Tamingthesru

Air Care Orientation Curriculum, Prehospital Medicine, Procedural Education Jeffery Hill, MD M.Ed Air Care Orientation Curriculum, Prehospital Medicine, Procedural Education Jeffery Hill, MD M.Ed

Finger Thoracostomy

We talked about needle thoracostomy a while back and when we did, we talked about the propensity for the needle to fail.  There are a lot of reasons why the needle could fail to relieve a tension pneumothorax (or to only temporarily relieve a tension pneumothorax).  The needle may be too short to enter the thorax in the first place* or the catheter could kink, allowing reaccumulation of air in the thorax.

Read More
Air Care Orientation Curriculum, Prehospital Medicine Bill Hinckley, MD Air Care Orientation Curriculum, Prehospital Medicine Bill Hinckley, MD

Transporting Intra-Aortic Balloon Pump Patients by Air Care

Many historians argue that the first use of aeromedical evacuation was during the Siege of Paris in 1870, using hot air balloons (though there seems to be some question regarding the truth of this claim).  We're still using balloons during air medical missions in 2014, albeit in a much different way.

The efficacy of IABPs has recently been called into question; see Cliff Reid's recent blog post at http://resus.me/double-balloon-pump-fail/ .  Regardless, the decision to initiate IABP therapy isn't going to be ours.  But the challenge of moving an extraordinarily sick patient receiving this therapy WILL be ours.  We must be ready.  How?

Read More
Lessons in Transport Medicine, Prehospital Medicine Ryan Gerecht, MD Lessons in Transport Medicine, Prehospital Medicine Ryan Gerecht, MD

Lessons in Transport - Upper GI Bleeding

It is 2am on a cold, dark, winter night and you are dispatched to a small rural hospital to transport a patient by ground with a GI bleed back to UCMC medical ICU. Enroute dispatch notifies you that your patient has deteriorated and is profoundly hypotensive. The ED physician at the outside hospital is attempting intubation for airway control. On arrival you find a middle-aged male with all the classic stigmata of end-stage liver disease. More importantly he has a systolic blood pressure of 60 and a HR of 130. A literal fountain of blood spews from the patients mouth, around a successfully placed endotracheal tube, and is now beginning to pool on the floor. You know this patient needs massive resuscitation from his likely bleeding esophageal varices... but you are 55 minutes by ground to UCMC and know that your patient will not survive the transport unless something is done to control the bleeding...

Read More