If you have a comment or question about one of the podcasts, chuck it into the comments section.
But I get a ton of clinical cases and questions by email or the contact form that have not been covered on a podcast yet. I love this–it exposes me to some great cases I would never hear about otherwise. Problem is, up until this point, it has been a 1 on 1 conversation. This is sort of a waste because nobody else benefits except you and me. So in the future, when you have a case or question like this, I would love it if you posted to the Google Plus EMCrit Community page. This allows a few things:
- it allows my answer to be seen by a much larger group of people
- it allows folks smarter than me to chime in as well
- it keeps a record of these case interactions so I can refer people to them in the future
So how do you do it? Easiest way to learn is to watch this video:
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Professor
Chief, Division of Emergency Critical Care
Director, Resuscitation and Acute Critical Care Unit
Stony Brook Medicine
Stony Brook, NY, USA
No conflicts of interest (coi).
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First of all, thank you Scott for the great podcasts, which have managed to make my recent hour long commute time well spent! I am an Emergency Medicine Trainee in the UK, and as part of of my final exams need to write a in depth critical appraisal topic review (basically a literature review). My topic is ‘ In a patient in traumatic cardiac arrest following blunt trauma, in whom a eFAST scan idetifies a pericardial effusion, is there any benefit of performing an Emergency Department Thoracotomy?’. There is a lot of research out there, but none looking at blunt… Read more »
Hi Scott,
I really liked the chapter about errors in your book, but I can’t find any links on the blog to discussing these.
Any external links/ resources on cognition etc would be great
Will
I have a question: I listened to the first and second vent lectures which I loved- but you talk about IFR and we don’t have that on our vent (LTV 1200). We have I -time which on an adult on our vent ranges from 0.3 to 3.0. I could find specific i-times for infants and pediatrics but not adults. Without having to do an equation what is the standard i time for an adult? Our vent has been at 1.0, which according to the pediatric information is less than recommended for over 6 years old (1.2). Thanks!
Hi Scott,
My question relates to the Boston Bombings.
Jeff Bauman lost both his legs in the attack but did not appear to lose a
great quantity of blood.
This is something I do not understand.
Can you clear this up for me ?
I have searched the internet but have been unable to find an answer.
I understand that cauterisation and crushing injuries can restrict blood loss but
I do not think these causes were relevant in this instance.
Many Thanks
John
aside from those mechanisms; hypotension will lead to limited blood loss until someone raises the pressure.
Thank you for responding.
I looked up hypotension and it did not mention trauma as a cause.
Can you explain how it would be a factor in the case of Mr Bauman ?
Many Thanks
John
I’m sorry I don’t understand your question
Sorry ! Mr Bauman had 2 people lying beneath him soon after the explosion which removed his legs, his right leg above the knee , his left below the knee. I would have expected those 2 people to have had significant amounts of his blood on them. Subsequent photographs do appear to show this to be the case. I am sure there is a good medical reason for this and I would like to know what it is. From your last answer you seemed to imply that hypotension could be a factor given that the other reasons for limiting blood… Read more »
Hello Scott, Question re: autotransfusion. “Literature at that time (I don’t have it at hand) strongly suggested that activated complement and clotting factors in shed blood from mediastinum / chest could initiate or worsen a consumptive coagulopathy. There was certainly no apparent benefit of this practice to patients and so it was discontinued. Reinfusion only occurs after washing. Subsequently, I have personally seen severe DIC associated with direct re-infusion of unwashed pericardial blood (high bleeding rate) following complications of ablation procedures. Re-infusing activated clotting factors, activated complement, etc. can obviously be harmful re: coagulopathy.” (hematologist). When PRBCs are available, should… Read more »