Leo Murray

1
(No Transcript)
2
Leo Murray

• FRCSEd MRCP MRCGP DA FFAEM
• Variety of clinical experience
• 10 years running AE service Ayr
• Then to Skye 1999

3

• What are we trying to do?
• What have we done?
• How are you helping
• Discussion

4
Broadford
5
(No Transcript)
6
(No Transcript)
7
120km by 60 Km

• Hospital at Inverness 180km / 2-4 hrs
• Head injuries to Glasgow 300km / 4-6 hrs
• 13 to 30,000 people - tourist area

8
(No Transcript)
9
(No Transcript)
10
What Are We Trying to Provide?
11

• See and assess
• Resuscitate
• Evacuate
• Keep what?

12
How to provide advanced airway management?

• Lost Resident Surgical Cover
• Loss of Anaesthetic Cover

13
(No Transcript)
14
(No Transcript)
15
(No Transcript)
16
2000 to 2004

• 24 intubations
• With use of drugs not dead intubations

17
20 alive 4 died

• 33 year old SAH deteriorated in air- died
  Raigmore
• 61 year old intracranial bleed died in Southern
  General Hospital
• 74 year old man acute subdural died Southern
  General Hospital
• 72 year old respiratory failure extubated and
  then deteriorated and died in Raigmore

18

• 38 year old quarryman

19
8 other head injuries
Intoxicated head inj Age 24
Intoxicated head inj Age 27
skull gcs 7 Age 44
Extradural male Age 33
Head inj, fitting Age 6
Head inj, fit Age 55
Intracranial haem Age 62
Head inj, status Age 19
20

• 3 overdoses
• 1 stayed on Skye !!

21

• 2 status epilepticus

22

• Toxic shellfish poisoning

23

• Epiglottitis

24

• Liver failure

25

• 2 intracranial bleeds salvaged

26
January to May 2005

• 5 most recent cases

27
January to May 2005

• 23 March 1942
• 09 January 1958
• 05 August 1957
• 05 August 1943
• 16 May 1951

28
January to May 2005

• 12 March 2005
• 02 February 2005
• 27 April 2005
• 20 February 2005
• 15 May 2005

29
January to May 2005

• 2345
• 1415
• 1600
• 1900
• 2150

30
January to May 2005

• copd/lvfstatus
• sah
• icb
• intracranial bleed
• Anaphylaxis

31
January to May 2005

• Turton
• Campbell
• Innes
• Murray
• Davidson

32
January to May 2005

• raigmore
• aberdeen
• raigmore
• sgh
• raigmore

33
January to May 2005

• fitted in ae room to raigmore itu by road -
  snowing - no air evac possible
• sah confirmed organs harvested at 48 hrs
• no beds aberdeen no beds glasgow raigmore
• to sgh intracranial bleed stepped down to ward
  at 24 hrs
• thought to be anaphylaxis not clear several
  days ventilated in itu

34
Does it matter?
35
How to sustain this service?
36
Need generally trained doctors with extra
resuscitation skills Rural Practitioners!
37
(No Transcript)
38
School-leavers

• Perform all succesful intubations
• Perform all neurosurgery worldwide
• Perform all open heart surgery worldwide

39
Current plan

• Generally trained doctors
• Work 40 hours
• Pay 90,000
• Provide airway training
• ABLE TO RECRUIT!!!

40
Resuscitation training

• ATLS
• ALS
• EPLS
• ALSO

41
Skill maintenance in a low volume situation

• 10 days per year study leave
• 6 weeks per annum in major hospitals

42
Anaesthetic Experience

• Comfortable with critical care

43
To paralyse and ventilate

• Anaesthetic experience
• Minimum acceptable standard?
• Fixed time?
• Competency based?
• Annually refreshed

44
How to Get Training in Critical Care Management
45
(No Transcript)