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 ☺️. 🎖️🤓🚑

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: The #TRAUMOX2 Randomized Clinical Trial | ⁦‪JAMA - ‬⁩ Just published! #ccrdownunder jamanetwork.com/journals/jam...

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....

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#POCUS #FOAMcc #foamus @icmteaching @ICUltrasonica Where do we scan then?? Linear/curvilinear or phased probe positions shown👍👇

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).

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

At Ambulance Victoria, around 40% of our patients have pain as part of their presentation and we stand to make a real difference in the patient's experience of their illness. I was extremely fortunate to discuss the topic with paramedicine legend @billlord.bsky.social & @expensivecare.bsky.social

Great to see the papers in our Special Issue on the Commercial Determinants of Health already getting media attention! @inquisitivegyn.bsky.social You can read all the papers in the special issue here: academic.oup.com/heapro/issue... www.theguardian.com/australia-ne...

Women are less likely to receive lifesaving CPR after cardiac arrest and less likely to survive. This interesting research looks into how CPR training & the sex of CPR manikins contributes to inequitable cardiac arrest outcomes. #MedSky #ResusSky #CriticalCare academic.oup.com/heapro/artic...

The latest episode of Clinical Conversations - Ambulance Victoria’s clinical podcast is out! Its the 1st part of a 3 part series where James chats with paramedicine legend @billlord.bsky.social about all things prehospital assessment and management of pain. Tune in wherever you get your podcasts!

I’m going to write a short blog on how to get started on MedSky (starter packs etc). What are useful pointers for people migrating from med-twitter to medsky? I’m no expert on this, but I think a short how-to post could help bring more people over.

Register for CCR Down Under ASAP… 😄 We’d love to see you in Melbourne for more @CritCareReviews magic, December 10th & 11th, 2024. A few rego spots are still open but they’re filling fast… criticalcarereviews.com/meetings/ccr...

It takes a system to save a life in cardiac arrest. I’m proud to have played a small part in this paper in The MJA which shows how survival has incrementally improved in Victoria over 25 years and highlights the value of a registry. If you don’t measure, you can’t improve 🤓 🚑

Oh this is so lovely. So clean and unpolluted. Like taking a drive out from the smog of the city, climbing to the top of a hillock and sharing the vista with old friends and new. Raising a glass of hope in the sunshine of sharing. #FOAMed #MedSky

🧐🧐🧐

Happy to share an invited article I wrote looking at what #EM in Australasia can learn from the #NHS for Emergency Medicine Australasia. This was part of a discussion on the future of emergency care in Australasia in the EMA. onlinelibrary.wiley.com/share/author... #MedSky #BlueSky

Another day, another million new people have joined Bluesky! 18M users? 🙂‍↔️ 18M friends 🙂‍↕️

Ceftriaxone 2 gm IV q12h for 3 days vs. matching placebo reduced early-onset pneumonia occurring ≤4 days after intubation in OHCA survivors treated with TTM and may reduce antibiotic resistance gene acquisition through a decrease in antibiotic exposure #ReSS24 @ahascience.bsky.social

A whiteboard from our Jan 2023 team retreat where I wrote down our goals, and the top one was “10k user signups.” We’re growing by 10k users every 10-15 minutes right now.

Set up a paramedic researcher starter pack for those just joining Bluesky.... go.bsky.app/BZpAcQN Let me know if you want to be added.

This song has aged surprisingly well

Anyone else tried to use the Blue Sky app to do an ultrasound yet? Or just me?

➡️ The PARAMEDIC3 & IVIO trials were presented at #ERC24 & published in @NEJM 2 weeks ago ➡️ We have a podcast on each with their investigators ➡️ Yesterday, we reviewed PARAMEDIC3 ➡️ Today, it's IVIO criticalcarereviews.com/podcasts/ivio

Excited to receive my contributing author advance copy of this great new text - Critical Care Paramedicine: A cased based approach #Paramedicsky #EMSky 🚑🩺 Available here: www.classprofessional.co.uk/ems-fire/par...

Hi everyone. This seems…. Promising…. 🤓 #medsky #FOAMed