....or an argument against throwing the baby out with bathwater. Invariably we've all heard it on the podcasts, blogs and at the conferences. The reasons why we shouldn't do panscans are all over the internet. From conspiracy theories that radiologists and hospital admins are doing it for the money to the argument that it dulls clinical accumen.
IMHO panscans are a product of technology moving too fast for the literature. We keep asking questions like we did in 1999 when we're seeing the technology of 2017.
The question shouldn't be do panscans influence outcome or "flow" in the ED. The question should be: "In which patients has focused history, examination and selective CT scanning failed us?"
By and large the studies on which we've based our arguements against panscans are based on older CT scanners, retrospective data and radiation "risk" that is miniscule compared to the risk of missed injuries. You cannot use retrospective studies in which hemodynamically unstable patients are taken for a CT in 2000 (17 years ago) to make a point that panscans are evil. You can however say "just because the microwave is there doesn't mean we have to use it every day" . Like your microwave your panscan should have indications for use (never try and make pancakes in a microwave BTW), the trouble is we haven't figured them out yet.
Some alternative points of view that are probably more valid than mine :
ALIEM Top ten trasons not to Panscan.
Life in the Fast Lane Brief review .
Trauma.co.nz , The Debate:Panscan.
well .... most times ....
This podcast can't be about resuscitation if I didn't include an airway talk in the first 5 episodes.
It happens to all of us from time to time, you get called at 2 am for a can't intubate, can't ventilate disaster that's been going on for far too long .... this episode is about how to avoid it. FRom pre planning to setting up a comfortable bailout plan.
Laryngoscope as a murder weapon.
RSI from Life in the Fast Lane.
Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults
C. Frerk, V. S. Mitchell, A. F. McNarry, C. Mendonca, R. Bhagrath, A. Patel, E. P. O’Sullivan, N. M. Woodall and I. Ahmad, Difficult Airway Society
intubation guidelines working group
British Journal of Anaesthesia, 115 (6): 827–848 (2015) doi:10.1093/bja/aev371
Preoperative airway assessment - experience gained from a multicentre cluster randomised trial and the Danish Anaesthesia Database.
Diagnostic accuracy of anaesthesiologists' prediction of difficult airway management in daily clinical practice: a cohort study of 188 064 patients registered in the Danish Anaesthesia Database.
Apologies if I didn't recap at the end .... completely forgot.
Figured I'd start with a little about my self and why I'm doing this.
The reality is that I'm not sure.
More (better) sources of #foamed and another introduction to it:
Life in the Fast Lane.
Scott on Emcrit.
Basically a test of how everything works.