A practical view of PEEP

This video made the rounds of social media some time ago, but it seems that not everyone had an opportunity to see it.

I was running a table-top scenario with a Graduate Paramedic recently and the discussion turned to the virtues of Non-Invasive Ventilation and pre-oxygenation strategies using PEEP valves, which reminded me of this great video;

As the idiom suggests, a picture is worth a thousand words.

If you would like to dive a little deeper, check out these links to the wonderful Life In The Fast Lane Critical Care Compendium pages on Non-Invasive Ventilation and PEEP.


Who (or what) is ViCTOR ?

You might be familiar with the expression “kids are just small adults” – reasonable in a few respects, but with regard to vital signs, you would already know they’re very different.

The service I work with is a few days away from introducing a new clinical approach for paediatric assessment, and this revision affirms that categorising the little tykes into just a couple of different categories is not the way forward.  If you think about it for a moment, it’s not really reasonable to expect that a 1 year old should have the same resting heart rate as an 8 year old !


Apologies to fans of ‘How I Met Your Mother’

The Victorian Children’s Tool for Observation and Response was developed through a collaboration of the The Royal Children’s Hospital and Monash Children’s Hospital to bring consistency to charting and alerting of paediatric vital signs.

Based on evidence established by observing more than 14,000 paediatric admissions, ViCTOR specifies age-specific vital sign limits for 5 different categories of paediatric patients – Small and Large Infants, and Small, Medium and Large children.

While the addition of more categories might initially seem daunting, these map directly to well-understood (and easy to remember) stages of development; Infants who are “Head Rollers” or “Head Holders”, Pre-School, Primary School and Secondary School children.

What I think is most encouraging though, is that our revised clinical approach won’t require practitioners to commit these new vital-sign ranges to memory – we are taking this opportunity to introduce decision-support tools (checklists and other references) into our regular practice.

This is a load off our minds, as well as providing a tremendous advantage in safety.

Here is a neat set of ViCTOR introduction videos with some great tips for getting a reliable vital signs in specific age ranges;


Or for more general information about how ViCTOR is used in hospitals, take a look here;

Acute coronary syndrome

I think there is a lot to be said for going back to the start of a knowledge base and reviewing the basics again.

(You might find this especially useful as a backgrounder if you were about to transition from 3-lead to interpreting 12-lead ECG)

Here’s an excellent presentation (especially the first 37 minutes !) from the Louisville Lectures which will take you through coronary perfusion, ECG interpretation and STEMI;



Brain impact apnoea

I was listening to one of the excellent SMACC Chicago panel discussions on the management of traumatic brain injury recently, and it occurred to me that the pathophysiology of patients presenting in cardiac arrest secondary to head-strike might be under appreciated pre-hospital.

After checking-in with a few colleagues to see if they were familiar with the concept of Brain Impact Apnoea, I thought you might find this quick summary from Life In The Fast Lane useful;


Here’s the ‘It’s a Knockout’ panel discussion from SMACC Chicago;

TLDR; It seems that the mechanism of a head-strike, leading to respiratory arrest, which then progresses to cardiac arrest might be poorly understood in the pre-hospital setting.  Attending a scene where a patient is in arrest post head-strike might be averted by simple airway management.


Facts about the Zika virus

In case you missed the latest round of histrionics from the popular media, there have now been a couple of cases of Zika virus reported in Australia.

Here are the peer-reviewed facts about Zika from Lauren Pike at ALiEM that should answer any nagging questions you might have;


Aedes Aegypti

TLDR; Zika is transmitted by Aedes mosquitoes (so it’s unlikely that you would get bitten anywhere South of Far North Queensland in Australia) and the first human case was 62 years ago !



New year celebrations

I’m working on an event car tonight (yes, I know) and it occurred to me that there are likely a number of people presenting at hospital over the next 24 hours that might not really need to be there.

Here’s a great (albeit older) article from the folk at Guy’s & St Thomas’  via PubMed that discusses their revised recommendations for revellers who appear to be unwell, but in context, might not need to present at the local emergency department.

Something to think about.



My best wishes for your year ahead.