physicians. This is a monthly series that will continue through the R1’s Flight Physician Orientation Day in June. First year residents discuss the case and its associated questions on our internal asynchronous learning forum, Slack. This month, a case of STEMI, seemingly simple, right… but what happens next?Read More
This is Case #2 of our Air Care Orientation Curriculum! This curriculum is designed to help prepare our rising R2's for their new responsibility as flight physicians. These cases are discussed amongst our training flight docs and this is the resultant learning points. In this case, we discuss a critical patient with a head injury. What interventions need to be performed? In what order? Who should do them? Read on to find out.Read More
This is Case #1 of our Air Care Orientation Curriculum! This curriculum is designed to help prepare our rising R2's for their new responsibility as flight physicians. These cases are discussed amongst our training flight docs and this is the resultant learning points. In this case, we discuss a sick trauma patient that needs multiple interventions. But what interventions need to be done? In what order? And who should do them? Read on to find out!Read More
It is early October and you are the flight doc in C-pod on a brisk but clear Saturday morning. The day starts out with several challenging patients with vague complaints and has just begun to ramp up in volume when a patient rolls into your pod by EMS, restrained face-down to the cot, covered in feces and urine, screaming about hearing voices. You begin to take report from EMS when, as if by divine intervention, the tones drop and you are dispatched for an inter-facility transfer. You gleefully (almost too gleefully…) give a brief patient sign-out to your staff, grab the blood cooler, and head to the roof...Read More
Air Care Grand Rounds
What do I need to assess before I load this patient in the heli?
- Does your patient need plastic? (ETT, needle/finger thoracostomy)
- Get breath sounds / anticipate your possible interventions you may need
- Is your patient in shock?
- Don't have a lactate? Hyperglycemia in the absence of diabetes, thirst and diaphoresis should lend you towards 'yes'
Just prior to SMACC (the Social Media and Critical Care Conference), we were lucky enough to have Dr. Brian Burns of Sydney HEMS stop through Cincinnati. In the video below you can see his lecture on when the 1% makes all the difference. Dr. Burns talks about how we should strive for excellence in prehospital care not simply meeting minimum standards. Watch the lecture below to hear Dr. Burns discuss the importance of incremental changes, cognitive offloading, checklists, and continuous improvement and training through simulation.Read More
Thanks to everybody who commented and contributed to the discussion on our final “Flight!” If you missed out on the case, check it out here. Below you’ll find a curation of the comments to each question and a podcast with expert commentary from Jenn Lakeberg, APRN. This was the final “Flight” for this spring/summer. Look for the cases to return again in January 2016 as we begin Flight MD Orientation with the next class of future Air Care Flight Docs.Read More
Thanks to everybody who chimed in on our last "Flight"! We had a great discussion on the management of the STEMI transfer patient. These aren't just "milk runs" as pointed out by Dr. Hinckley. The highlights of the discussion are below with additional commentary on the case by Dr. Bill Hinckley and Air Care Resident Assistant Medical Director Dr. Matt Chinn. Out final flight will be lifting off June 1 and it's a doozy - looking forward to the discussion!Read More
Hey, everybody! Today we are going to talk about field limb amputation.
I know what you are all thinking… No, I’m not crazy. Yes, you’ll probably never do one. No, this is not a common procedure. You just might, however, be in a situation on Air Care where knowing how to correctly perform this procedure can safe a life.
First, let’s provide a little background on the pre-hospital limb amputation. The procedure itself has gained much more press in the FOAMed world and the emergency medicine and pre-hospital literature since the 2010 earthquake in Haiti during which early physician responders were faced with large numbers of patients trapped under debris and few responders with familiarity or basic working knowledge of the procedure (Lorich et al, 2010). A few of case reports and articles surfaced around this time and the field amp even made an appearance in an episode of the popular television show ‘Greys Anatomy’ in 2011.
So I was told…Read More
Thanks to everybody who contributed to an excellent discussion of the care of the patient on our second “flight.” If you didn’t get a chance to check out the case and the discussion, check it out here. Below is the curated comments from the community and a podcast from Dr. Hinckley and Flight Nurse Practitioner Jason Peng
Q1 - Walk through your initial assessment of this patient. What are the critical aspects of the assessment of this patient?
In response to this question, most everybody wanted to first act on the bleeding wound in the patient’s right antecubital fossa. As explained by Dr. Renne, “I would want to be systematic but efficient, probably using a C-ABCD approach to these kind of critical patients, with the first C being any sort of life-threatening but "C"ontrollable hemorrhage.” Dr. Renne also had a fine point with regards to checking for other potential, as of yet unseen, injuries. This is a patient with multiple stab wounds, it is crucial to conduct a quick, but thorough search for stab wounds to the back, axilla, groin, and/or other locations where significant blood loss could be caused by a stab wound.Read More