Per P. Bredmose

Bondi Beach 🙏🏼 Thinking of you all. ❤️

@cliffreid Couldnt agree more. And many more causes… and dont forget the NEC diag in neonate shock.

There's more to shock management than fluids and vasopressors For every type of shock there are important surgical causes to consider which can kill the patient if missed Primary and secondary surveys don't just apply to trauma!

@turtlemedic Agree, however, if there r no alternatives (and a NEED), ie hypothermic CA, then CPR to an ECMO facility is the right choice

@VikingOne_ Only things I won't move are ongoing CPR and childbirth. Can't do quality CPR in a vehicle, and safer for all concerned to delay transport until after delivery. Everything else may need some optimization, but can otherwise move

NEVER to sick to be retreived.. a matter of skills, experience, tools, platforms and the TEAM. #oslohems

@gareth_grier Nice one

Speaker line-up coming together really well. Tickets on sale now. More to follow!! fundraising.londonsairambulance.org.uk/event/resus-sy…

@gareth_grier @QMUL Count me in

…and now an evening of the @QMUL Prehospital Care Programme - great presentations and discussions from the students.

@gareth_grier @EHAAT_ @ehaatClinical Very good sir

We’re off on day one of our Prehospital Care Course @EHAAT_ @ehaatClinical Fab to have docs and paramedics from across the U.K. and beyond, as well as our own team. A big week, with tens of people from our team involved in the education process. Loving Lisa’s intro!!

(1/3) In the ICU we focus a lot on Mean Arterial Pressure, Systolic Blood Pressure, and even Pulse Pressure Variation... Pulse Pressure itself is often overlooked but one of the most valuable quick upgrades to your blood pressure assessments! Why? Its a great surrogate of Stroke Volume 🧵

@ross_prager @emcrit @icmteaching @KiranRikhraj @ThinkingCC @khaycock2 @NephroP @nickmmark @TheSGEM @tjelle13 I do the same in icu, OR, and prehospital: Art line Adrenaline infusion, bolus ready Best larynscopist, gentle ventilation during apnoa, and always stay for next 30 min

(9/x) How else do the experts intubate to prevent hemodynamic collapse and cardiac arrest? Would love your pearls. @emcrit @icmteaching @KiranRikhraj @ThinkingCC @khaycock2 @NephroP @nickmmark @TheSGEM @tjelle13

(1/x) Intubating patients with shock in the ICU is by far the most dangerous bedside procedure we perform in ALL of medicine. There is a 3.1% cardiac arrest rate during ICU intubations (JAMA 2021: PMID 33755076) Here’s how you can make it as safe (as possible) 👇

@ross_prager Not infrequently half dose is too much. Occasionally 10-20% is enough.

(4/x) For a patient in shock that you are intubating, half the sedative dose and double the paralytic dose (as a general rule). In shock, you need less sedatives (and their hemodynamic impact are worse) and paralytics take longer to circulate (a higher dose can help reduce time to onset) This has been something that @emcrit has preached for over a decade and it is still so true. I see the mistake commonly where someone is intubated with 50mg of Rocuronium and then after 1 minute people wonder why they are still moving!

@ross_prager Always Art Line

(7/x) After you intubate, stick around the bedside for 10 minutes or so. Most cardiac arrests post intubation occur 5-10 min post intubation. Stick around the bedside as there are lots of things to do… monitor the hemodynamics like a hawk! Look for: 1. Dropping BP (obviously) 2. Loss of pulse ox pleth waveform (shock) 3. Falling ETCO2 not accounted for by ventilation 4. Narrowing of the pulse pressure 5. Mottling / worsening cap refill time. These are all indicators you might be heading towards a cardiac arrest.

@HGoharism @ross_prager @R_Tambelli Prehosp I do the same: Art like, adrenalinet infusion, ventilator during apnoa

@ross_prager @R_Tambelli Agree! Unless there is an airway obstruction with imminent respiratory arrest, C should always come before A

@cliffreid @SydneyHEMS @nattiejpk @DrPaulRees Very very good!!!!

Essential cardiac arrest listening - HEMS Debrief podcast from @SydneyHEMS where @nattiejpk and @DrPaulRees discuss diastolic blood pressure targets amongst other physiological principles podcasts.apple.com/au/podcast/pod… sydneyhems.com/2025/06/10/hem…

@cliffreid Can You e-mail a programme?

Two days of Resus Magic eventbrite.com/e/resuscitatio…

ECMO retrieval training for consult group at #oslohems

Association of mortality and physician experience in prehospital anaesthesia: a registry study on new physicians in Finnish helicopter emergency medical services | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Full Text sjtrem.biomedcentral.com/articles/10.11…

@realcreid @cliffreid Yes

@cliffreid Yes. We have protocolised it. It’s quite common in QLD as mentioned

Anyone using intranasal dexmedetomidine for emergency department pediatric procedural sedation?

@cliffreid @DocJohnsMum Awesome

.@DocJohnsMum #ResuscitateWithHonourableIntentions

@cliffreid Niiiiice

Good morning

@UWEmerMed @DrewCathers @UWHealth @UWMedFlight How can I either sign up or contribute from Iversens

Prehospital and emergency care providers at all levels are invited to a *Special Edition* of the @UWHealth Emergency Education Night Webinar Series tomorrow: "Med Flight Chronicles: Against the Odds — A Farm Rescue and Recovery Story" 🔗 Register now at uwhealth.webex.com/webappng/sites…