The Secondary Survey

Episode 4 Haemorrhage Control

In this month’s episode we are exploring major and catastrophic bleeding. Death from haemorrhages represents approximately 35% of all traumatic deaths. Lessons learned from the experiences of the military, tragic mass shootings, violent crimes and terrorist attacks, have lead to the adoption of techniques, such as tourniquets, wound packing and the use of haemostatic gauze being adopted into civilian prehospital practice. These techniques have not only been adopted by Emergency Medical Services but by civilian programmes such as “Stop the Bleed” course and the Daniel Baird Foundation’s “Control the Bleed”.

In this episode our first guests, Mick and Kieran will help us explore this topic and will hopefully build confidence in Irish practitioners in the use of tourniquets and Wound packing.

 

 

References:

 

https://handbook.bcehs.ca/clinical-practice-guidelines/pr-clinical-procedure-guide/pr04-wound-packing/

 

 Donley ER, Loyd JW. Hemorrhage Control. [Updated 2021 Jul 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK535393/

 

Chitosan-based dressing for the treatment of external/accessible bleedings in children with bleeding tendency, https://pubmed.ncbi.nlm.nih.gov/23588337/

 

https://www.cureus.com/articles/7905-pre-hospital-hemorrhagic-control-effectiveness-of-axiostat-dressing-versus-conventional-method-in-acute-hemorrhage-due-to-trauma

 

   Antifibrinolytics in a rural trauma state: assessing the opportunities     https://pubmed.ncbi.nlm.nih.gov/29766102/

 

Spahn, D.R., Bouillon, B., Cerny, V. et al. The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition. Crit Care 23, 98 (2019). https://doi.org/10.1186/s13054-019-2347-3

 

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwjxnLWJwdX1AhVBUMAKHcHGBn4QFnoECAoQAQ&url=https%3A%2F%2Fwww.euro.who.int%2Fen%2Fhealth-topics%2Fdisease-prevention%2Fviolence-and-injuries%2Fnews%2Fnews%2F2020%2F7%2Fwho-report-on-violence-and-injuries-reveals-grim-statistics-on-preventable-deaths&usg=AOvVaw3_W_8Uzzq5Y23CuRPXiDdC

 

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwiwpIGqwdX1AhXSgVwKHcGmBYIQFnoECAUQAQ&url=https%3A%2F%2Fwww.hse.ie%2Feng%2Fabout%2Fwho%2Facute-hospitals-division%2Ftrauma-services%2Ffurther-information-and-documentation%2Freport-of-the-trauma-steering-group.pdf&usg=AOvVaw1wjLDfsjPkHZ-XmfyRjaNh

 

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwjk7qTCwdX1AhWKTsAKHTl-DRkQFnoECAcQAQ&url=https%3A%2F%2Fec.europa.eu%2Feurostat%2Fstatistics-explained%2Findex.php%2FAccidents_and_injuries_statistics&usg=AOvVaw2ViPnJuFdi19vALBwDorPf

 

https://www.youtube.com/watch?v=p41qvnFn--c

 

 

Stop The Bleed: Tourniquet Application

 

HaemorrhageContro

 

Stop the Bleed (Full Course)

PrepMedic

165K views2 years ago

 

 

 

 

 

 

Teaser - Haemorrhage Control

We planned on releasing this as a Supplemental Episode to our upcoming Haemorrhage Control Episode, but we decided to release it as a Teaser Episode instead.

Keep your eyes and ears out for the full episode on 1st February 2022!!!

Episode 3 Clinical Practice Guidelines 2021

In this episode, we go through some of the updates to The Prehospital Emergency Care Councils new Clinical Practice Guidelines. We will talk about some of these changes and speak about the new medications added to them. It’s important to point out that these new CPGs are not to be used until you have undergone training and have been privileged by  your PHECC Organisation, be that voluntary services or state prehospital providers.

EMT CPGs Link https://www.phecit.ie/Custom/BSIDocumentSelector/Pages/DocumentViewer.aspx?id=oGsVrspmiT0dOhDFFXZvIz0q5GYO7igwzB6buxHEgeDBS9BbdRZpZNKt9Y89hp%252bGEhGQslpxcyoYmdTLu78H9r76oZTnilm7mlbqDvzJntWlMW756bp2SpJvrdd59AwKjghcMgxg%252baL7Q4mhgOBetkyf7Z4CcxuK2Yxi6SCL0J%252f0jnChy4SHjBix4tYfFiZ4Fvz5FZZpvvQ%253d

Paramedic CPGs Link

https://www.phecit.ie/Custom/BSIDocumentSelector/Pages/DocumentViewer.aspx?id=oGsVrspmiT0dOhDFFXZvIz0q5GYO7igwzB6buxHEgeDBS9BbdRZpZNKt9Y89hp%252bGEhGQslpxcyoYmdTLu78H9r76oZTnilm7mlbqDvzJntWlMW756bp2SiwLHTchpmEjSJkla05iww4DH8GQDvJatGOxRLqNEW7Q4XY3WM%252bbBTeWJ82lbF%252bJzKCzDlYJtCNiIWesB5W%252bHxE%253d

Advanced Paramedic CPGs Link

https://www.phecit.ie/Custom/BSIDocumentSelector/Pages/DocumentViewer.aspx?id=oGsVrspmiT0dOhDFFXZvIz0q5GYO7igwzB6buxHEgeDBS9BbdRZpZNKt9Y89hp%252bGEhGQslpxcyoYmdTLu78H9r76oZTnilm7mlbqDvzJntWlMW756bp2Sss33aOudBIeG7u3HIUnGBWa2plxYfgV6QyPTmWeB%252ff%252bOOyImbeSBq24mcIZtwFS%252fHI1d9DL61G9QbZ9GHMdoig%253d

Procedural Sedation Links

Predictors of airway and respiratory adverse events with ketamine sedation in the emergency department: an individual-patient data meta-analysis of 8,282 children https://pubmed.ncbi.nlm.nih.gov/19201064/

https://www.rcemlearning.co.uk/reference/procedural-sedation-emergency-medicine-2018/#1571048556060-300cb36c-1059

 

https://www.rcem.ac.uk/docs/College%20Guidelines/Pharmacological%20Agents%20for%20Procedural%20Sedation%20and%20Analgesia%20(Oct%202016).pdf

 

https://www.rcem.ac.uk/docs/RCEM%20Guidance/Ketamine%20procedural%20sedation%20for%20children%20in%20EDs%20(Feb%202020).pdf

 

Incidence of Adverse Events in Adults Undergoing Procedural Sedation in the Emergency Department: A Systematic Review and Meta-analysis https://pubmed.ncbi.nlm.nih.gov/26801209/

Episode 2 Chest Pain

Welcome to The Secondary Survey episode on Chest Pain.

In this episode, we take a look at ACS and some of the Non-ACS causes of chest pain. 

Think Aorta Global Meet Up https://www.youtube.com/watch?v=Pevx8zQY1bM 

https://litfl.com/acute-aortic-dissection/

Bilateral blood pressure differential as a clinical marker for acute aortic dissection in the emergency department

Sung Wook Um , Robert Ohle , Jeffrey J Perry 

Emerg Med J 2018 Sep;35(9):556-558. doi: 10.1136/emermed-2018-207499. Epub 2018 Jul 18.

https://www.thinkaorta.net/

Aortic Dissection Risk Assessment Tool (ADDRS) https://rebelem.com/the-advised-trial-a-novel-clinical-algorithm-for-the-diagnosis-of-acute-aortic-syndromes/

 

https://croi.ie/health/heart-conditions/heart-attack/

https://www.youtube.com/redirect?event=video_description&redir_token=QUFFLUhqbC16R0Q0WFVoQU54NENSeG90NkctLU5fc1Q4d3xBQ3Jtc0tsXzNFUHdFQm02RmhxNTlmVEVQWW9nQkNDZUVWTUdoZ01mWnQ3MGd4SXNic21YemV0SEZHY0xjVmpGdEZqQ3c1dWE5SGQ5Y3VzSTZGc3lOdG54VGR2NnphUmd6SjVjUllMcUhPai10ZWJuR2l2eUp2VQ&q=http%3A%2F%2Farmandoh.org%2F

 

https://armandoh.org/

 

https://dx.doi.org/10.7861%2Fclinmedicine.14-2-128

 

https://erj.ersjournals.com/content/44/Suppl_58/P2308

 

http://thrombosisireland.ie/wp-content/uploads/2017/10/irish-stats.pdf

 

http://bmjopen.bmj.com/chttps:ontent/9/6/e030059

 

https://www.hse.ie/eng/services/publications/clinical-strategy-and-programmes/management-of-pulmonary-embolism-presentation.pdf

 

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwihwZv30MD0AhWBY8AKHaGaBr0QFnoECAcQAQ&url=https%3A%2F%2Fgeekymedics.com%2Frespiratory-examination-2%2F&usg=AOvVaw0ciHT10mtiIh92BbpwqedE

 

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwiIi8_N08D0AhVbhlwKHXrVApYQFnoECBIQAw&url=https%3A%2F%2Fwww.merriam-webster.com%2Fmedical%2Fbronchophony&usg=AOvVaw2hRSxwGNKnx4u6rCs9u-M1

 

Episode 1 Scene Safety

Welcome to the Secondary Survey. This Month's episode looks at Scene Safety, something that all Pre-Hospital care providers, EMT, Paramedics and First Responders should appreciate and be mindful off. A phrase often uttered at the beginning of an OSCE but sometimes under appreciated.  Thanks for listening and stay safe. 

 

please find some links to the material we discussed during this months episode. 

https://smacc.net.au/2016/09/think-youre-resuscitationist/

https://play.acast.com/s/smacc/smaccforce-rant-scene-safety-is-bullshit

 

https://www.stemlynsblog.org/jc-the-zero-point-survey-optimising-resuscitation-teams-in-the-ed-st-emlyns/

Creative adapting in a fluid environment: an explanatory model of paramedic decision making in the pre-hospital setting

Gudrun Reay1* , James A. Rankin1, Lorraine Smith-MacDonald1 and Gerald C. Lazarenko2

DOI https://doi.org/10.1186/s12873-018-0194-1

 

https://www.unitekemt.com/blog/5-most-common-emt-injuries/

 

https://www.irishexaminer.com/news/arid-30982838.html

 

https://www.irishtimes.com/news/health/no-prosecutions-in-any-attacks-on-paramedics-last-year-1.3082822

 

We all have Biases as part of the human condition and prehospital practitioners are no different.

Paramedics tend to learn to diagnose through pattern recognition and that can lead us to make assumptions on cases on prearrival information. Add in stressors such as hunger, tiredness etc and this can lead to a confirmation bias which may lead us to miss a diagnosis or leave us ill prepared when we are faced with a case that might be far sicker than anticipated.

The free radical paramedic podcast goes in to this in far more detail, as are these helpful guide to cognitive biases.

https://podcasts.apple.com/ie/podcast/free-radicals-paramedic-podcast/id1437228859?i=1000428897089

 

https://first10em.com/cognitive-errors/

 

https://hbr.org/2015/05/outsmart-your-own-biases

 

https://www.simplypsychology.org/cognitive-bias.html

 

Meet the Team

It is finally here!  The Secondary Survey launches on the 1st of November. An Irish podcast all about the world outside the hospital. We will look at topics that will interest everyone who provides pre-hospital care from the Community First Responder to the Advanced Paramedic and beyond.