Here are the slides for this weeks journal club presentation.
Here are the slides for this weeks CGD - Journal Club.
Welcome to June 14 CGD.
Here are the slides for the presentation for todays talk.
This month's journal club is a mixed bag.
It starts with a paper on sepsis focussing on the concept of hyperoxia in sepsis.
The next paper looks at whether there is a role for tranexamic acid in intracranial haemorrhage - a question which remains unanswered.
Then there is a review paper on tracheobronchial injuries and their management.
The next paper looks at pre-hospital fluids and hartmans or hypertonic fluids. There doesn't appear to be any difference between either fluids in this review article.
Then there is a review article on seat belt injuries which is worth looking at.
The next paper looks at prehospital "Code Red" activation and shows that a simple algorithm can be used to activate massive transfusion accurately in the pre-hospital setting.
The final paper looks at the different types of anticoagulants and reversal agents when patients present with bleeding.
A copy of the slides is below.
This months journal club has a trauma flavour with an emphasis on damage control resuscitation.
Damage control resuscitation is the concept of abbreviated surgery to control bleeding, followed by resuscitation in the ICU and finally definitive surgery. WIth regards to DCR, there are 3 critical components - reversal of acidosis, prevention and treatment of hypothermia and treatment of the patients coagulopathy.
Acquired Trauma Coagulopathy (ATC) is an endogenous coagulopathy affecting 25-30% of all trauma patients. It appears that activated Protein C plays a central role in its development.
VIscoelastic devices such as TEG & ROTEM are now being used for the rapid assessment of patients with ATC. Early studies are suggesting improved outcomes in patients with ATC when compared to those with fixed ratio resuscitation.
The concept of permissive hypotension has been around for a while now - this is where there is a restriction on the use of blood products while maintaing the patients blood pressure in the low normal range. Patients recieving permissive hypotension receive less blood products with no change in the mortality and are less likely to develop a coagulopathy.
Finally the use of tranexamic acid decreases mortality from bleeding, however it is still controversial whether tranexamic acid is associated with thromboembolic events and more research is required to answer this question.
The following slides were used in the presentation for Journal Club - please feel free to use them for refreshing your memory.
Subarachnoid haemorrhage is life threatening condition that needs early neurosurgical intervention. It also needs aggresive medical management to optimise the patients clinical outcome. The following slides outline the approach to the patient with aneurysmal subarachnoid haemorrhage.
Here are the slides for the journal club for this months journal club.
Ventilation can often be confusing, but here is a basic introduction to ventilation which makes it easy for you to start and maintain ventilation in the emergency department. Basically, there are two approaches - a lung protective strategy which you should use for all patients who don't have obstructive lung disease and an obstructive approach. The following slide show will walk you through both approaches.
Here are the slides for the Wollongong CGD Journal Club.
Euglycaemic DKA is a rare entity which is under-recognised. It has been mainly described in type 1 diabetics, however it is increasingly being seen in patients on SGLT-2 inhibitor medications. These are a relatively new oral hypoglycaemic which are mainly used in type 2 diabetics (however they are also being used in an off-label indication for better glycaemic control in type 1 diabetics as well).
Euglycaemic DKA is essentially DKA without the hyperglycaemia. It is essential your diabetic patients - especially type 1 and those on SGLT-2 inhibitors should have their ketones checked in addition to their glucose when they are unwell in order not to miss this rare condition.
All things interesting to the realm of Emergency Medicine