Rollcage Medic Podcast

Feast your ears and eyes on podcast and vodcast goodness, as I pick the brains of the leading lights of the motor sport medicine and rescue community.

Some will be well known, others working in the background, but all are experts in their field with acres of experience that they are willing to share.

So tune in, turn on and absorb the goodness.

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Podcast 12 - Impact Brain Apnoea with Mark Wilson

May 1, 2015


Impact brain apnoea is a topic I've wanted to cover for a little while now. It's something that I became aware of about eighteen months ago and I've been planning to put something on the Rollcage Medic site for the last couple of months. Chatting to a motorsport medical provider recently gave me the spark to get on with it and track down someone who I could tease out the topic with.

And through the myriad corridors that make up the online world of FOAMed (Free Open Access Medical education, #FOAMed) I met Mark Wilson, who apart from his knowledge on this topic, is a really interesting guy. He'll be featuring at the SMACC conference in Chicago this June if you want more of him after this podcast.



While your suspicion of Impact Brain Apnoea might be heightened for an arrested trauma patient with what appears to be an isolated head injury (especially after listening to this podcast), you usually won't be able to confirm this until after the patient has been treated in the ED resus bay and had their CT imaging completed. So, use a standardised approach to the undifferentiated trauma patient and make sure you are covering the basics.

If it turns out that the injury has caused Impact Brain Apnoea, there may still be other critical injuries as well and airway, ventilation and perfusion support is still central to management. So, use a standardised approach to the undifferentiated trauma patient and make sure you are covering the basics.

While the duration of Impact Brain Apnoea seems to be proportional to the force of the blow, it is a transient condition and is eminently surviveable if supported properly. So, yet again, use a standardised approach to the undifferentiated trauma patient and make sure you are covering the basics.

There is a phase of catecholamine surge associated associated with Impact Brain Apnoea, which may result in pulmonary oedema, myocardial impairment including leakage of troponin and gut mucosal ulceration. However, this too is self limiting and with proper supportive care, the patient should get through it.

Listen carefully about 9 minutes in where Mark casually summarizes the London HEMS approach to the shocked polytrauma patient from first contact to scene departure in one sentence. Mastery!

It was also great to hear Mark in talking about the prehospital resuscitation of a patient, start with a quick step back to mention scene safety and management and so avoid getting sucked into the tunnel vision of the patient on the ground in front of him. Good stuff.



Finally, make sure you listen all the way to the end. If you don't yet know about the GoodSAM app, you should.

The podcast




Resources and references

Some of the historial papers

Littré A: Histoire de l’Académie Royale des Sciences 54, Année 1705. Paris, 1706, Obs. XII, p 54.
Alexis Littre's description of head trauma without visible injury that has been credited as the first documented description of Impact Brain Apnoea (though it has been criticised for not having examined for an associated craniocervical injury to explain the patient's death).
(You can access a link to article by providing your name and email at this url: http://pdf12.landbooks.org/pdf/histoire-de-l-acad-eacute-mie-royale-des-sciences-ann-eacute-e-1714-avec_1w7wyg.pdf)

Koch, W and Filehne, W. Belträge zur experimentellen chirurgie. Arch Klin Chir. 1874; 17: 190–231.

Gross AG: A new theory on the dynamics of brain concussion and brain injury. J Neurosurg 15:548–561, 1958.PMID:13576198. One of the early studies of the effects of percussive blows to the head.

Experimental cerebral concussion. D. Denny-Brown and W. Ritchie Russell. J Physiol. 1940 Dec 20; 99(1): 153. PMCID: PMC1394062
One of the early literature reviews of animal experiments exploring the relationship of percussive blows to the head and subsequent apnoea and other deficits.

Treatment of severe head injuries. IanN. Maciver et al. The Lancet, Volume 272, Issue 7046, 13 September 1958, Pages 544–550.


Impact Brain apnoea rises again

The Neglected Prehospital Phase of Head Injury: Apnea and Catecholamine Surge. John L D Atkinson. Mayo Clinic Proceedings; January 2000, Volume 75, Issue 1, Pages 37–47

The early critical phase of severe head injury: importance of apnea and dysfunctional respiration.Atkinson, JLD, Anderson, RE, and Murray, MJ. J Trauma. 1998; 45: 941–945.

The role of secondary brain injury in determining outcome from severe head injury. Chesnut, RM, Marshall, LF, Klauber, MR et al. J Trauma. 1993; 34: 216–222


Resources and Links

GoodSAM app on iTunes

GoodSAM website

GoodSAM overview on Tim Leeuwenburg's KI Doc site: "Are you a Good Samaritan?"

Gareth Davies, a colleague of Mark's, discussed Impact Brain Apnoea with Iain Beardsell at the London Trauma Conference last year. Their interview is hosted on the St Emlyn's website.

EMCrit Podcast 135 – Trauma Thoughts with John Hinds. Covers a motorsport orientated approach to blunt traumatic arrest and key points on impact brain apnoea.

John Hinds "The motorcyclist in extremis: Cases from the Races" talk at smaccGOLD
 

Podcast 11 - Hugh Scully and Rob Seal - Part 2

April 2, 2015


This podcast continues on from Podcast 10 and was recorded at the end of the FIA Medical Summit in Doha in December last year. Profs Hugh Scully and Rob Seal and I talk about motorsport medicine as a pre-hospital entity, the importance of data, audit and research in the evolution of motorsport medicine rescue and safety and the roles that motorsport competitors have in their own rescue.

For more information on the content of the FIA Summit, go here: FIA Institute Medicine in Motorsport Summ...
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Podcast 10 - Hugh Scully and Rob Seal - Part I - History, Track craft and Crew Retention

March 9, 2015


Doha was fun! Not as much fun as Istanbul two years ago, but still fun. Hopefully you've had a chance to skim through the overviews of the two day Medicine in Motorsport conference, held as part of the FIA AGM last December which I posted a while ago, so you know roughly what was discussed. Certainly the social program at Istanbul was a lot better, but this time I met a lot more people and really interesting people. It's really clear that there are a bunch of really smart individuals who work...
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Podcast 9 - Dr Ian Roberts and lessons learned in motorsport

January 2, 2015
I hope you all had a good Christmas and sent 2014 out with a bang. It's probably why I haven't gotten much work done over the past ten days.



However, it's time to get 2015 up and running and to do that here is the podcast that I recorded with Ian Roberts while we were at the FIA Medicine in Motorsport Summit in Doha. If you want to know more about what was discussed at the Summit itself, I've posted a summary here.

Ian and I sat down in a side room of the ASPETAR Orthopedic and Sports Medicine...
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Podcast 8 - Decision making in high stakes environments with Mike Lauria

August 28, 2014


So last week I wrote a post about a presentation by a guy named Mike Lauria (@ResusPadawan)on the topic of "Making the call" that I found on Scott Weingart's EM Crit site.

Mike's presentation covers all of the key areas relevant to current thinking on critical decision making in high stakes environments, drawing on his experience as a U.S. military pararescueman and a civilian paramedic. (He is also now studying to be doc.)


This is an area I've been following for a little while now, through...

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Podcast 7 - Irish road racing and Australian circuits with John Hinds and Brent May

March 26, 2014
I spent last week in the Gold Coast at possibly the best critical care conference in the world ... smaccGOLD (You can find out the details in my blog post smaccGOLD ... All the hype and more). Amongst the greats like Scott Weingart, Cliff Reid, Victoria Brazil, Karim Brohi, Simon Carly, John Myburgh and Rich Levitan and the rising stars such as Louise Cullen, Grace Leo, Liz Crowe and Lauren Westafer, there was an Irish anesthetist and pre-hospital physician from Belfast who spends his weekend...
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Podcast 6 - The roles of the event Chief Medical Officer with Dr Rik Hagen - Part II

March 11, 2014
In Part II of this podcast interview, Rik and I talk about the responsibilities and tasks that occupy a motorsport chief medical officer's time during and after an event.



We also take a look at some tips, advice and sources of information for budding CMOs and how the role is being developed in the context of a wider evolution of the provision of rescue and medical service provision at motorsports events.




Resources & links

DRIVE.DR - A checklist of items that need to be put in place for a motors...
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Podcast 5 - The roles of the event Chief Medical Officer with Dr Rik Hagen

February 18, 2014
So Christmas is a distant memory by now, and the motorsport season has already started, with the WRC several events in, the Melbourne F1 GP opener around the corner and the V8 Supercars having held their season opening test day at the Sydney Motor Sport Park last Saturday.

To kick of the Rollcage Medic podcasting season I thought we'd take a look at the role of the Chief Medical Officer at motorsport events. There's a full chapter devoted to outlining the CMO responsibilities in the first edi...
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Podcast 4 - Interview with Dr Terry Trammell - Part II

January 16, 2014
Posted by Matthew Mac Partlin on Saturday, October 5, 2013

Yes, I know, it's been a while. I've been off chasing rally cars in Coff's Coast at the WRC Rally Australia and been part of the Bedside Critical Care Conference so time seems to have slid past. However, it's time to get part two of the Terry Trammell interview up, so here it is.

In this half, Terry and I talk about the position of the driver's body in an open-wheel, open-cockpit race car and how it predisposes to vertebral injury. We ...
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Podcast 3 - Interview with Dr Terry Trammell - Part I

January 16, 2014
Posted by Matthew Mac Partlin on Tuesday, August 27, 2013

I feel like I've scored big this time. I'm on the podcasting steam train and this one's a gem. The audio quality could be better, but it was recorded over a mobile phone line on speaker phone.

I emailed Dr Terry Trammell after reading an article that he co-authored with Kathy Flint and asked if he would be prepared to sit down to record a podcast interview. And being a gentleman, he agreed. I can't share a link to the article with you, a...
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