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Showing category "Clinical topics" (Show all posts)

Cervical collars and spinal cord injury protection

Posted by Matthew Mac Partlin on Friday, June 14, 2024, In : Clinical topics

It’s not a black and white choice of collar or not, good or bad, routine or never.

In the setting of an actual or probable cervical spine injury, providing stability control is widely accepted as better than providing no stabilization at all. It is then an issue of how best to provide that stability control.

The choice is dynamic, not “set and forget”. Two things are important in making one’s choice:

Being able to justify the choice based on a sound assessment of the evidence and how it...

Pre-hospital TXA for trauma - The STAAMP Trial

Posted by Matthew Mac Partlin on Tuesday, October 13, 2020, In : Clinical topics

Tranexamic acid (TXA) is an antifibrinolytic medication that displaces plasminogen from the fibrin complex which should result in a more persistent clot. Given that the majority of trauma deaths are due to haemorrhage, this would seem to be a reasonable therapeutic target.

TXA has established use in the management of epistaxis and postpartum haemorrhage (1) . The CRASH-2 (2) and MATTERS (6) trials demonstrated mortality benefit in trauma patients at risk of bleeding by adding TXA to the ...

Ankle injuries - A good review on the Emergency Medicine Case site

Posted by Matthew Mac Partlin on Wednesday, July 4, 2018, In : Clinical topics

The ankle joint was one of the last things I studied in anatomy waaaay back in university; probably in First or Second Med. It seemed to be a victim of priority and as a result was never studied that well. Yet we see 'sprained' ankles all the time in the ED and there is a goodly proportion of them that end up in the circuit medical centre.

Often it's an official who has rolled their ankle while accessing or leaving their track position. Sometimes someone has gone over in the paddock. It might...

Back yourself - A cautionary tale

Posted by Matthew Mac Partlin on Wednesday, July 4, 2018, In : Clinical topics

OK, I promised that I would lay off concussion for a while but on the same day that I published the first part of the concussion podcast with Prof David Hughes, I received an email from a friend in the U.S.

Gregg Summerville is a New Jersey emergency physician who also works with Corvette Racing, travelling with them to places like LeMans and Watkins Glen. As a result, he gets to know the drivers and administrative staff quite well. He sent me a piece that he wrote based on a clinical scenari...

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...

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...

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:

Fernando Alonso's horrifying rollover at the Melbourne F1GP where h...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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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