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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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 TCA with an identified potential cardiac tamponade, and whegher this small select group might have a better then nil outcome from EDT.
I am hunting for any as yet unpublished research, or papers awaiting publication, or any evidence at all relating to this question that I might have missed in my literature searches.
PLEASE HELP!! AND THANKS!
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 loss can probably be ruled out.
This blog may not be the right place to get an answer to my question so please feel free to ignore this query as I am sure you have many more important things to attend to.
Thanks for your responses
Best wishes
John
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 we be autotransfusing? We currently do not use autotransfusion due to availability of blood products and considerably lower frequency of traumas where autotransfusion may be utilized. Is there a podcast in the works to talk about autotransfusion? Pros and Cons? Benefits or harmful? Thanks!