Hands Off The Ketamine!


Welcome 2015

It seems ages since I was revising for my FFICM and set this blog up–though its only a matter of months–and this site has stood a bit stagnant. So, the first few months of this year will be do or break for this site. I hope build better coverage of the curriculum onto the site. I have quite a few revision notes that I will be looking over and editing for public consumption.

2015 has brought in other big changes for me. Later this week, I’ll be travelling to West Africa to help with the Ebola crisis for 7 weeks. While Ebola has been largely viewed and managed as a Public Health crisis, it is very much a critical illness. What an Intensivist can add to the situation has yet to be seen. I’ll be documenting my experiences on my other blog.

If you have any spare Christmas pennies, I’d be grateful if you could send them over to the guys at MSF who are doing a sterling work over in West Africa.



Drowning is defined as respiratory impairment due to submersion in liquid. Often associated with hypothermia, trauma and result in multi-organ failure.

  • The aspirate is either hypertonic (sea water) or hypotonic (fresh water) leading to pulmonary oedema; the water may carry bacteria or particulate matter.
  • Initial assessment: precipitating event (alcohol/drugs), water type and temperature, known medical history, ABCDE.



paper Drowning, Carter & Sinclair. CEACCP (2011)


Extracorporeal Membrane Oxygenation


  • veno-arterial ECMO (VA-ECMO): gas exchange and haemodynamic support
  • veno-venous (VV-ECMO): gas exchange
  • arterio-venous ECMO (AV-ECMO): gas exchange (mainly CO2 removal; no pump)


paperExtracorporeal membrane oxygenation in adultsMartinez & Vuylsteke, CEACCP 2012