I just have to give a shout out to the RAGE PODCAST this week. If you have been living under a rock, the RAGE podcast is a semi-regular “resuscitationists awesome guide to everything” featuring top quality FOAMed contributers who are credible in their field.
“Do not go gentle into that good night
Rage, rage against the dying of the light“
This months session is entitle neuroRAGE and deals with all things to do with neurosurgical emergencies. It features Mark Wilson who speaks authentically on experiences as a HEMS physician, neurosurgeon and with some significant anaesthetic experience. I managed to talk with Mark on “Burr holes in the bush” a couple of years ago and since then the idea of prehospital Burr holes has been enthusiastically mooted elsewhere. Is this something that a prehospital service clinician needs to be able to do? Is an extradural the ‘tension pneumothorax of the skull?
Mark gives good talks (if you saw him at smaccGOLD and were impressed, the good news is that he’s back at smaccUS). He’s also prepared to share – he gave a great talk at medSTAR clinical governance day earlier this month and was a major contributor to Sydney HEMS themed neurotrauma session earlier this year – content from the latter is available online. He also runs the AcuteBrain website and is a coninventor of the GoodSAMApp
Also on RAGE, Cliff Reid also gives a lovely description of being on the end of both an LP and in the K-hole, reinforcing the need for concomitant benzos and (where possible) a calm, low stimulus environment to avoid emergence phenomena.
I’ve certainly noticed similar tales of spiral ‘helter skelter’ sensations amongst my dissociated patients…to me this emphasises the need to be familiar with ketamine for both induction, dissociation and analgesia – something all trainees should endeavour to gain experience with in their anaesthetic placements or in ED.
Here’s a video of the potential nasty dissociative effects of ketamine – I love the drug, but consider adding some benzo if appropriate
Anyhow – trust me on this – LISTEN TO THE neuroRAGE podcast. It’s a good one!