John was one of the most wonderful people I knew in medicine. He was kind. He was an amazing doc; strong and confident in what he believed was right, but the consistent trait noticed by all who met him in the FOAM world was his rare humility. John was just lovely, with an acerbic wit that kept me in tears whenever I was around him. He was trying to better the trauma care of Northern Ireland, hopefully his work will be continued and his amazing contributions remembered. My thoughts are with John's family. He left us far too soon, and I miss him so.
If you want to send condolences to John's Family, please contact Rob Mac Sweeney–Tweet (@CritCareReviews)
Please see these words from John's friends in the FOAM World:
- The St. Emlyn's folks
- Michelle from the LitFL Crew
- Cliff from resus.me
A few months ago, John came and visited us at Stony Brook to give EM Critical Care Grand Rounds. He was easily the speaker of the year. He gave an amazing lecture on how he ran his unit (along with his 5 amazing colleagues). The audio quality of the recording was crap (my fault, not John's). We had plans to rerecord it as a podcast, but that can't happen now, so I hope you love listening to John in any form possible, as I know I do:
How John Ran His Unit
When not in the field as a road-racing doc, John was an Anesthesia-Intensivist at Craigavon Area Hospital. He worked in a ten bed unit, only eight of which could have mechanically ventilated patients and yet…
The unit has
- CO2 Dialysis with Novalung
- One of the first centers in the UK to offer REBOA (done by the intensivists)
- Tele-Critical Care
- TEE
Central Lines
- Remove all peripheral ivs
- Remove all resus placed lines
- Place all resus lines 5x ports in left sub clav sunk to 20cm. 10% of them sit in the right atrium; they've had no problem with cardiac erosion. John felt this is a relic of the past.
- Place all CRRT lines r subclav sunk to 20 cm (intra-arial)
- They get CVP off prox port
- Most dangerous drug in the distal
- Subclav is the Line of Champions
- 800-1000 lines per year, no infections in the past year. Pneumothorax rate 0.8% in the last 300 lines tracked
Sepsis
- All get arterial line
- Serial Lactates
- All get a central line
- Fresh PIVs
- Norepi or epi
- Max fluid load of ~2 liters and then need a good reason to give anymore
- No etomidate; They use ketamine, it is open shelf
- No Inodilator (b/c they run their patients extremely dry)
- Phenylephrine and Metaraminol are banned to prevent lazy resuscitation
- No cardiac output monitors until they are not random number generators–they use TTE and TEE
- They don't see ARDS (You need to listen to the Podcast)
- No standing maintenance fluids
InoPressors
Not in the lecture, but here is John's correction of my algorithm
Aggressive De-Resuscitation
-Start with Diuretics
Lasix
- 50 mg IV, they infuse over 30 minutes
- Double dose if it doesn't work
- 500 mg/dose max
- Max dose 2g/day
- Back off if they become hemodynamically unstable, BUN/Cr start to rise, or you are needing to go up on Inopressors
Complications: Metabolic Alkalosis, Hypokalemia, Hypernatremia. Do not stop for these complications–fix them
Metabolic Alkalosis
- Sig. Metabolic alkalosis ( BE > 6) is always unphysiological and should not be tolerated.
- Treat underlying cause, but you'll rarely be able to
- If urine pH < 6.5 – acetazolamide 500 mg IV up to TID
- If urine pH > 6.5 or in ARF there are 2 choices-the best is HCl
- Use this formula: Weight (kg) x 0.5 x BE = mmol of HCl or give 80 ml of 0.1 molar HCl in 500 ml D5W via central line over 6 hours
Hypernatremia
- When Na hits 147, they give IV free water (not D5W)
- sterile water
Hypokalemia
- Never less than 3.7
-If that doesn't work, IV Spirnolactone
-If that doesn't work, Dialyze
- Up to 600 ml/hr
Update
Recent Article by Marik and folks re: DeResuscitation
Remember there is a patient under all that gear and tech
- They screen for noise and light excess every day. If there is too much, patients get eye masks and earplugs
- Bring family in (if that is the patient's wont)
- Pet visitations
- Stand the patient up every day, and walk them if possible
Watch More of John's Lectures
Additional New Information
More on EMCrit
- EMCrit Podcast 135 – Trauma Thoughts with John Hinds(Opens in a new browser tab)
- John Hinds on Crack the Chest–Get Crucified
- EMCrit Wee – Cricolol by Dr. John Hinds
Additional Resources
Professor
Nassau University Medical Center
No conflicts of interest (coi).
- EMCrit 385 – Eye Trauma I – Retrobulbar Hematoma, Orbital Compartment Syndrome, and Paracanthal Decompressions - October 5, 2024
- EMCrit Wee – Did this Really Just HAPPEN? – The HAPPEN Trial Hot Take – NIPPV for COPD - September 29, 2024
- EMCrit 384 – The Vascular Guy on Vascular Access - September 23, 2024
My first ICU job was in that unit. I remember thinking – “sterile water? we’re giving F&*^%^ sterile water???” Between that and the hydrochloric acid and the mega doses of furosemide it was a fun intro! I spent 6 years in Criagavon all in all (and another 4 as a cleaner when I was med student) . Great place, good memories. John’ll be sorely missed.
Andy Neill, EM Trainee, Mater North Dublin
Dr. Weingart, My deepest sympathy on the loss of your dear friend. Thank you for sharing his lecture on emcrit. It is definitely hard to grasp this news especially since we just saw Dr. Hinds at SMACC last week. It reminds us how precious life really is.
Scott, not many people embodied your principle of “maximally aggressive care anywhere” quite as fully as John.
Thanks for Sharing. Very Sad week.
Andrew
Dr. Weingart: Thank you for sharing this, and the audio quality is just fine. Dr. Hinds’ reminder that beyond the knobs and drips there is a Patient in our care speaks volumes about him. I also listened to his lectures this week-end and it was helpful. Take Care. @mainecrit
I am writing on behalf of all paramedics in Northern Ireland. John was so ‘for us’, any of us were so relieved when we saw John arrive to bad RTC’s in his role as a BASICS Dr. We are all so sad at his loss, both as a refreshing, witty character and someone who was not afraid to push the boundaries of pre hospital care, and a true professional, committed to the progression of emergency medicine. We will miss you so much.
Thanks for sharing this Scott. I think we are all in a dark place after John’s death.
Thoughts with his family who will feel the loss more than anyone.
A truly tragic loss to so many people near and far.
S
Thanks Scott,
I’m saddened by the loss of John. You knew him far better than me, my condolences for the loss of your friend. In my opinion he stole the show at SMACC Chicago.
I loved this talk, thanks for posting! John and his colleagues are pretty hardcore when it comes to diuresis. Would you go as far as he does with pushing big lasix doses and aggressively treating the side effects with diamox, HCl and IV free water?
Note: I think you made a typo in your show notes – BE>6 is met alkalosis, not “acidosis”.
Cheers,
Sean
I put off listening to the podcast for a few days because I didn’t think I could handle it emotionally. I wasn’t sure if I was going to cry or laugh. Ended up doing both. Thank you for posting the lecture to help up us deal with our deep sadness.
Sir,
My sympathy to that great great loss!
Concerning the subclavian access performed under EMERGENCY conditions: would John/would you be using the landmark method for speed or be using ultrasound for success rate? If landmark: would you be going for a certain number/a certain degree of expertise of ELECTIVE landmark subclavians before allowing your staff to switch to the US-guided technique for elective lines?
Thanks for so many great posts!
Simon
I live in Australia and I’ve never been to a NI road race, nor am I in the medical profession. So sadly I hadn’t heard about John until after he passed. In the past two days I’ve listened to all his podcasts. I’ve laughed and cried. I’m shocked that such an amazing person has gone. Now when I watch races I think that rather than barracking for the riders, I’ll be cheering on the travelling resuscitationist and retrieval experts. The real heroes of the racing world. I’m in awe at their skill and bravery.
An interesting lecture and a very sad story to read, made even sadder when I heard your broken hearted voice on the podcast…Praying for the family, friends, colleagues, and the community at large affected by the life and loss of Dr. Hinds.
Thanks for sharing this (and all the other great work you do). Kind Regards.
Thanks Dr. Weingart,
I am deeply sadden by the loss of Dr. Hinds. Inspirational speaker, saw him at SMACC Chicago. He will be greatly missed by all of us in the FOAM world.
I was so extremely excited to see all the great providers I follow, listen to, and read about at SMACC Chicago. The conference exceeded my expectations. It took by breath away to hear of the tragic passing of Doc John Hinds, it seems just moments after we met. Thank you Scott, for this tribute podcast. My hardest laugh…what effect does the pony visit have on ICU delirium? I’m still laughing.
What a great lecture, at three podcasts of there own in there that I would have loved to hear. This lecture emphasises what has been lost. However, his lectures could influence and enhance practice for years to come. How many more people might survive because one of us was influenced by theses talks.
Scott
Thanks for this post, searching for meaning in John’s loss has been hard, but feeling the community’s response is significant.
Attempting to live up to his example will remain a life goal.
Yours
Rusty
Paramedic in Virchester