Recent content by Melclin

  1. Melclin

    CARING for the patient :wub:

    On a vaguely related note.... Love it! Lock up. Feed the dog. Contact the day care centre looking after the kids. Organize respite for the frail husband...the disabled kid. Ring a relative for a lift home. We are potentially the only healthcare professionals in the spectrum of their care who...
  2. Melclin

    4 hours of CPR and survived (hypothermic)

    Yup interesting stuff. I've heard a few people talking lately about the idea that duration of cardiac arrest is less and less a predictor of outcome as long as CPR starts early. Especially with aggressive therapies like ECMO, there are some amazing outcomes. I think we're going to see the...
  3. Melclin

    Who's still routinely c-spining?

    I really hate this street vs book type thing and always have. If some reasonable practice is genuinely acceptable, then why is some utterly different 'theoretical' alternative being taught as gospel? Currently one of the local universities is teaching that pts be rigidly interviewed along...
  4. Melclin

    Who's still routinely c-spining?

    I don't quite follow. What type of L1 fracture was it? I figure maybe burst? Regardless of what you might feel about SMR, its still indicated in one form or another for unstable injury. You haven't mentioned whether this was an unstable type fracture. Also, my understanding is that the...
  5. Melclin

    CARING for the patient :wub:

    I've heard this. I don't think I read it anywhere authoritative but its pretty effective isn't it? Assists sleep/wake cycles and what not? I had to work on it too. I'm an esoteric, nerdy kinda guy and it didn't come naturally to talk to truck drivers or farmers etc. I had to pick up many...
  6. Melclin

    NC or NRB when suction is needed?

    Yup it was. The link you posted isn't the same one (but I don't think it was supposed to be :-)) but contained a lot of the same anatomy. I wish I had been able to jot down a few of his references. But they all changed slides so quickly. I'm sure it'll be up somewhere soon.
  7. Melclin

    NC or NRB when suction is needed?

    At SMACCgold, Rich Levitan had some interesting things to say about the apparent superiority of nasal cannulae over face masks for many purposes (not just the apneic oxygenation during intubation for which he is well known). Personally, I hate face masks. I always have and this trend towards...
  8. Melclin

    CARING for the patient :wub:

    Once or twice in the past I have taken palliative or lonely nursing home patients to their destination via some lovely spot to which they've not been in many years. Once to the lakeside and another to the beach, each time unloading the stretcher to sit in the sun with the patient. I stole the...
  9. Melclin

    Patient interviewing Trauma/Medical

    First is usually introductions and quick look or whatever you want to call it. Specifically look the patient up and down and palpate a radial pulse. You can tell so much in the first 5 seconds this way. Distressed? Diaphoretic? Pallor? Increased WOB? Lethargy? Meaningfully interactive and...
  10. Melclin

    Whatcha pocket?

    I don't know what it is about threads like this but they just make me want to detail every bit of lint in my workin' pockets. They're oddly compelling. Its the bureaucrat in me I'm sure. Especially when you've had a few beers. I work with a guy who actually carries several huge camouflage...
  11. Melclin


    Its worse when these rules use "brought in by ambulance" as a criteria. How do you take that in the prehospital environment? I've used Ottawa ankle rule in the past. Got the cheat sheet in pocket along with the rest of things I can't be arsed remembering. Its usually a moot point though, on...
  12. Melclin

    Anterior Ischemia or Syncope?

    I was just so confused by this entire thread until jrm piped up.
  13. Melclin

    50 yo male with AMI

    Sounds like what would have been ideal for this pt was mechanical CPR to the cath lab. Failing that, I don't see the point of redirecting to the smaller hospital. What more are they going to do and more importantly, what happens when the pt gets ROSC? If you are willing to do CPR during...
  14. Melclin

    Permissive hypotension

    Reading of the question aside... talking about haemorrhagic shock mostly in the setting of trauma patients. Was not aware that kind of terminology was in use for any other disease process for which people would have guidelines.
  15. Melclin

    Permissive hypotension

    Its not about correlating to a specific blood pressure. Its quite the opposite. The idea is that chasing the same specific number in all patients is a flawed idea as the number alone may not necessarily mean a blood pressure associated with a minimum level of acceptable perfusion state. I...