Prehospital Ultrasound-Guided Pediatric Fascia Iliaca Block.

The fascia iliaca block (FIB) provides effective regional anesthesia for fractures of the femur. There is 1 previous case report of a prehospital FIB in a child using a landmark technique. We report the successful prehospital application of a FIB using ultrasound guidance in a 7-year-old girl.

Prehospital Care: An International Comparison of Independently Developed Training Courses.

Objective: Prehospital and retrieval medicine (PHRM) occurs in a complex work environment. Appropriate training is essential to ensure high standards of clinical care and logistic decision making. Before commencing the role, PHRM doctors have varying levels of experience.

Fentanyl versus placebo with ketamine and rocuronium for patients undergoing rapid sequence intubation in the emergency department: The FAKT study-A randomized clinical trial.

Objective: The objective was to determine whether the use of fentanyl with ketamine for emergency department (ED) rapid sequence intubation (RSI) results in fewer patients with systolic blood pressure (SBP) measurements outside the pre-specified target range of 100-150 mm Hg following the induction of anesthesia. Methods This study was conducted in the ED of five Australian hospitals. A total of 290 participants were randomized to receive either fentanyl or 0.

Crisis Resource Management and High-Performing Teams in Hyperacute Stroke Care.

Background And Purpose: Management of stroke patients in the acute setting is a high-stakes task with several challenges including the need for rapid assessment and treatment, maintenance of high-performing team dynamics, management of cognitive load affecting providers, and factors impacting team communication. Crisis resource management (CRM) provides a framework to tackle these challenges and is well established in other resuscitative disciplines. The current Coronavirus Disease 2019 (COVID-19) pandemic has exposed a potential quality gap in emergency preparedness and the ability to adapt to emergency scenarios in real time.

FentAnyl or placebo with KeTamine for emergency department rapid sequence intubation: The FAKT study protocol.

Background: Some critically ill patients require rapid sequence intubation in the emergency department, and ketamine is one sedative agent employed, due to its relative haemodynamic stability. Tachycardia and hypertension are frequent side effects, and in less stable patients, shock can be unmasked or exacerbated. The use of fentanyl as a co-induction agent may lead to a smoother haemodynamic profile post-induction, which may lead to reduced mortality in this critically ill cohort.

Zero point survey: a multidisciplinary idea to STEP UP resuscitation effectiveness.

The primary survey assessment is a cornerstone of resuscitation processes. The name itself implies that it is the first step in resuscitation. In this article, we argue that in an organized resuscitation the primary survey must be preceded by a series of steps to optimize safety and performance and set the stage for the execution of expert team behavior.

Pre-hospital advanced airway management in children: a challenge that training can handle.

We respond to the Tarpgaard et al. article reporting on pre-hospital endotracheal intubation (PHETI) success and complications by Danish critical care teams including critical care anaesthetists. We compare the authors' results with previously published results from our service's experience with PHETI in a similar patient population, also with physician and paramedic medical teams.

Analysis of Out-of-Hospital Pediatric Intubation by an Australian Helicopter Emergency Medical Service.

Study Objective: We examine first-look success in emergency pediatric intubation by a physician-staffed helicopter emergency medical service (EMS).

Methods: A database analysis of all pediatric (<16 years) intubations during a 64-month period was undertaken, using data from a prospectively enrolled electronic airway registry form. Recorded findings included patient demographics, operator background, airway intervention including intubation attempts, complications, and critical timings.

Does end-tidal capnography confirm tracheal intubation in fresh-frozen cadavers?

Background: Life-like end-tidal capnography (ETCO) waveforms have been demonstrated in recently deceased and fresh-frozen cadavers following tracheal intubation, offering potential for high fidelity airway simulation training. As the mechanism for carbon dioxide production is not fully understood, it is possible that oesophageal intubation may also generate a capnograph. Our aim was to measure ETCO levels following (1) oesophageal and (2) tracheal intubation in fresh-frozen cadavers, and to observe the size, shape and duration of any capnographic waveform.

A human cadaveric workshop: One solution to competence in the face of rarity.

Competent performance of cricothyroidotomy, lateral canthotomy and resuscitative thoracostomy is an expected standard for Australasian emergency physicians, but infrequent exposure to these procedures could impair physician confidence, reducing the likelihood of their execution in a critical timeframe. Training to perform these procedures is a recognised challenge for non-surgeons, and cadaver-based training is one method of addressing this need. We describe a 1 day cadaver-based workshop for emergency medicine doctors and briefly report on its impact on physician confidence.

Hemodynamic Response After Rapid Sequence Induction With Ketamine in Out-of-Hospital Patients at Risk of Shock as Defined by the Shock Index.

Study Objective: Ketamine is considered a stable induction agent for rapid sequence induction; however, hypotension rates up to 24% are reported. The shock index (shock index=pulse rate/systolic blood pressure [SBP]) may identify patients at risk of adverse hemodynamic change. We investigate whether SBP and pulse rate response to ketamine induction differ when patients are classified as being at risk of shock by their shock index.

Interrater agreement between expert and novice in measuring inferior vena cava diameter and collapsibility index.

Background: In critical care medicine, US views of the inferior vena cava (IVC) and its change with respiration are used to estimate the intravascular volume status of unwell patients and, in particular, to answer the question: 'Is this patient likely to be fluid responsive?' Most commonly in the literature, the subxiphisternal (SX) window in the longitudinal plane is utilised. To date, no study has specifically assessed interrater agreement in estimating IVC diameter between emergency medicine specialists (experts) and trainees (learners).

Objectives: To determine the interrater agreement between an expert (senior emergency specialist with US qualifications) and learner (emergency medicine trainee) when measuring IVC diameter (IVCD) and IVC collapsibility index (IVCCI) in the SX longitudinal US window in healthy volunteers.

Apneic oxygenation was associated with decreased desaturation rates during rapid sequence intubation by an Australian helicopter emergency medicine service.

Study Objective: The Greater Sydney Area Helicopter Emergency Medical Service undertakes in excess of 2,500 physician/paramedic out-of-hospital and interhospital retrievals each year, of which 8% require intubation. Emergency anesthesia of critically ill patients is associated with complications, including hypoxia. In July 2011, the service introduced apneic oxygenation with nasal cannulae to its emergency anesthesia standard operating procedure to reduce rates of desaturation during rapid sequence intubation.

Sustained life-like waveform capnography after human cadaveric tracheal intubation.

Introduction: Fresh frozen cadavers are effective training models for airway management. We hypothesised that residual carbon dioxide (CO2) in cadaveric lung would be detectable using standard clinical monitoring systems, facilitating detection of tracheal tube placement and further enhancing the fidelity of clinical simulation using a cadaveric model.

Methods: The tracheas of two fresh frozen unembalmed cadavers were intubated via direct laryngoscopy.

The obstetric caseload of a physician-based helicopter emergency medical service: case review and recommendations for retrieval physician training.

Background: The Greater Sydney Area Helicopter Emergency Medical Service provides physicians for undertaking prehospital and inter-hospital critical care. We quantified the obstetric caseload of our service with respect to primary diagnosis and interventions in order to provide targeted physician training.

Materials And Methods: Retrieval records over a 4-year period were searched to identify keywords associated with pregnancy or obstetric complications.