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Velkommen tilbage til 2.del af vores føljeton on postoperativ smertebehandling med Ole Mathiesen. Hvis ikke du allerede har hørt del 1 så er den tilgængelig lige herunder og det tilhørende blogindlæg findes her. I denne del fortæller Ole endnu mere om den multimodale strategi til smertebehandling og vi taler om vigtigheden af at patienterne får en velvalgt præmedicinering for at sikre et optimalt postoperativt forløb. Vi har en mere overordnet samtale om fremtidens perioperative smertebehandling både med hensyn til anæstesilægens rolle men også med hensyn til hvilke patienter vi måske skal bruge lidt mere tid på både før og efter operation. Vi gennemgår en case og behandler patientens smerter med Oles hjælp og så gennemgår vi overordnet de forskellige opioider vi anvender i behandlingen af akutte smerter. Lyt til 2.del lige her: Det er ikke nemt at finde den nødvendige information om de forskellige opioider hverken online eller i bøger, så vi har gjort lidt af arbejdet for dig og kondenseret de vigtigste informationer ned i vores nyeste infographic lige herunder (1,2). Husk at patienter med kronisk nedsat nyrefunktion udgør en helt særlig gruppe når det kommer til administration af morfin. Det kan du læse mere om lige her open access (3). Kh Sandra & Tobias Referencer: Thompson J, Moppett I, Wiles M. Smith and Aitkenhead’s textbook of Anaesthesia. 7e. April 2019 Kapitel 6. Elsevier. Gropper MA, Cohen NH, Eriksson LI, et al. Miller’s Anaesthesia. 9e. 2020.Bind 1. Kapitel 24. Elsevier. Tawfic QA, Bellingham G. Postoperative pain management in patients with chronic kidney disease. J Anaesthesiol Clin Pharmacol. 2015;31(1):6–13. PMID: 27991730

Fra flaskedreng til professor. Sådan lyder overskriften i Bramming ugeavis om denne episodes gæsteekspert og har du lyst, kan du læse mere om ham og hans karriere fra Brugsen i Bramming til Professor i Køge lige her. Den unge 10 årige Ole, der startede som falskedreng i Brugsen er nu lidt ældre, professor i Køge og denne episodes ekspert. Og hvilken ekspert vi her har besøg af til emnet om postoperativ smertebehandling. Professor Ole Mathiesen har brugt sit anæstesilæge-liv på andre folks smerte. I klinikken, i forskningen og undervisningen. Han har sammen med Jørgen B. Dahl skrevet kapitlet om postoperativ smerte i anæstesibogen og i denne episode beriger han os med sin store viden om smertebehandling. Under vores besøg på Oles kontor på Region Sjællands universitetshospital Køge faldt snakken så nemt, at tiden løb og indholdet voksede, så det er nu blevet til hele 3 episoder om emnet postoperativ smertebehandling. I denne første episode bliver du klogere på hvad smerte er og smertefysiologi, hvordan vi måler den og hvad smerterne gør ved patienterne og deres morbiditet og mortalitet. VI åbner op for behandling af smerter og evidensen bag den multimodale smertebehandlingsstrategi. Hvis du har behov for lige at få repeteret smertefysiologi kan vi varmt anbefale denne video: https://www.youtube.com/watch?v=5c8maFAhqIc For dig der vil dykke lidt dybere i litteraturen er det vigtigste udpluk af referencer til dagens episode at finde herunder i reference afsnittet. Kh Sandra og Tobias Referencer Thybo KH, Hägi-Pedersen D, Dahl JB, Wetterslev J, Nersesjan M, Jakobsen JC, Pedersen NA, Overgaard S, Schrøder HM, Schmidt H, Bjørck JG, Skovmand K, Frederiksen R, Buus-Nielsen M, Sørensen CV, Kruuse LS, Lindholm P, Mathiesen O. Effect of Combination of Paracetamol (Acetaminophen) and Ibuprofen vs Either Alone on Patient-Controlled Morphine Consumption in the First 24 Hours After Total Hip Arthroplasty: The PANSAID Randomized Clinical Trial. JAMA. 2019 Feb 12;321(6):562-571. PMID 30747964 Schwenk ES, Viscusi ER, Buvanendran A, Hurley RW, Wasan AD, Narouze S, Bhatia A, Davis FN, Hooten WM, Cohen SP. Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Acute Pain Management From the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists. Reg Anesth Pain Med. 2018 Jul;43(5):456-466. PMID 29870457 Fabritius ML, Wetterslev J, Mathiesen O, Dahl JB. Dose-related beneficial and harmful effects of gabapentin in postoperative pain management – post hoc analyses from a systematic review with meta-analyses and trial sequential analyses. J Pain Res. 2017 Nov 1;10:2547-2563. PMID 29138592 Fabritius ML, Strøm C, Koyuncu S, Jæger P, Petersen PL, Geisler A, Wetterslev J, Dahl JB, Mathiesen O. Benefit and harm of pregabalin in acute pain treatment: a systematic review with meta-analyses and trial sequential analyses. Br J Anaesth. 2017 Oct 1;119(4):775-791. PMID 29121288 Fabritius ML, Geisler A, Petersen PL, Nikolajsen L, Hansen MS, Kontinen V, Hamunen K, Dahl JB, Wetterslev J, Mathiesen O. Gabapentin for post-operative pain management – a systematic review with meta-analyses and trial sequential analyses. Acta Anaesthesiol Scand. 2016 Oct;60(9):1188-208. doi: 10.1111/aas.12766. Epub 2016 Jul 18. PMID 27426431 Dahl JB, Nielsen RV, Wetterslev J, Nikolajsen L, Hamunen K, Kontinen VK, Hansen MS, Kjer JJ, Mathiesen O; Scandinavian Postoperative Pain Alliance (ScaPAlli). Post-operative analgesic effects of paracetamol, NSAIDs, glucocorticoids, gabapentinoids and their combinations: a topical review. Acta Anaesthesiol Scand. 2014 Nov;58(10):1165-81. PMID 25124340 Mathiesen O, Wetterslev J, Kontinen VK, Pommergaard HC, Nikolajsen L, Rosenberg J, Hansen MS, Hamunen K, Kjer JJ, Dahl JB; Scandinavian Postoperative Pain Alliance (ScaPAlli). Adverse effects of perioperative paracetamol, NSAIDs, glucocorticoids, gabapentinoids and their combinations: a topical review. Acta Anaesthesiol Scand. 2014 Nov;58(10):1182-98. PMID 25116762

Siden ca 4000 f.kr har mennesket forsøgt at finde metoder til at dulme vores smertefulde oplevelser. Alt fra valmuefrøenes bitre opiumdråber, til brugen af bumleurt, pilebark og kokablade er blevet anvendt i et forsøg på at forhindre, at patienter løb skrigende væk fra (tand-)lægens instrumenter. Tandlægerne har især bidraget til begyndelsen af anæstesiens historie i et forsøg på at gøre tandudtrækning mindre smertefuld og tandlægen Horace Wells, kom endda rigtigt langt med brugen af lattergas. Efter at have lært at fremstille gassen og bruge den i sin praksis, forsøgte han sig i 1945 med en demonstration af anæstesi til tandudtrækning på Harvard. Forsøget mislykkedes og Wells blev gjort til grin og hans metode betegnet som humbug. Men ca. 1 år senere oprandt “Ether Day”. Den 16. Oktober 1846 i Boston, Massachusetts, på den gamle del af Harvard Medical School i et auditorium, der bare året tidligere havde været vidne til Wells fiasko, var rækkerne nu igen fyldt.  Tandlægen (og lægestudenten) William Morton gav her verdens første offentlige og succesfulde inhalationsanæstesi med æter til kirurgisk fjernelse af knude på halsen. Dekanen på Harvard Medical School og kirurg John Collins Warren udbrød de berømte ord ” Gentlemen, this is no humbug” og siden midten af 1800 tallet har inhalationsanæstesi været en del af den anæstesiologiske værktøjskasse. Mange forskellige inhalationsanæstetika har haft deres indtog på operationsgangene rundt omkring og næsten lige så mange har forladt den igen. Alle sammen fordi, de var for flygtige og dermed brændbare og besværlige at styre for anæstetisten. Tilbage står vi med fire inhalationsanæstetika som rutinemæssigt anvendes i klinikken; lattergas, isofluran, desfluran og sevofluran, hvor sevofluran klart er den vi anvender hyppigst på operationsgangene i Danmark. Lyt med i denne episode hvor Sandra og Tobias, sammen med episodens gæsteekspert, Claus Bretlau, behandler emnet inhalationsanæstesi og gør dig klogere på indikationer, tips og trick til at bedøve med gas og begreberne fordelingskoefficient og MAC. I episoden kommer vi også ind på malign hyperthermi (MH), som disponerede patienter er i risiko for at udvikle under anæstesi, hvor der gives inhalationsanæstesi eller suxamethon. Du kan læse i detaljer om behandling af malign hyperthermi her eller kigge nærmere på den infographic vi har lavet herunder. Referencer Landoni G, Lomivorotov VV, Nigro Neto C, Monaco F, et al. Volatile Anesthetics versus Total Intravenous Anesthesia for Cardiac Surgery. N Engl J Med. 2019 Mar 28;380(13):1214-1225. PMID 30888743 Miller D, Lewis SR, Pritchard MW, et al. Intravenous versus inhalational maintenance of anaesthesia for postoperative cognitive outcomes in elderly people undergoing non-cardiac surgery. Cochrane Database Syst Rev. 2018 Aug 21;8. PMID 30129968 Glahn KP, Ellis FR, Halsall PJ, Müller CR, Snoeck MM, Urwyler A, Wappler F; European Malignant Hyperthermia Group. Recognizing and managing a malignant hyperthermia crisis: guidelines from the European Malignant Hyperthermia Group. Br J Anaesth. 2010 Oct;105(4):417-20. PMID 20837722 Kh Sandra og Tobias

I denne udgave af Anæstesi A til Z er emnet ultralyd. Podcasten er baseret på kapitel 3 i bogen Anæstesi og ugens gæste-ekspert er Søren Hofmann, afdelingslæge på Bispebjerg Hospital. Søren har skrevet ph.d i ekkokardiografi og er særligt passioneret omkring brugen af ultralyd i anæstesien. I podcasten gennemgås ultralydens historie og indtog i anæstesien og hvordan anæstesien nu er nærmest uundgåeligt for enhver, der træder ind i specialet. Der tales om, hvordan man kan bruge og lære ultralyd og begreber som POCUS, FAST, FATE, og FLUS gennemgås. Er alle de ord bare bogstaver for dig, så lyt med nedenfor eller hent vores podcast på iTunes. I episoden vender vi bl.a ultralyd til udelukkelse af pneumothorax og placering af CVK efter CVK anlæggelse – det gjorde os nysgerrige på evidensen og anvendelsen. Det resulterede i denne blogpost med en litteraturgennemgang på emnet https://scanfoam.org/ultrasound-to-verify-cvc-placement/. I podcasten nævner vi også, at vi her på bloggen ville dele links til dig der gerne vil igang med at bruge ultralyd. Download CEKU’s Akut Ultralyd App her Lær ultralyd – tag DUDS Basiskursus  gennem Dansk Ultralyddiagnostisk Selskab Start din ultralydsrejse og find flere avancerede kurser gennem usabcd, der har kurser i både ind- og udland. Og for dig, der bare vil have endnu mere så følg endeligt disse #FOAMed resourcer hvor du kan lære ultralyd døgnet rundt. Ultrasound Podcast  Og glem ikke alle de andre lækre ting, de har på deres hjemmeside, inkl interaktive bøger, der kan guide dig sikkert ind i brugen af ultralyd /Sandra & Tobias

Synopsis How can we identify STEMI in patients with ventricular paced rhythm? Can we use the Sgarbossa Criteria? Below you’ll find what’s most likely (and hopefully) the silliest, catchiest and nerdiest talk on this topic recorded at the ECG masterclass from SWEETS2019. In it, Jonathan Ilicki, Alex Szeps and Elena Sgarbossa delve into how we best assess these patients. Here, first, is a bit more detail. So what are the Sgarbossa criteria? The Sgarbossa Criteria are three ECG rules that were developed by Dr Sgarbossa in 1996: Concordant ST elevation ≥ 1mm in a lead with a positive QRS complex (5 points) ST depression ≥ 1 mm in V1, V2 or V3 (3 points) Discordant ST elevation ≥ 5 mm in a lead with a negative QRS complex (2 points) 3 or more points has been shown to be highly specific (98%) for ACS in patients with LBBB​[1]​. Life on the Fast Lane has a great ECG database with a page about the Sgarbossa criteria. So can I use this for patients with ventricular paced rhythm (VPR)? There is limited research (key articles below​[2–7]​), but what has been published to date indicates the criteria are very specific, but not sensitive for ACS in patients with VPR​[8]​ (open access here). Amal Mattu has a great ECG resource called ECG Weekly. Here is an episode where he discusses using the Sgarbossa Criteria for Ventricular Paced Rhythm. This sounds great! Could anything possibly be better than the Sgarbossa criteria? Interestingly, the Smith-modified Sgarbossa Criteria have recently been shown to have superior sensitivity and specificity to the original criteria​[9]​. It wasn’t included in the presentation as it’s tricky to fit the phrase “Smith-modified Sgarbossa Criteria” into a song… Dr Smith is an ECG wizard (and also a really nice guy) and has a great blog entirely focused on how to get better at assessing ECGs. Here are a couple of posts on assessing for ACS/ACO in ECGs with VPR: Anterior MI in paced rhythm Ventricular paced rhythm and chest pain Case illustrating false positive Sgarbossa criteria Ventricular paced rhythm and chest pain again Enough of that – here’s the talk https://youtu.be/mtqhnmasaiA Audio Slides Credits Alex Szeps – find his music here on Spotify! Elena Sgarbossa – for impactful research and generous participation Therese Djärv, Jonas Willmer – for serendipitous questions Emil Boström, Niclas Lewisson, Lesli Liljegren, Johanna Berg, Lina Holmberg, Patrik Nilsson – for recording what is most likely the internet’s only song on ventricular paced rhythms A patient that permitted us to write a case report​[10]​ and spread the knowledge about how to identify ACS in ventricular paced rhythms Swedish Emergency Talks References 1. Tabas J, Rodriguez R, Seligman H, Goldschlager N. Electrocardiographic criteria for detecting acute myocardial infarction in patients with left bundle branch block: a meta-analysis. Ann Emerg Med. 2008 Oct 1;52(4):329-336.e1. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18342992 2. Herweg B, Marcus M, Barold S. Diagnosis of myocardial infarction and ischemia in the setting of bundle branch block and cardiac pacing. Herzschrittmacherther Elektrophysiol. 2016 Sep 1;27(3):307–22. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27402134 3. Freitas P, Santos M, Faria M, Rodrigues G, Vale N, Teles R, et al. ECG evaluation in patients with pacemaker and suspected acute coronary syndrome: Which score should we apply? J Electrocardiol. 2016 Sep 1;49(5):744–8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27430208 4. Sgarbossa E, Pinski S, Gates K, Wagner G. Early electrocardiographic diagnosis of acute myocardial infarction in the presence of ventricular paced rhythm. GUSTO-I investigators. Am J Cardiol. 1996 Feb 15;77(5):423–4. Available from: https://www.ncbi.nlm.nih.gov/pubmed/8602576 5. Bertel N, Witassek F, Puhan M, Erne P, Rickli H, Naegeli B, et al. Management and outcome of patients with acute myocardial infarction presenting with pacemaker rhythm. Int J Cardiol. 2017 Mar 1;230:604–9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28040280 6. Macfarlane P, Browne D, Devine B, Clark E, Miller E, Seyal J, et al. Modification of ACC/ESC criteria for acute myocardial infarction. J Electrocardiol. 2004 Jan 1;37 Suppl:98–103. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15534817 7. Maloy K, Bhat R, Davis J, Reed K, Morrissey R. Sgarbossa Criteria are Highly Specific for Acute Myocardial Infarction with Pacemakers. West J Emerg Med. 2010 Sep 1;11(4):354–7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21079708 8. Jothieswaran A, Body R. BET 2: Diagnosing acute myocardial infarction in the presence of ventricular pacing: can Sgarbossa criteria help? Emerg Med J. 2016 Sep 1;33(9):672–3. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27539980 9. Meyers H, Limkakeng A, Jaffa E, Patel A, Theiling B, Rezaie S, et al. Validation of the modified Sgarbossa criteria for acute coronary occlusion in the setting of left bundle branch block: A retrospective case-control study. Am Heart J. 2015 Dec 1;170(6):1255–64. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26678648 10. Ilicki J, Bruchfeld S, Kolsrud B, Böhm F, Djärv T. Sgarbossa criteria used to identify cardiac ischemia in patient with ventricular paced rhythm. J Electrocardiol. 2018 Jan 1;51(5):830–2. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30177322

Synopsis How do you become awesome at emergency triage? Is it possible to create a perfect emergency triage system? How will triage work in the future? This lecture from the Swedish National Emergency Nursing Conference (Akutsjuksköterskedagarna 2019) busts some triage myths, provides top advice from experienced nurses and offers a glimpse into the future of triage. The lecture is in Swedish and has English subtitles. Video https://youtu.be/03cVCXrxqxw Audio Slides Conflicts of interest I previously performed a project for Predicare (a non-profit company developing RETTS, a triage system commonly used in Sweden) I currently work for Doktor24, a digiphysical healthcare provider that develops and provides digital triage systems Credits All the nurses that responded to the survey regarding triage SENA (Swedish Emergency Nurse Association) and Dagens Medicine for inviting me to speak Helena Forsén & Johan Hultgren (sharing their top advice) Sofie Naredi (valuable feedback) Therese Djärv and Patrik Nilsson (recording) References 1) Mackway-Jones K. Emergency triage: Manchester Triage Group. London: BMJ Publishing Group, 1997. 2) Wuerz RC, Milne LW, Eitel DR, Travers D, Gilboy N. Reliability and validity of a new five-level triage instrument. Acad Emerg Med. 2000 Mar;7(3):236-42. [PubMed] 3) Gottschalk SB, Wood D, DeVries S, Wallis LA, Bruijns S; Cape Triage Group. The Cape Triage Score: a new triage system South Africa. Proposal from the Cape Triage Group. Emerg Med J. 2006 Feb;23(2):149-53. [PubMed] 4) Widgren BR. [Results following standardized routine at the emergency department. Fewer circulatory/respiratory arrest and increased survival with METTS]. Lakartidningen. 2009 Sep 23-29;106(39):2444-5. [PubMed] 5) Christ M, Grossmann F, Winter D, Bingisser R, Platz E. Modern triage in the emergency department. Dtsch Arztebl Int. 2010 Dec;107(50):892-8. [PubMed] 6) van Ierland Y, van Veen M, Huibers L, Giesen P, Moll HA. Validity of telephone and physical triage in emergency care: the Netherlands Triage System. Fam Pract. 2011 Jun;28(3):334-41. [PubMed] 7) Ng CJ, Yen ZS, Tsai JC, Chen LC, Lin SJ, Sang YY, Chen JC. Validation of the Taiwan triage and acuity scale: a new computerised five-level triage system. Emerg Med J. 2011 Dec;28(12):1026-31. [PubMed] 8) Bambi S, Ruggeri M, Sansolino S, Gabellieri M, Tellini S, Giusti M, Ciulli E, Franchi F, Petrocchi L, Olivi M, Gravili RC, Biancalana P, Millanti A, Martini L, Sgrevi P. Emergency department triage performance timing. A regional multicenter descriptive study in Italy. Int Emerg Nurs. 2016 Nov;29:32-37. [PubMed] 9) Rutschmann OT, Hugli OW, Marti C, Grosgurin O, Geissbuhler A, Kossovsky M, Simon J, Sarasin FP. Reliability of the revised Swiss Emergency Triage Scale: a computer simulation study. Eur J Emerg Med. 2018 Aug;25(4):264-269. [PubMed] 10) Iversen AKS, Kristensen M, Østervig RM, Køber L, Sölétormos G, Lundager Forberg J, Eugen-Olsen J, Rasmussen LS, Schou M, Iversen KK. A simple clinical assessment is superior to systematic triage in prediction of mortality in the emergency department. Emerg Med J. 2019 Feb;36(2):66-71. [PubMed] 11) Swedish Council on Health Technology Assessment. Triage Methods and Patient Flow Processes in Emergency Departments: A Systematic Review. Swedish Council on Health Technology Assessment (SBU); 2010 Apr. SBU Yellow Report No. 197 [PubMed] 12) Moll HA. Challenges in the validation of triage systems at emergency departments. J Clin Epidemiol. 2010 Apr;63(4):384-8. [PubMed] 13) Hinson JS, Martinez DA, Cabral S, George K, Whalen M, Hansoti B, Levin S. Ann Emerg Med. Triage Performance in Emergency Medicine: A Systematic Review. 2018 Nov 20. pii: S0196-0644(18)31282-4. [PubMed] 14) Brouns SHA, Mignot-Evers L, Derkx F, Lambooij SL, Dieleman JP, Haak HR. Performance of the Manchester triage system in older emergency department patients: a retrospective cohort study. BMC Emerg Med. 2019 Jan 7;19(1):3. [PubMed] 15) Dabby R, Watemberg N, Lampl Y, Eilam A, Rapaport A, Sadeh M. Pathological laughter as a symptom of midbrain infarction. Behav Neurol. 2004;15(3-4):73-6. [PubMed] 16) Beaumont O, Miller R, Guy R. Atypical presentation of appendicitis. BMJ Case Rep. 2016 Nov 10;2016. pii: bcr2016217293. [PubMed] 17) Saunders T, Suzuki T. Atypical presentation of acute aortic dissection in a young competitive rower. BMJ Case Rep. 2018 Sep 4;2018. pii: bcr-2018-225712. [PubMed] 18) Levin S, Toerper M, Hamrock E, Hinson JS, Barnes S, Gardner H, Dugas A, Linton B, Kirsch T, Kelen G. Machine-Learning-Based Electronic Triage More Accurately Differentiates Patients With Respect to Clinical Outcomes Compared With the Emergency Severity Index. Ann Emerg Med. 2018 May;71(5):565-574.e2.[PubMed] 19) Hong WS, Haimovich AD, Taylor RA. Predicting hospital admission at emergency department triage using machine learning. PLoS One. 2018 Jul 20;13(7):e0201016. [PubMed] 20) Kim D, You S, So S, Lee J, Yook S, Jang DP, Kim IY, Park E, Cho K, Cha WC, Shin DW, Cho BH, Park HK. A data-driven artificial intelligence model for remote triage in the prehospital environment. PLoS One. 2018 Oct 23;13(10):e0206006. [PubMed] 21) Rendell K, Koprinska I, Kyme A, Ebker-White AA, Dinh MM. The Sydney Triage to Admission Risk Tool (START2) using machine learning techniques to support disposition decision-making. Emerg Med Australas. 2018 Nov 23. [PubMed] 22) Goto T, Camargo CA Jr, Faridi MK, Freishtat RJ, Hasegawa K. Machine Learning-Based Prediction of Clinical Outcomes for Children During Emergency Department Triage. JAMA Netw Open. 2019 Jan 4;2(1):e186937. [PubMed]

Synopsis This is the talk by Richard Lyon at The Bick Sick in Zermatt, 2018. Richard goes over initiatives taken to improve what were dismal outcomes in Scotland in the out-of-hospital cardiac arrest population. Tune in to hear about the marginal gains approach applied with attention to every little detail. Learn how to improve your clinical audit data to allow feedback to the clinicians and how to lead the way forward in your own organisations and communities. Finally, some thoughts on how new and upcoming technology can be harnessed to provide even better care for this patient group. Video Audio Slides References Surviving out of hospital cardiac arrest at home: a postcode lottery? (Lyon et al, EMJ 2004 open access) Variability in cardiac arrest survival: the NHS Ambulance Service Quality Indicators (Perkins et al, EMJ 2011 open access) The Wissenberg et al study from Denmark (JAMA 2013 open access) The GoodSam App Equivalent apps in Denmark are Hjerteløber (register as CPR provider) and Hjertestarter (find nearest AED) Save a life for Scotland Matrix, the movie (if Ken Milne does must-know 80s film references, we’ll do the 90s) Vinnie Jones teaches CPR, the full clip Support Richard’s research and learn to make your own Mars bar fritters Speaker bio Dr. Lyon is a consultant in emergency medicine and clinical lead for Medic1 at the Royal Infirmary of Edinburgh. He is associate medical director of Kent, Surrey & Sussex Air Ambulance and chair or Pre-hospital Emergency Care at the University of Surrey. Born in Luxembourg, he became a volunteer fireman at the age of 15 and developed an early passion for pre-hospital emergency care. He completed a unique doctorate thesis on out-of-hospital cardiac arrest (OHCA) – the TOPCAT study, which has formed the basis of a successful programme of work to improve outcome from OHCA across Scotland. He is active in resuscitation and trauma research and was proud to be part of the winning BMJ Awards Emergency Medicine Team of the Year. He has won numerous national and international awards for his work and in 2017 was awarded an MBE in Her Majesty The Queen’s Birthday Honours for services to emergency healthcare. Find him here twitter email Pubmed Before you go, don’t forget to share widely, options below leave a comment and join the #FOAMed conversation in general connect with the scanFOAM project and team on Twitter, Facebook, Instagram or write us an old fashioned email get the new stuff via RSS

Synopsis This is James DuCanto‘s talk at the airway session of The Bick Sick in Zermatt, 2018. Jim is well known in the FOAM sphere and beyond for his passion on airway management and is a very dedicated and ingenious inventor of equipment for airway simulation and airway management. Jim is tinkerer of epic proportions and is always great fun to hang out with as there’s bound to be some new crazy contraption he wants to show off. I for one personally feel his beeryngoscope deserves a lot more recognition (no, I don’t think it’s trademarked yet, but it ought to be). Here it is out in the wild at #smaccUS. https://youtu.be/o3_DMrWVQSY On a more serious note, in recent years Jim has focused a lot of energy on the SALAD concept (Suction Assisted Laryngoscopy Airway Decontamination) which essentially is continuous large bore catheter suctioning of the upper airway through the whole intubation process. He has demonstrated it at numerous conferences throughout the world including at iterations of SMACC. The amount of flights cases he drags around the world for his SALAD teaching is quite insane and a testiment to Jim’s no holds barred approach to airways. If you get a chance to try it out do take it as it’ll probably be your one shot at intubating a regurgitating wookie with a laryngoscope blade fitted to an axe. Follow Jim down the rabbit hole of contaminated airways in this talk. Video https://youtu.be/uSYFamlG_N0 Audio Slides Related resources Mostly from Jim’s slide set Jim’s website SALAD 2.0 video General Description of system and demonstration by Jeff Hill of the University of Cincinnati’s EM Program Product page of SALAD Mannequin, Nasco Video of the University of Wisconsin HEMS Fellow with the “Static” Excercise Video of the University of Wisconsin HEMS Fellow with the “Dynamic” Excercise Video of the University of a Wisconsin HEMS Attending taking on the SALAD Simulator System construction—how to build your own SALAD training system Before you go, don’t forget to share widely, options below leave a comment and join the #FOAMed conversation in general connect with the scanFOAM project and team on Twitter, Facebook, Instagram or write us an old fashioned email get the new stuff via RSS

Synopsis Geir Strandenes’ talk at The Bick Sick in Zermatt, 2018. Geir does a tour de force on blood transfusion, its history, physiology, the evidence base and ongoing developments in prehospital transfusion practice in both civilian and military settings. He specifically adresses how to apply principles of damage control resuscitation to remote locations and the introduction of fresh whole blood prehospitally from the point of injury onward. Geir represents the THOR network (Trauma Hemostasis and Oxygenation Research network). You can find a lot more information on their website. Video Audio Slides Before you go, don’t forget to share widely, options below leave a comment and join the #FOAMed conversation in general connect with the scanFOAM project and team on Twitter, Facebook, Instagram or write us an old fashioned email get the new stuff via RSS

Synopsis The Big Sick conference in february 2018 was a hugely rewarding, small-format conference that brought resuscitation nerds together in the perfect setting of Zermatt, Switzerland. Top speakers and top talks, but the conference was a total blast not least because the group of delegates was very sociable and interested in learning from each outside the sessions as much as during them. Other commitments have postponed editing, but the talks are now getting ready to go online and we hope you’ll find the content was worth the wait. We will release talks intermittently these next few months awaiting the next installment in february 2019. Here first is a talk by prof. Samuel Tisherman from Baltimore’s shock trauma center on deep hypothermia as a means to buying time in refractory traumatic cardiac arrest. He describes the history of how this therapy was developed from early animal models up until the current human EPR-CAT trial. Video Audio Slides Before you go, don’t forget to share widely, options below leave a comment and join the #FOAMed conversation in general connect with the scanFOAM project and team on Twitter, Facebook, Instagram or write us an old fashioned email get the new stuff via RSS

Synopsis Cliff Reid and Brian Burns are known world wide for their work in prehospital education, training and research, most notably at the Greater Sydney Area HEMS service. We were fortunate to have them come visit at the REPEL course and they kindly agreed to give a talk each at Odense University Hospital. Here’s Brian’s talk on the efforts required to securing optimal team performance from an organisational and systemic view point. This is very applicable to other prehospital services and the GSA HEMS service sets an admirable example on transparency in education and data sharing. Related FOAMed GSA HEMS website, for educational goodies and information on the service Cliff Reid’s talk from the same day on training HEMS teams Video Audio Slides Before you go, don’t forget to share widely, options below leave a comment and join the #FOAMed conversation in general connect with the scanFOAM project and team on Twitter, Facebook, Instagram or write us an old fashioned email get the new stuff via RSS

Synopsis Cliff Reid and Brian Burns are known world wide for their work in prehospital education, training and research, most notably at the Greater Sydney Area HEMS service. We were fortunate to have them come visit at the REPEL course and they kindly agreed to give a talk each at Odense University Hospital. Here’s Cliff’s talk with 10 lessons from his many years developing a world class HEMS training programme. Related FOAMed The GSA HEMS website for educational content and info on the service Brian Burn’s talk from the same day on governance and the systemic view on obtaining high performance teams Cliff has loads of amazing resus and training related musings on his blog resus.me Video Audio Slides Before you go, don’t forget to: share widely, options below leave a comment and join the #FOAMed conversation in general connect with the scanFOAM project and team on Twitter, Facebook, Instagram or write us an old fashioned email get the new stuff via RSS

Speaker: Sandra Viggers Event: Copenhagen Critical Care Symposium 2018 Session: Critical Care i perspektiv Return to index Synopsis Sandra Viggers taler om, hvordan vi kan udnytter simulation til at gøre os bedre og øge patientsikkerheden Video https://youtu.be/https://youtu.be/Z1syQ31g9XQ Podcast Slides Before you go, don’t forget to: share widely comment below and join the #FOAMed conversation in general connect with the scanFOAM project and team on Twitter, Facebook, Instagram or write us an old fashioned email get the new stuff via the newsletter (sign up on frontpage) or via RSS

Speaker: Daniel Kondziella Event: Copenhagen Critical Care Symposium 2018 Session: Hjernestop – akut kritisk blod i hjernen Return to index Synopsis Daniel Kondziella taler om neurologisk tilgang til den akutte neurologiske patient, når CTC er blank Video https://youtu.be/https://youtu.be/K7v5F5iHEVk Podcast Slides Before you go, don’t forget to: share widely comment below and join the #FOAMed conversation in general connect with the scanFOAM project and team on Twitter, Facebook, Instagram or write us an old fashioned email get the new stuff via the newsletter (sign up on frontpage) or via RSS

Speaker: Morten Hylander Møller Event: Copenhagen Critical Care Symposium 2018 Session: The Magical Mystery Tour – sepsis 2018 Return to index Synopsis Morten Hylander Møller forsøger at besvare, om der stadig er magic bullets tilbage i sepsisbehandling Video https://youtu.be/https://youtu.be/wu2obLdNEcQ Podcast Slides Before you go, don’t forget to: share widely comment below and join the #FOAMed conversation in general connect with the scanFOAM project and team on Twitter, Facebook, Instagram or write us an old fashioned email get the new stuff via the newsletter (sign up on frontpage) or via RSS

Speaker: Nicolai Haase Event: Copenhagen Critical Care Symposium 2018 Session: The Magical Mystery Tour – sepsis 2018 Return to index Synopsis Nicolai Haase giver sit bud på væskebehandling ved sepsis Video https://youtu.be/https://youtu.be/_9A7y-tJqT0 Podcast Slides Before you go, don’t forget to: share widely comment below and join the #FOAMed conversation in general connect with the scanFOAM project and team on Twitter, Facebook, Instagram or write us an old fashioned email get the new stuff via the newsletter (sign up on frontpage) or via RSS

Speaker: Peter Berlac Event: Copenhagen Critical Care Symposium 2018 Session: Critical Care i perspektiv Return to index Synopsis Peter Berlac gennemgår status for terrorberedskabet i Danmark Video https://youtu.be/https://www.youtube.com/watch?v=TV4G0Ap3-Es Podcast Slides Before you go, don’t forget to: share widely comment below and join the #FOAMed conversation in general connect with the scanFOAM project and team on Twitter, Facebook, Instagram or write us an old fashioned email get the new stuff via the newsletter (sign up on frontpage) or via RSS

Speaker: Thomas Strøm og Lars Simon Rasmussen Event: Copenhagen Critical Care Symposium 2018 Session: Critical Care litteratur – update 2018 Return to index Synopsis Nøglestudier fra 2018 som alle bør kende, udvalgt og gennemgået af Lars Rasmussen og Thomas Strøm Video https://youtu.be/https://www.youtube.com/watch?v=V9wkCZRuKy8&t=79s Podcast Slides Before you go, don’t forget to: share widely comment below and join the #FOAMed conversation in general connect with the scanFOAM project and team on Twitter, Facebook, Instagram or write us an old fashioned email get the new stuff via the newsletter (sign up on frontpage) or via RSS

Speaker: Thomas Birkelund Event: Copenhagen Critical Care Symposium 2018 Session: Det ustabile kredsløb – kardiovaskulære resuscitation Return to index Synopsis Ove Bergdal gennemgår erfaringer med og tilgang til E-CPR/ECMO i Aarhus Video https://youtu.be/https://youtu.be/4TUijMzyJbA Podcast Slides Before you go, don’t forget to: share widely comment below and join the #FOAMed conversation in general connect with the scanFOAM project and team on Twitter, Facebook, Instagram or write us an old fashioned email get the new stuff via the newsletter (sign up on frontpage) or via RSS

Speaker: Peter Dieckmann Event: Copenhagen Critical Care Symposium 2018 Session: Critical Care i perspektiv Return to index Synopsis Peter Dieckmann gennemgår erfaringer med og tilgang til E-CPR/ECMO i Aarhus taler om beslutningstagning i kliniske virkelighed hos de kritiske patienter Video https://youtu.be/https://youtu.be/CbrYuW13YcM Podcast Slides Before you go, don’t forget to: share widely comment below and join the #FOAMed conversation in general connect with the scanFOAM project and team on Twitter, Facebook, Instagram or write us an old fashioned email get the new stuff via the newsletter (sign up on frontpage) or via RSS