NACCS Update: Immediate Management of Cervical Spine Injuries

This is a copy of the slides I used during a talk I gave at the NACCS Neuroanaesthesia and Critical Care Update Day (AAGBI November, 2016). The full programme of the meeting can be found here.

The talk was designed to look at the evidence for spinal immobilisation and the optimal technique for tracheal intubation.

The pdf of my presentation can be downloaded by clicking the link below:

NACCS SCI Update 2016

 

Mythbusting: ATLS and Cervical Spine Injury

These are the slide sets for the talks I was invited to give at the 2016 GAT (Group of Anaesthetists in Training) ASM. The full program of the meeting can be found here.

The ATLS talk was designed to look at the history leading to the development of the ATLS course and how it fits in with the management of trauma in the 21st century. I also made some suggestions as to how trauma training could be improved in the UK. The cervical spine injury talk aimed to dispel the many myths that surround spinal cord injury and airway management.

The pdf of my presentations can be downloaded by clicking the links below:

SCI Mythbusting GAT 2016

ATLS GAT 2016

I published an editorial on the weaknesses of ATLS earlier last year in Anaesthesia. The article is open access and can be found at the link below:

ATLS: Archaic Trauma Life Support?

Trauma Team Training: life after ATLS

This is a copy of the slides I used during a talk I gave at Trauma Care 2016. The full programme of the meeting can be found here.

The talk was designed to look at the history leading to the development of the ATLS course and how it fits in with the management of trauma in the 21st century. I also made some suggestions as to how trauma training could be improved in the UK.

The pdf of my presentation can be downloaded by clicking the link below:

ATLS TraumaCare 2016

I published an editorial on the same topic earlier this year in Anaesthesia. The article is open access and can be found at the link below:

ATLS: Archaic Trauma Life Support?

Management of Suspected Cervical Spine Injury in Motorsport

This is a copy of the slides I used during a talk I gave at the RCoA Pre-hospital Medicine & Motorsport Study Day. The full program of the meeting can be found here.

The talk was designed to examine the changing approaches to the use of cervical spine protection techniques and to discuss the evolving interest in concussion.

The pdf of my presentation can be downloaded by clicking the link below:

RCoA Motorsport 2016

 

ATLS: Archaic or advanced trauma life support?

This is a copy of the slides I used during a talk I gave at the 2016 RCEM Annual Scientific Meeting in Leeds. The full programme of the meeting can be found here.

The talk was part of a debate of ATLS: Advanced or Archaic Trauma Life Support?

I have included my slide set and that from a similar talk then I have delivered previously that contains a greater number of references.

The talk was designed to look at the history leading to the development of the ATLS course and how it fits in with the management of trauma in the 21st century. I also made some suggestions as to how trauma training could be improved in the UK.

The pdf of my presentations can be downloaded by clicking the link below:

ATLS RCEM 2016

ATLS RCEM/RCoA Trauma 2015

I published an editorial on the same topic earlier this year in Anaesthesia. The article is open access and can be found at the link below:

ATLS: Archaic Trauma Life Support?

ATLS: Archaic or advanced trauma life support

This is a copy of the slides I used during a talk I gave at the RCEM/RCoA Major Trauma Study Day. The full programme of the meeting can be found here.

The talk was designed to look at the history leading to the development of the ATLS course and how it fits in with the management of trauma in the 21st century. I also made some suggestions as to how trauma training could be improved in the UK.

The pdf of my presentation can be downloaded by clicking the link below:

ATLS RCEM/RCoA Trauma 2015

I published an editorial on the same topic earlier this year in Anaesthesia. The article is open access and can be found at the link below:

ATLS: Archaic Trauma Life Support?

LTC 2014 Session 4

Summary of the final afternoon session at the 2014 London Trauma Conference. The full programme of the meeting can be found here.

Meaningful monitoring of the head injured brain – Dr. Mauro Oddo, CHUV Hospital, Switzerland.

What is the role for non-blood products in pre-hospital and emergency department trauma management? – Mr. Ross Davenport, Barts & London.

Should isolated head injuries be cooled in the early phase of care? – Mr Mark Wilson (@markhwilson)

  • Cochrane 209 showed no evidence of benefit of cooling in TBI in ICU.
  • Unclear about prehospital care….
  • Head cooling (e.g. ThermaHelm) in isolation of no benefit.
  • Need further trials!

Should calcium be given to all shocked patients? – Dr. Julian Thompson, Bristol.

  • No, but maybe if the patient is shocked.
  • Calcium vital for coagulation & platelet function.
  • Ca(i) < 1 mmol/l associated with increased mortality and greater transfusion requirements (predicts better than fibrinogen levels).
  • Highest levels of citrate in FFP/platelets; takes 5 mins to metabolise the citrate in one unit of red cells. Try to avoid citrate toxicity.
  • Replacement of calcium doesn’t alter outcomes however. Short half-life. 5-10 mg/kg CaCl ideally via CVC (need 3x as much calcium gluconate).
  • Suggest give 10mls 10% CaCl every 4u PRCs (keep > 0.9 mmol/l)

IO access is overrated – Dr. Dan Ellis, Director MedSTAR.

  • IO better, faster, quicker than iv cannula.
  • Cheaper than CVCs
  • Useful in cardiac arrest
  • Use if time critical and/or need for emergent drugs or fluids.
  • IO fine for RSI.
  • IO flows 70-160 mls/min (cf 250 for 14G cannula).
  • Much more difficult to infuse blood through IO and may all be haemolysing due to pressure required.
  • Complications <1% but due to increased use, these may increase!

FAST scanning has had its day – Professor Tim Harris, Barts & London.

  • Increased access and use of [fast] CT scans may render USS unnecessary.
  • In stable patients FAST adds nothing, and 1/3 fast negatives.
  • Poor sensitivity for PTX outside expert hands (but we don’t know what levels of scans define expert).
  • Difficult to differentiate between pleural, pericardial and peritonel free fluid.
  • In summary, FAST was better than DPL, but has now been superseded by rapid CT panscan.