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Showing category "Clinical topics" (Show all posts)

Renal tract trauma

Posted by Matthew Mac Partlin on Thursday, August 10, 2017, In : Clinical topics 

You've picked up a competitor from the track following a collision that occurred on the exit of a high speed turn. He's now at the medical centre and has begun to complain of flank pain. He's certainly pretty tender over his right lower ribs posteriorly and on further examinations there's a little bit of blood where wee usually comes out.

Eeek! He might have blunt renal tract trauma.

Luckily, you've just been to this website and read through the material below. Having taken care of the core res...

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The crushing weight of evidence

Posted by Matthew Mac Partlin on Wednesday, September 21, 2016, In : Clinical topics 
It's interesting how things sometimes seem to come together at the same time for different reasons. I've been thinking about extrication recently in the setting of a competitor trapped by compression. That got me thinking about a talk given by Sydney HEMS doctor, Cliff Reid, titled "The wrong stuff" during which he went through some pre-hospital dogma bug-bears (bug-dogs?), including the management of crush injury/syndrome. At the same time of my pondering a tweet went out for a doctor in Ita...

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Flight after a pneumothorax

Posted by Matthew Mac Partlin on Wednesday, August 10, 2016, In : Clinical topics 

There have been a number of incidents at motorsport events that have resulted in a blunt chest injury mechanism with the competitor presenting to the event medical centre for assessment and while no major injuries were found they have subsequently been diagnosed with a pneumothorax. Usually it has been a small one, associated with one or more fractured ribs, diagnosed on a CT. Some of the more high profile incidents include:


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How to do simulation training well

Posted by Matthew Mac Partlin on Tuesday, August 9, 2016, In : Clinical topics 
The previous blog post covered a recent session that I ran for some Australian Rally Championship competitors which covered First On Scene Response training. The aim of the session was to give the competitors some basic skills so that should they be the first to arrive at a rally accident where someone has been seriously injured they have a framework to get help and provide some potentially life or limb saving assistance, buying time for the medical team. The session was deliberately practica...

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Australian Resuscitation Council Guidelines 2016 update

Posted by Matthew Mac Partlin on Friday, February 26, 2016, In : Clinical topics 


The Australian Resuscitation Council, in co-operation with the New Zealand Resuscitation Council have at last published their local take on the recently released ILCOR 2015 guideline update for adult, paediatric and neonatal basic and advanced resuscitation. Released in mid January, the combined Australian and New Zealand update makes recommendations for how resuscitation should be conducted here based on the evidence and guidelines issued by the central body, ILCOR.

You can read my summary of...

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Pearls from FOAMed

Posted by Matthew Mac Partlin on Wednesday, November 18, 2015, In : Clinical topics 
Many of you reading this post will be familiar with the term FOAMed, which is an acronym for Free Open Access Meducation. (If it is new to you, find out more about this concept on these blog posts and articles - LITFL - FOAM / The Short Coat - What is FOAM?EMA - Free Open Access Medical education (FOAM) for the emergency physician). There are subsets of FOAMed, such as FOAMcc (critical care), FOAMped (paeds), FOAMlit (literature review and research) and FOAM4GP (general practice) which ca...

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ILCOR 2015 - Does it matter for motorsports?

Posted by Matthew Mac Partlin on Monday, November 9, 2015, In : Clinical topics 


Every five years the International Liason Committee On Resuscitation reviews the currently available evidence and updates its recommendations regarding resuscitation. The review board is large and made up of resuscitation experts from all over the world and from several specialty areas, including emergency medicine, prehospital medicine and critical care. The recommendations that they write carry a lot of weight and are in turn taken by the lead resuscitation bodies in the various countries a...

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Apnoeic oxygenation by nasal cannulae during RSI

Posted by Matthew Mac Partlin on Thursday, October 22, 2015, In : Clinical topics 
Apnoeic oxygenation has been around for a while and the NODESAT (Nasal Oxygen During Efforts Securing A Tube) application has become a fixture on many ED, ICU and Prehospital RSI checklists since the publication of Weingart and Levitan's 2011 article in the Annals of Emergency Medicine,

Preoxygenation and prevention of desaturation during emergency airway management.
Weingart SD1, Levitan RM. Ann Emerg Med. 2012 Mar;59(3):165-75.e1. doi: 10.1016/j.annemergmed.2011.10.002.
Epub 2011 Nov 3.

Desp...

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Article review - Concussion

Posted by Matthew Mac Partlin on Friday, May 8, 2015, In : Clinical topics 


Concussion has been a big topic over the past two years or so and it has certainly featured in a couple of posts on this website. There is a lot about it that is still poorly understood.
  • What is the pathophysiology?
  • Does second impact syndrome really exist?
  • Does chronic traumatic encephalopathy really exist?
  • What is the best marker of readiness to return to active competition?
There is a very helpful review article in the Seminars in Neurology journal written by Meeryo, Chloe and Giza, titled "Dia...

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Critical decision making

Posted by Matthew Mac Partlin on Thursday, August 21, 2014, In : Clinical topics 
For those of you who don't know him, Dr. Scott Weingart is a New York based emergency and critical care physician. He is a powerhouse of education and training in this specialist area, writing books and articles and speaking at top end conferences and workshops. He is someone I have gotten to know through various contacts and consider him a friend.



Scott runs his own site, called EM Crit, which is a fantastic resource, choc full of everything critical care, from procedures to cutting edge conc...

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C-spine collar glory days

Posted by Matthew Mac Partlin on Wednesday, May 21, 2014, In : Clinical topics 


Sorry about this. I had planned to put up a post on the devolving role of the semi-rigid cervical spine collar two weeks ago. However, the more I read about it, the more I wrote and I ended up with a five page document. Waaay too long for a blog post!

So what I'm going to do instead is submit the original piece to a journal as an opinion piece and see if I can get it published. If that happens I'll put up a link to the article. In the meantime, as it may take some time to get through the edito...

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Concussion biomarkers - The new brain 'troponins'?

Posted by Matthew Mac Partlin on Wednesday, April 2, 2014, In : Clinical topics 


My thanks to Rik Hagen for the heads up on this article on a trial of brain injury biomarkers; specifically neuron-specific enolase (NSE), S100 calcium-binding protein (S100-B) nad total tau protein (T-tau).

Now, I can hear your eyelids closing already, but stick with me on this because it may be an indicator of future directions, both in terms of how we approach concussion in sport and perhaps for the level of expectation that is placed on the abilities of medics providing cover at sporting e...

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Compensation for Chronic Traumatic Encephalopathy

Posted by Matthew Mac Partlin on Sunday, January 19, 2014, In : Clinical topics 
Posted by Matthew Mac Partlin on Wednesday, September 4, 2013

Concussion in sports and its associated complications have bubbled to the surface of public media again recently. And there may be wider implications to the latest development, which relates to the controversial entity known as Chronic Traumatic Encephalopathy, or CTE.

Competitors who suffer repeated concussion events are considered by many experts to be at risk of developing cognitive, behavioural, mood and somatic d...
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The 2013 AAN Guidelines on sports related concussion

Posted by Matthew Mac Partlin on Sunday, January 19, 2014, In : Clinical topics 
Posted by Matthew Mac Partlin on Thursday, March 28, 2013



The American Academy of Neurology released their guidelines on concussion in sport this month. They serve as an update to the existing guidelines, orginally published in 1997. The evidence is mostly drawn from field sports; rugby, soccer, hockey, basketball. 7 of the 12 panel of experts were non-neurologists, drawing from other specialties that are involved in managing concussed athletes. The 2013 guidelines involved a review of all ava...
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Monitoring on the go

Posted by Matthew Mac Partlin on Sunday, January 19, 2014, In : Clinical topics 
Posted by Matthew Mac Partlin on Saturday, March 16, 2013

I'm sitting in the front passenger seat of a Mercedes E250 station wagon between Turns 13 and 14 of the Albert Park Formula 1 GP circuit watching Ferrari, Red Bull, McLaren and the others zip around. Earlier in the day I was chatting to the senior ambulance co-ordinator who gave me some interesting reading material.

It is a brochure from a company called Remote Diagnostic Technologies Ltd who produce a portable patient monitor called the...
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Swept into the Vortex

Posted by Matthew Mac Partlin on Sunday, January 19, 2014, In : Clinical topics 
Posted by Matthew Mac Partlin on Wednesday, March 6, 2013



Yet another development in airway management has appeared. I came across it about a month ago and it's worth having a think about how it might fit in with motorsports resuscitation.

It is called the Vortex Approach and is designed for use when you find yourself in an unexpected difficult or failed airway situation. The Vortex Approach is a cognitive model developed by two Australians, Dr Nicholas Chrimes, an anaesthetist at Monash Medica...
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Pre-hospital RSI - Addressing some of the challenges

Posted by Matthew Mac Partlin on Sunday, January 19, 2014, In : Clinical topics 
Posted by Matthew Mac Partlin on Wednesday, January 23, 2013



Airway management can be a cause of great stress in the well apportioned and resourced resus bay of an ED or an ICU or in an operating theatre. The stress factor is magnified in the pre-hospital environment where the conditions and elements may operate against you. This can be even worse if you are working with people and equipment that you are unfamiliar with, as is not uncommon at motorsport events.

So it's always worth seeing how t...
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Extraglottic airway device review

Posted by Matthew Mac Partlin on Sunday, January 19, 2014, In : Clinical topics 
Posted by Matthew Mac Partlin on Wednesday, January 16, 2013

Back when I started up the ASMMR and put out a newsletter, I wrote a piece on the range of airway devices available, from simple oropharyngeal airways to endotracheal intubation (You can read it here: ASMMR Vol 1, Issue 3, July 2009). Recently I came across a review article in Anaesthesia & Analgesia devoted just to extraglottic airways (also known as supraglottic airways, though there is some semantics involved) and it makes a good ...
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Pre-hospital intubation using ultrasound - What, huh?

Posted by Matthew Mac Partlin on Saturday, January 18, 2014, In : Clinical topics 
Posted by Matthew Mac Partlin on Friday, November 16, 2012

OK, so we all love ultrasound; who doesn't? I remember a time when ultrasound was a diagnostic utility that gave medical school physics lecturers something to talk about and later on, a modality that lived somewhere at the back of a dark corner of the radiology department, crooned over by pale-faced, moon-eyed individuals. In the past couple of years, it is a modality that has arisen phoenix-like and has become almost the next Seldinge...
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The truth about Permissive Hypotension in Trauma

Posted by Matthew Mac Partlin on Saturday, January 18, 2014, In : Clinical topics 
Posted by Matthew Mac Partlin on Monday, September 10, 2012

Trauma is a diaphenous beast, simultaneously simple and complex. The priciples that underpin it are apparently straight-forward enough and yet some of the concepts and management strategies generate intense controversy and debate. If you read much trauma literature, there are a couple of names that recur routinely; one of those is London-based Trauma and Vascular surgeon, Dr. Karim Brohi, who is the driving force behind the Trauma.org...
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Clinical logistics: A key pillar for efficient provision of acute care

Posted by Matthew Mac Partlin on Saturday, January 18, 2014, In : Clinical topics 
Posted by Matthew Mac Partlin on Monday, September 10, 2012

One of the many nice things about working as a medic at motorsports events, apart from the cars, the racing and the atmosphere, is the chance to work alongside a focused group who share the same goals and work co-operatively to a purpose. Everyone brings something to the playing field and a lot of traditional barriers come down. This probably explains in part why managing a trauma victim in a hazardous, resource-limited, potentially h...
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Trauma coagulopathy & Head and Spinal injury prediction

Posted by Matthew Mac Partlin on Saturday, January 18, 2014, In : Clinical topics 
Posted by Matthew Mac Partlin on Wednesday, August 1, 2012

If you keep an eye on some of the great critical care blog sites, at some point you will have come accross Cliff Reid's Resus M.E. site. Recently he has put up 2 great posts that should be of interest to all of us who practice medicine and rescue in motor sports.

The first is a presentation given by HEMS doctor, Pete Sherren, on the bleeding trauma patient. He outlines an illustrative pre-hospital case and follows through to the ICU ad...
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Ketamine in trauma and pre-hospital medicine

Posted by Matthew Mac Partlin on Saturday, January 18, 2014, In : Clinical topics 
Posted by Matthew Mac Partlin on Sunday, July 22, 2012

Ketamine seems to be one of those divisive drugs that some practicioners really love using (professionally of course), some seem to despise and some are put off by the scare stories that permeate the textbooks. The preservation of airway reflexes and comparative haemodynamic stability draws favour, while the age-associated emergence phenomenon, increase in ICP and incidence of laryngospasm draws fire.

From a practical point of view, it is a...
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Concussion and the 'Second Impact Syndrome'

Posted by Matthew Mac Partlin on Saturday, January 18, 2014, In : Clinical topics 
Posted by Matthew Mac Partlin on Friday, June 8, 2012

I've been working away on a project for concussion in motorsport and it seems that, much like the rest of medicine, the more we examine what we think we know, the less we find we really do.

Concussion is a problematic injury in sports in general. It's easy to miss and has the potential to do further harm. Watching a rugby player stumble around the field after a blow to his head makes it easy to see how he could fall over and dislocate a sho...
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Captain Morgan, sailing the salty seas

Posted by Matthew Mac Partlin on Saturday, January 18, 2014, In : Clinical topics 
Posted by Matthew Mac Partlin on Wednesday, May 30, 2012

Out of theatre hip reductions are notoriously difficult and usually require a fairly beefy proceduralist (Thank Heaven for orthopods), a good deal of sedation and have a fair degree of risk of injury to both patient and practitioner. A competitor who's had his or her foot braced against the cockpit's firewall for a head on impact runs the risk of a posterior hip joint dislocation, with an associated acetabular fracture risk. Any vascular...
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Scalpel-finger-tube emergency surgical cricothyroidotomy

Posted by Matthew Mac Partlin on Saturday, January 18, 2014, In : Clinical topics 
Posted by Matthew Mac Partlin on Saturday, May 19, 2012

Airway management is a hot topic amongst ED, critical care and pre-hospital communities and emergency cricothyroidotomies are generally the procedures that create the most angst. Largely it's the decision that it needs to be performed that fills most pants, rather than the actual doing. But just to make it a bit more troublesome, there are several approaches that are promoted.

Two Adelaide anaesthetists who also work in retreival, have rep...
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Continuing after concussion

Posted by Matthew Mac Partlin on Saturday, January 18, 2014, In : Clinical topics 
Posted by Matthew Mac Partlin on Thursday, April 26, 2012

I caught up with the IRC Series recently and watched the Circuit of Ireland event on wrcforeva's YouTube channel. If you watch "IRC 2012 Circuit of Ireland - Day 2 Highlights" at about 17:54 on the timeline, Andreas Mikkelsen has a high speed side impact with a haybale barrier on the short Lisburn stage.



The commentator states that Mikkelsen lost 40 seconds on the stage and complained of "dizziness". It is suggested that he sustained a ...
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Good stuff from online

Posted by Matthew Mac Partlin on Saturday, January 18, 2014, In : Clinical topics 
Posted by Matthew Mac Partlin on Wednesday, April 4, 2012

Some good stuff coming from ED and Critical care blogosphere and Twitterverse. Here are some recent ones:

George Douros (Victorian ED physician) RSI checklist. relevant to in-hospital practice but worth looking at and I like the S.O.A.P.M.E. mnemonic (not for the reasons you might think).

Minh Le Cong (Queensland retrievalist and regular guest on multiple blogs and sites) - Pre-hospital retrieval pearls. Worth listening to as they are cl...
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Fluid type in volume resuscitation

Posted by Matthew Mac Partlin on Saturday, January 18, 2014, In : Clinical topics 
Posted by Matthew Mac Partlin on Friday, March 9, 2012

The European Society of Intensive Care Medicine recently issued a consensus statement on volume therapy in critically ill patients , in which they make 10 recommendations in all, based on the GRADE system. Of interest to the motorsport medical community is their recommendations on choice of fluid for trauma, traumatic brain injury and burns.

Recommendation 4 states that albumin and synthetic colloids (e.g. gelofusin, hydroxyethyl starch) s...
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Tranexamic acid in trauma

Posted by Matthew Mac Partlin on Saturday, January 18, 2014, In : Clinical topics 
Posted by Matthew Mac Partlin on Monday, March 5, 2012

The use of Tranexamic Acid in truamatic haemorrage has been gaining increasing attention since the publication of the CRASH-II trial in 2010. Tranexamic acid (TXA) is an antifibrinolytic, meaning that it prevents the breakdown of clot that has already formed. This is different to the commonly used FFP and prothrombin complex concentrates (PCC), which provide clotting factors to facilitate clot formation and the much more expensive Factor ...
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The value add of hard c-spine collars

Posted by Matthew Mac Partlin on Saturday, January 18, 2014, In : Clinical topics 
Posted by Matthew Mac Partlin on Monday, February 27, 2012

Courtesy of Cliff Reid's Resus.ME blog, here's an interesting article (Emerg Med J. 2012 Feb;29(2):104-7) that questions the added value of applying a hard c-spine collar to a trauma victim who is already secured on a spine board with head blocks and strapping. Balanced against the apparent lack of benefit is the potential for harm due to a greater limitation of mouth opening while a hard collar is in situ; though conventional practice...
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Intubation in the field - Clear enough space!

Posted by Matthew Mac Partlin on Thursday, January 16, 2014, In : Clinical topics 
Posted by Matthew Mac Partlin on Tuesday, December 13, 2011

Check out this article for some insights on factors that make pre-hospital intubation a challenge.

Difficult prehospital endotracheal intubation – predisposing factors in a physician based EMS. Resuscitation 2011 Dec;82(12):1519-24.

A European study that attempted to identify factors that influenced the difficulty of pre-hospital, physician conducted intubation. Along with the usual patient features that have previous been identified,...
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Inventive approach to rapid cricothyroidotomy

Posted by Matthew Mac Partlin on Thursday, January 16, 2014, In : Clinical topics 
Posted by Matthew Mac Partlin on Tuesday, November 1, 2011

Emergency cricothyroidotomy is a scary beast in the resus room of a tertiary hospital ED. Having it flop down in front of you at a race event is a pant filler!

There is constant debate over the best method to use, bouncing between needle cric and scalpel cric with various versions of tube introduction. There are supporters of both approaches, with cogent arguments on both sides, as seen on the previously mentionned EM Crit debate, betw...
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Can't intubate, can't oxygenate debate

Posted by Matthew Mac Partlin on Thursday, January 16, 2014, In : Clinical topics 
Posted by Matthew Mac Partlin on Friday, August 19, 2011

Scott Weingart, of EMCrit, has podcasted a useful debate on the pros and cons of two airway techniques for the "can't intubate, can't oxygenate" disaster. He has also linked to several useful YouTube videos. Check out the details here.

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