It isn’t often that you need to provide a risky treatment before you’ve even assessed the patient, but that’s what prehospital clinicians sometimes need to do when caring for patients with acute behavioural disturbance. @jamesoz1.bsky.social & I talk sedation safety on Clinical Conversations.

James Oswald@jamesoz1.bsky.social · 2y ago

🚑 New Episode of Clinical Conversations🎙️ Pre-hospital sedation carries serious ethical and clinical risks. In this episode of Clinical Conversations, @expensivecare.bsky.social and I explore why it’s risky and how to make it safer. #Paramedicine #PreHospitalCare #EmergencyMedicine #Sedation #EMS

ECG Patterns of Occlusion Myocardial Infarction: A Narrative Review CCR Journal Watch https://criticalcarereviews.com/latest-evidence/journal-watch Get the latest critical care literature every weekend via the CCR Newsletter - subscribe at https://criticalcarereviews.com/newsletters/subscribe

More medical inspired art: coronary arteries as subway map.

So humbled and proud to have been awarded an Ambulance Service Medal is this year’s Australia Day honours list. Thanks to those who nominated me and to the friends and colleagues I’ve worked with over the ups and downs of 25+ years in prehospital care ☺️. 🎖️🤓🚑

I’ve learned so much from @jamesoz1.bsky.social chatting all things pain with @billlord.bsky.social in this series, and we’ve saved the best for last. An exacerbation of chronic pain is a common reason to call an ambulance. What can we do as paramedics and as an EMS system? Let’s find out!

James Oswald@jamesoz1.bsky.social · 2y ago

🎙️ New Podcast Alert The final episode in our pain management series with @expensivecare.bsky.social and @billlord.bsky.social is now live. 🔥 Topics: Pain care performance measures 📊 Chronic pain challenges Opioid myths & realities 💊 👉 Tune in: open.spotify.com/episode/5MMs...

This article rings true everywhere. It might be more pressing in the UK, as other countries willingly accept their senior staff with better pay and/or work hours, but it's still a factor in rural areas of the US and Australia. And certainly worth a read.

Alison Leary @alisonleary1.bsky.social · 2y ago

My latest @bmj.com on why an experienced workforce is necessary for safety and productivity www.bmj.com/content/387/...

Word of the Day is one I keep posting at the end of the year, hoping its time will come. ‘Respair’, from the 16th century, is fresh hope, and a recovery from despair. Here’s to a few drops of respair in 2025.

Morphine or fentanyl? Does splinting really reduce pain? Is ketamine the ideal prehospital analgesic? Is there a role for paramedic administered NSAIDs? What about nerve blocks? Find out the answer to these and more on part 2 of James’ interview with Bill Lord. 🚑💊🤕

James Oswald@jamesoz1.bsky.social · 2y ago

Pain relief is important, so what can we actually do to help? In Part 2 of my conversation with @billlord.bsky.social and @expensivecare.bsky.social, we look at best practice in the care of people with pain.

Wonderful feedback on our new book. 🤓 The perfect gift for the discerning paramedic in your life! 😃

Class Professional@classprofessional.bsky.social · 2y ago

Critical Care Paramedicine "creates an immersive experience" by placing you in the centre of the action. Whether you're studying, a working paramedic or an aspiring #criticalcareparamedic, this book will deepen your understanding and knowledge.🚑 bit.ly/CriticalCare... @expensivecare.bsky.social

Presented at #CCRDownUnder: In the SAHARA trial involving patients with subarachnoid hemorrhage and anemia, liberal transfusion of red cells did not result in a lower risk of an unfavorable neurologic outcome than a more restrictive strategy. nej.md/4ilTVdO

Early Restrictive vs Liberal Oxygen for Trauma Patients: The #TRAUMOX2 Randomized Clinical Trial | ⁦‪JAMA - ‬⁩ Just published! #ccrdownunder jamanetwork.com/journals/jam...

Early Restrictive vs Liberal Oxygen for Trauma Patients

This randomized controlled trial investigates whether an early 8-hour restrictive oxygen strategy compared with a liberal oxygen strategy lowers the incidence of death and/or major respiratory complic...

jamanetwork.com

We have seen a number of trials with non-significant findings at #CCRdownunder. There is often debate then about what next? This paper by Pocock & Stone is a useful discussion piece to inform this type of discussion www.nejm.org/doi/full/10....

The Primary Outcome Fails — What Next? | NEJM

When the primary outcome of a clinical trial fails to reach its prespecified end point, can any clinically meaningful information still be derived from it? This review article addresses that question.

nejm.org

Published in JAMA with #CCRdownunder: In critically ill adults with suspected sepsis, antibiotic regimens were safely reduced when guided by measurement of procalcitonin but not by C-reactive protein. @criticalcarereviews.com ja.ma/3BovM5v

ADAPT-SEPSIS: “Care guided by measurement of PCT reduces antibiotic duration safely compared with standard care, but CRP does not. All-cause mortality for CRP was inconclusive.” #ccrdownunder

Today it’s Lung #POCUS for you! It is: Easy to perform Accurate Sensitive Repeatable Negates irradiation or transport elsewhere! #FOAMed #POCUS #FOAMcc #foamus @icmteaching @ICUltrasonica Where do we scan then?? Linear/curvilinear or phased probe positions shown👍👇

During #WW1, Marie Curie created a vehicle that contained a hospital bed, generator, X-ray machine & photographic darkroom equipment. These “petite Curies" (below) could be driven right up to the Front. Curie trained 150 women as radiology technicians. #histmed #skystorians #histsci

I almost didn’t write this blog in *2015* about how contrast nephropathy isn’t real, because I thought it was already pretty obvious at that point (https://emcrit.org/pulmcrit/do-ct-scans-cause-contrast-nephropathy/) nearly a decade later, we’re still struggling with knowledge translation 🙈

Steven Mathern@stevenmathern.bsky.social · 2y ago

'Conclusion Based upon the available literature, the use of IV contrast for CT imaging does not appear to be associated with an increased risk of #AKI' acute kidney injury, IV contrast dye for imaging probably dsnt harm kidneys. #angiogram #emimcc #cardiosky www.jem-journal.com/article/S073...

this is so brutal it hurts, but it’s true 😳

Andrea Poggi@poggial.bsky.social · 2y ago

open.substack.com/pub/thethoug... #EMIMCC #Pulmsky #Medsky

So sad that I wasn’t able to be there for the official celebration of our new critical care paramedicine book. I was looking forward to my biscuit 😋. Great to finally see it on the shelves though!

Class Professional@classprofessional.bsky.social · 2y ago

Kate and Josie are excited to be attending the Air Ambulance UK National Conference today. They'll be holding a book celebration for our newly published title Critical Care Paramedicine, so make sure to say hi and grab one of our yummy biscuits!

A liberal transfusion strategy compared with a restrictive strategy resulted in a lower rate of unfavorable neurological outcome among patients with acute brain injury. ja.ma/3V5z1p9

Lot's of answers approximating what I think is best: 1. Are you in the Vortex? (can you ventilate?) 2. Have you ever been in the Green Zone (able to ventilate). If so, try to go back and do that. 3. Have you had a best effort at any lifeline? (define what can be abandoned/what's left to try).

Nicholas Chrimes@chrimesy.com · 2y ago

Was discussing this yesterday while teaching #VortexApproach. We ask participants to consider the 1st 3 questions they should ask when arriving at something they recognise as an airway crisis. Thoughts? (specific qtns to get oriented to the airway issue beyond “who’s in charge”, etc)

Renal replacement therapy (RRT) in the ICU OnePager 📟 onepagericu.com/rrt

I used to post visitors to my garden to the other place. Here’s my first Bluesky garden friend. I think a juvenile male Australian king parrot. Very friendly 🤓🦜

Being a 'good rescuer' is: • counterintuitive eg the advice to stand back & analyse rather than pile in & do something • counter-cultural eg using checklists rather than relying on memory Specific rescuer training would reinforce these skills. #AnSky #MedSky #HFESky https://buff.ly/3COBTjM

Such important work Kudos to Ambulance Vic - integration of @goodsamapp - public access defib registry - system based reform - audit & publication

David Anderson ASM@expensivecare.bsky.social · 2y ago

It takes a system to save a life in cardiac arrest. I’m proud to have played a small part in this paper in The MJA which shows how survival has incrementally improved in Victoria over 25 years and highlights the value of a registry. If you don’t measure, you can’t improve 🤓 🚑

Twitter is dead. Long live BlueSky.

Thanks David. It was great chatting with James about this important topic

David Anderson ASM@expensivecare.bsky.social · 2y ago

The latest episode of Clinical Conversations - Ambulance Victoria’s clinical podcast is out! Its the 1st part of a 3 part series where James chats with paramedicine legend @billlord.bsky.social about all things prehospital assessment and management of pain. Tune in wherever you get your podcasts!

At Ambulance Victoria, around 40% of our patients have pain as part of their presentation and we stand to make a real difference in the patient's experience of their illness. I was extremely fortunate to discuss the topic with paramedicine legend @billlord.bsky.social & @expensivecare.bsky.social

Clinical Conversations

Podcast · The Ambulance Victoria Office of the Medical Director · Ambulance Victoria's clinical podcast bringing you the latest need-to-know clinical pearls.

open.spotify.com

Great to see the papers in our Special Issue on the Commercial Determinants of Health already getting media attention! @inquisitivegyn.bsky.social You can read all the papers in the special issue here: academic.oup.com/heapro/issue... www.theguardian.com/australia-ne...

Learning CPR on manikins without breasts puts women’s lives at risk, study finds

Analysis of training models on global market found all had flat torsos with just one having a breast overlay

theguardian.com