This is the very first episode of the Emergency Trauma Management Podcast, created for those who manage trauma in the Emergency Department. In our first episode we are very lucky to have had the chance to interview airway guru and all around nice guy, Minh Le Cong. Minh runs the fantastic Prehospital and Retrieval Medicine (PHARM) blog and podcast, and has a wealth of experience in trauma airway management. He also helps run the RFDS Prehospital Anaesthesia & Airway Management Course. In this episode, we talk about intubation in the head-injured patient, Minh’s favourite drug, Ketamine, dealing with cervical spine immobilisation and airway management, and some really great tips on managing the airway in patients with actual spinal injury.
Stay tuned for part 2, with more great airway pearls from Minh. If you enjoy the podcast, leave us a comment below (by clicking on “Comments”).
Here’s Minh’s references about ketamine use for RSI in head injury:
http://www.utexas.edu/pharmacy/divisions/pharmaco/rounds/09-15-11.pdf
http://www.ncbi.nlm.nih.gov/pubmed/16454773
http://www.cjem-online.ca/v12/n2/p154
And a couple of others we’ve found:
A very comprehensive review by the crowd over at Best Bets and one from the omnipresent Chris Nickson at LITFL
In a nutshell, it appears it’s safe to use for RSI in head injured patients, particularly those with haemodynamic instability.
And here’s a reference about the risks to the C-spine during laryngoscopy:
http://bja.oxfordjournals.org/content/84/6/705.full.pdf
This is a great review of the documented case-reports and pathophysiology of spinal cord injury. Food for thought, and sure to generate debate. Should we ditch MILS (manual in-line stabilisation)? No way. It is way too early for that.
Is this a case of dogma over evidence – for sure. What do you think?