David Anderson ASM

It isn’t often that you need to provide a risky treatment before you’ve even assessed the patient, but that’s what prehospital clinicians sometimes need to do when caring for patients with acute behavioural disturbance.

@jamesoz1.bsky.social & I talk sedation safety on Clinical Conversations.

ECG Patterns of Occlusion Myocardial Infarction: A Narrative Review

CCR Journal Watch
https://criticalcarereviews.com/latest-evidence/journal-watch

Get the latest critical care literature every weekend via the CCR Newsletter - subscribe at https://criticalcarereviews.com/newsletters/subscribe

More medical inspired art: coronary arteries as subway map.

So humbled and proud to have been awarded an Ambulance Service Medal is this year’s Australia Day honours list.

Thanks to those who nominated me and to the friends and colleagues I’ve worked with over the ups and downs of 25+ years in prehospital care ☺️.

🎖️🤓🚑

Thanks Bill. Truly honoured!

I’ve learned so much from @jamesoz1.bsky.social chatting all things pain with @billlord.bsky.social in this series, and we’ve saved the best for last.

An exacerbation of chronic pain is a common reason to call an ambulance. What can we do as paramedics and as an EMS system?

Let’s find out!

This article rings true everywhere. It might be more pressing in the UK, as other countries willingly accept their senior staff with better pay and/or work hours, but it's still a factor in rural areas of the US and Australia.
And certainly worth a read.

Word of the Day is one I keep posting at the end of the year, hoping its time will come.

‘Respair’, from the 16th century, is fresh hope, and a recovery from despair.

Here’s to a few drops of respair in 2025.

Morphine or fentanyl? Does splinting really reduce pain? Is ketamine the ideal prehospital analgesic? Is there a role for paramedic administered NSAIDs? What about nerve blocks?

Find out the answer to these and more on part 2 of James’ interview with Bill Lord.

🚑💊🤕

Wonderful feedback on our new book. 🤓
The perfect gift for the discerning paramedic in your life! 😃

Presented at #CCRDownUnder:

In the SAHARA trial involving patients with subarachnoid hemorrhage and anemia, liberal transfusion of red cells did not result in a lower risk of an unfavorable neurologic outcome than a more restrictive strategy. nej.md/4ilTVdO

Early Restrictive vs Liberal Oxygen for Trauma Patients This randomized controlled trial investigates whether an early 8-hour restrictive oxygen strategy compared with a liberal oxygen strategy lowers the incidence of death and/or major respiratory complic...

Early Restrictive vs Liberal Oxygen for Trauma Patients: The #TRAUMOX2 Randomized Clinical Trial | ⁦‪JAMA - ‬⁩ Just published! #ccrdownunder jamanetwork.com/journals/jam...

The Primary Outcome Fails — What Next? | NEJM When the primary outcome of a clinical trial fails to reach its prespecified end point, can any clinically meaningful information still be derived from it? This review article addresses that question.

We have seen a number of trials with non-significant findings at #CCRdownunder. There is often debate then about what next? This paper by Pocock & Stone is a useful discussion piece to inform this type of discussion
www.nejm.org/doi/full/10....

Figure 3. Kaplan-Meier Curves for Probability of Antibiotic Duration and Mortality to 28 Days

Published in JAMA with #CCRdownunder:

In critically ill adults with suspected sepsis, antibiotic regimens were safely reduced when guided by measurement of procalcitonin but not by C-reactive protein. @criticalcarereviews.com

ja.ma/3BovM5v

ADAPT-SEPSIS: “Care guided by measurement of PCT reduces antibiotic duration safely compared with standard care, but CRP does not. All-cause mortality for CRP was inconclusive.” #ccrdownunder

Today it’s Lung #POCUS for you!

It is:

Easy to perform
Accurate
Sensitive
Repeatable
Negates irradiation or transport elsewhere!

#FOAMed #POCUS #FOAMcc #foamus @icmteaching @ICUltrasonica

Where do we scan then?? Linear/curvilinear or phased probe positions shown👍👇

An old automobile from World War I with an open top. The side has a Red Cross on it and underneath it reads: "Radiologie."

During #WW1, Marie Curie created a vehicle that contained a hospital bed, generator, X-ray machine & photographic darkroom equipment. These “petite Curies" (below) could be driven right up to the Front. Curie trained 150 women as radiology technicians. #histmed #skystorians #histsci

I almost didn’t write this blog in *2015* about how contrast nephropathy isn’t real, because I thought it was already pretty obvious at that point (https://emcrit.org/pulmcrit/do-ct-scans-cause-contrast-nephropathy/)

nearly a decade later, we’re still struggling with knowledge translation 🙈

this is so brutal it hurts, but it’s true 😳

So sad that I wasn’t able to be there for the official celebration of our new critical care paramedicine book. I was looking forward to my biscuit 😋.
Great to finally see it on the shelves though!

A liberal transfusion strategy compared with a restrictive strategy resulted in a lower rate of unfavorable neurological outcome among patients with acute brain injury.

ja.ma/3V5z1p9

Lot's of answers approximating what I think is best:

1. Are you in the Vortex? (can you ventilate?)

2. Have you ever been in the Green Zone (able to ventilate). If so, try to go back and do that.

3. Have you had a best effort at any lifeline? (define what can be abandoned/what's left to try).

Have never worked anywhere that does weight based dosing (NZ, Aus & Canada). Only ever mcg/min, mg/h or ml/h. Would be nice if we all did the same things, but as long as it’s standardized across the hospital/health system, I don’t think it matters.

Renal replacement therapy (RRT) in the ICU OnePager

📟 onepagericu.com/rrt

I used to post visitors to my garden to the other place. Here’s my first Bluesky garden friend. I think a juvenile male Australian king parrot. Very friendly 🤓🦜

Being a 'good rescuer' is:

• counterintuitive eg the advice to stand back & analyse rather than pile in & do something
• counter-cultural eg using checklists rather than relying on memory

Specific rescuer training would reinforce these skills.

#AnSky #MedSky #HFESky

https://buff.ly/3COBTjM

Such important work

Kudos to Ambulance Vic

- integration of @goodsamapp

- public access defib registry

- system based reform

- audit & publication

Twitter is dead.
Long live BlueSky.

Thanks David. It was great chatting with James about this important topic