A ResusTEE case discussion with ED doc Serge Keverian. #FOAMed, #FOAMcc

So I’m really stoked about this story. Truly makes meducation worthwhile. While preparing H&R2019, I was chatting with Felipe Teran who suggested he could bring the ResuscitativeTEE course up, which I thought would be awesome. So we did, and got a bunch of local and international participants. Now to me this was part of exposing local ED docs to advanced resus, as we had recently started an Advanced Resus Committee at our shop, all in the line of upping the game and hopefully heading towards eCPR.

So some guys from another local community hospital also took the course and were pretty amped about it and wanted to pick our brains about the practical aspects of resusTEE, as we’ve got a bunch of cases under our belts at Santa Cabrini in the last couple of years.

Well, lo and behold, just days after the conference, these guys used resusTEE with awesome results!

Here is our discussion:

Resus TEE w Serge K

So we need to thank @FteranMD and the @resucitativeTEE team, Mae West, Laura Duggan, Tom Jelic and our own Philippe St-Arnaud for putting together a course solid enough that it had an immediate effect on the participants’ practice and on clinical outcomes.

It is also interesting because of all the political BS that takes place in a health care system, one of the common themes is the desire by some individuals and policies to “hog” the resources and want to centralize everything in so-called centres of excellence. There is, of course, some sense to this – concentrating the clinical experience (eg if you are only doing one central line or one heart transplant a year, you probably shouldn’t be doing any. This, to me, applies for many types of interventions or resources, especially those that are  not exceedingly time-sensitive, where the patients do have the time to get to the well-heeled service or doc that grows the elite expertise, no mater the field.

However, there are a lot of cases where the situation is critical and the patient lands in the closest ED, and the guys and gals in the trenches have to handle it. In my opinion, if these teams are motivated and willing to gain the skills, they need to be supported and equipped. This case is a great example of ED docs in a community hospital integrating an advanced resuscitation technique that is done in only a handful of centres, and in most cases, not yet being done in most tertiary/academic care centres, and doing so with great effect.

Same applies to techniques such as REBOA. We ran a workshop at H&R2019 using the REBOA simulator. It isn’t rocket science. If you’ve put in femoral art lines, let alone PA catheters, this is an exceedingly simple technique. It isn’t just the downtown academic centres that should be using resuscitative technology or procedures. Those patients living in the suburbs who arrest or get smashed may not have the time to make it to those EDs, and they pay the same taxes (in Canada) that keep the system going.

So if anyone reading this is involved even loosely in policy-making, whether institutional or broader, stop this childish nonsense. Let’s get everyone the care they need.






A #5minutesofCC discussion with Josh Farkas: Fluids in the ICU! #FOAMed, #FOAMcc

 So for me, the best part of organizing a conference is all the behind the scenes, car, hallway, brunch, lunch and gym discussions that take place. Of course the talks are great, but often it’s in these discussions that the nitty gritty of clinical opinions on management come out.

So we did manage to record a few, and since Josh wrote up essentially the definitive review of fluid boluses:


I thought it made sense to put our discussion out to #FOAMed at the same time:

Love to hear your ideas!