Clinical Conversations – Details, episodes & analysis

In Australia, penetrating truncal trauma is rare and the care of these patients involves a quite different mindset than we're used to. This is a cohort where our stay-and-play approach can do harm. James and David discuss the evidence relating to penetrating trauma and practical recommendations for your practice.

Further resources

Over view of major traumatic injury in Australia–Implications for trauma system design

The evil of good is better: Making the case for basic life support transport for penetrating trauma victims in an urban environment

Association of Police Transport With Survival Among Patients With Penetrating Trauma in Philadelphia, Pennsylvania - PubMed (nih.gov) 

The effect of transport mode on mortality following isolated penetrating torso Trauma - PubMed

Every minute counts: The impact of pre-hospital response time and scene time on mortality of penetrating trauma patients

Get in touch

clinicalguidelines@ambulance.vic.gov.au

X / Twitter

David: @expensivecare

James: @JamesOz1

Clinical practice varies between the different state ambulance services in Australia. Yet we all claim to be evidence-based. So why is this, how big of a problem is it and what should we do about it? Are national guidelines the answer? James speaks with paramedic and PhD candidate Matt Wilkinson-Stokes to find out, while David shares his perspective on national guidelines.

Further resources

Matt's presentation on the differences between state ambulance service guidelines

Comparisons of clinical guidelines between states

Other papers mentioned:

https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-017-2243-y

Get in touch

clinicalguidelines@ambulance.vic.gov.au

X / Twitter

David: @expensivecare

James: @JamesOz1

Ambulance Victoria recently introduced intranasal ketamine for the treatment of moderate and severe pain. It has proven to be effective but we have identified opportunities to do better.

Clinical Practice Development Specialist James Oswald and Medical Director David Anderson discuss the new Clinical Practice Guideline and some of the lessons we've learned along the way.

For over a decade after a large study showed a mortality benefit, this drug remained controversial. David and James look at the TXA saga.

Clinical conversations is back. But where have we been, what have we been doing and what do we have planned for the future?

We’re all familiar with the concept of STEMI. But the definition is built around a single ECG sign – not the underlying problem itself. Is that the best way to do it? Should we be thinking about this in a totally different way? Is Occlusive Myocardial Infarction (OMI) the new STEMI? Notes

OMI Manifesto

Amal Mattu on YouTube

Subtle STEMI iOS app

The Ancient Scholar

Capnography plays a crucial role in the treatment of a range of life-threatening conditions. Its central role following intubation is undeniable and it's also an important part of our approach to cardiac arrest and sedated patients of all kinds. Yet it is not always as straightforward as it might seem. In this episode, David and James speak with Matt Humar (intensive care paramedic, acting patient safety review lead at Ambulance Victoria, and secretary of the safe airway society) about matters capnographic. 

Further reading

• https://derangedphysiology.com/main/cicm-primary-exam/required-reading/respiratory-system/Chapter%20414/difference-between-end-tidal-and-arterial-pco2
• https://www.capnography.com/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4231274/

Shock is the quintessential critical illness. Bread and butter for everyone involved in prehospital and critical care. But do we really understand it? Could we be doing better for these patients?

James is joined by Assoc. Prof. David Anderson, intensivist and Ambulance Victoria Medical Director, for a... shocking discussion. 

People experiencing acute behavioral disturbance are some of the most vulnerable patients we treat. It’s a deeply distressing situation for the patient and extremely confronting for clinicians and carers. In this episode, we speak with psychiatrist Dr Alison Taylor about important changes we're making to improve care for these patients.

Family violence is a deeply confronting and serious problem that occurs across all ages, genders, and socioeconomic groups. It has a profound impact on the health and well-being millions of people across the globe. How can we identify family violence? How should we respond to a disclosure of family violence? How can we help victim survivors? Ambulance Victoria Safe Guarding Care Lead Amber Smith joins James and David to discuss this important issue.

MARAM Family violence practice guide