avalanche toys

laurence rowland laurencerowland at hotmail.com
Sun May 18 23:22:23 BST 2008 

Hi,
It's soon to be ski-season here in New Zealand.
Has anyone crunched the numbers to decide whether either Avalanche Air-Bags or the "Avalung" system actully work?
Physics suggests the air-bag is a fair idea in a single avalanche, maybe.
I'm less impressed with the idea of the "Avalung", even if I managed to get the tube in my moth and keep it there.
Does anyone know/care?
Thanks for any advice.
From: trauma-list-request at trauma.orgSubject: trauma-list Digest, Vol 59, Issue 27To: trauma-list at trauma.orgDate: Sun, 18 May 2008 22:36:29 +0100Send trauma-list mailing list submissions to	trauma-list at trauma.org To subscribe or unsubscribe via the World Wide Web, visit	http://list.mistral.net/mailman/listinfo/trauma-listor, via email, send a message with subject or body 'help' to	trauma-list-request at trauma.org You can reach the person managing the list at	trauma-list-owner at trauma.org When replying, please edit your Subject line so it is more specificthan "Re: Contents of trauma-list digest..."
--Forwarded Message Attachment--From: listen at doc-kalkum.deSubject: Re: Intubation post GM seizure: when ?Date: Sun, 18 May 2008 13:39:53 +0200To: trauma-list at trauma.orgIvan, this discussion becomes increasingly futile, it is not trauma related and I will be away from my computer for a couple of days, though I will have limited abilities to answer. Thus three good reasons for this to be my last post on this topic.> Matthias ..I hope they do get some benzos and other sedatives... Hopefully you do not advocate any "anticonvulsive treatment" in a single uncomplicated seizure - that would be kidding. Again, you did not give answer to any question I asked you, other than anecdotes. Instead you keep the discussion going like "Mathias cuts his toenails (true), women cut their toenails (true), thus Mathias is a woman (wrong, because you missed that these facts are unrelated)". People started wars by going like this.... The mere fact that aspiration is dangerous does not free you from the necessity to give evidence for your assertion that aspiration is a common and dangerous complication of *simple* single GM seizures *and* that intubation would lower this risk with less risk and less costs than simple observation / positioning the patient. Stay safe! Mathias   
--Forwarded Message Attachment--From: p.bjorn at netzero.netSubject: RE: Intubation post GM seizure: when ?Date: Sun, 18 May 2008 10:38:52 -0400To: trauma-list at trauma.orgThis is silly.  I need to cite references for the effects of gravity onsecretions? The treatment for a post ictal patient is to turn him on his side, observehim closely, and expect for him to wake up.  Millions of people grow to oldage with seizure disorders with thanks to this simple advice.  We don'ttrain families to tube them, because there is ZERO indication for it. Nobody is going to be faulted over reasonable and prudent care.  Intubation,on the other hand, is neither a reasonable nor prudent modality in thiscontext, and any consequences arising there from will carry a stiff civilpenalty and expose the provider as an abject doofus. Pret      -----Original Message-----From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]On Behalf Of Ivan HronekSent: Saturday, May 17, 2008 10:33 AMTo: Trauma &amp; Critical Care mailing listCc: Anesthideas at yahoogroups.com; ccm-l at ccm-l.orgSubject: Intubation post GM seizure: when ? Piet, why do you put them in the recovery position ? To please the authors of textbooks ?To prevent aspiration ?Is the recovery position a sufficient protection from aspiration in apatient with a full stomach ?The answer is:no, it is not.If a "post-ictal" patient after a seizure aspirates under your care, you aregoing to be faulted.Matthias, if the patient can be woken up, it is not coma, it is stupor, orsleep, then obviously there's no need to intubate as gag reflex will bepresent. If you cannot wake the patient up within minutes after a seizure, they areno "sleeping" but they are in a coma. Comatose patients most of the timehave no protective reflexes. That's why we intubate patients with a GCS < 8- to protect them from aspiration. A coma is a coma in the sense there will be no protective laryngeal reflexespresent with risk of aspiration.The etiology of the coma from that viewpoint is irrelevant. The fact thateveryone around the world considers the "post-ictal" state immune toaspiration and don't intubate is amazing. It is amazing how thoughtless wecan be. Ivan HronekMD                                                                              Nobody cares if you can't dance well. Just get up and dance. Greatdancers are not great because of their technique. They are great because oftheir passion. Martha Graham________________________________ Confidentiality Notice: This transmission and any attached documents may beconfidential and contain information protected by State and Federal MedicalPrivacy statutes and is legally privileged. They are intended for use onlyby the addressee. If you are not the intended recipient of thistransmission, or an agent of the intended recipient, you are prohibited fromreading, disclosing, printing, saving, copying, using, or otherwisedisseminating any information contained in this transmission. If youreceived this transmission in error, please accept our apologies and notifyme at  ivanhronek at yahoo.comand delete the entire message and itsattachments. Thank you. Disclaimer: this message contains the personal viewsof the author. The author will not be responsible in any way for proceduresor approaches perfomed in the way suggested in this note. ________________________________    ----- Original Message ----From: "Bjorn, Pret" <pbjorn at emh.org>To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>Sent: Saturday, May 17, 2008 5:37:30 AMSubject: RE: Intubation post GM seizure: when ? Agreed.  Simple seizures should be placed in a recovery position andwatched.  Bear in mind that they've survived x many years with a seizuredisorder which has hopefully not required repeated intubation.  The postictal phase is transient, and as such carries no indication forintubation.   Pret Bjorn RNBangor, ME USA -----Original Message-----From: trauma-list-bounces at trauma.org[mailto:trauma-list-bounces at trauma.org] On Behalf Of Mathias KalkumSent: Saturday, May 17, 2008 5:56 AMTo: Trauma &amp; Critical Care mailing listSubject: Re: Intubation post GM seizure: when ?  Ivan, you are still confusing me. What are we talking about? Are we talking about GM seizures after trauma (be it head or whatever)? Are we talking about GM seizures after poisoning? Or are we talking about epilepsy? In the first two entities our treatment has to take into account the underlying pathology, in the later we have to simply accept that postictal sleep is by no means what you like to call coma. Please do not make analogies where there are none (or, at least, show us the data!). Take care! Mathias--trauma-list : TRAUMA.ORGTo change your settings or unsubscribe visit:http://www.trauma.org/index.php?/community/  --trauma-list : TRAUMA.ORGTo change your settings or unsubscribe visit:http://www.trauma.org/index.php?/community/ SFMC, Los Angeles, CA                                                http://health.groups.yahoo.com/group/Anesthideas/                                   --trauma-list : TRAUMA.ORGTo change your settings or unsubscribe visit:http://www.trauma.org/index.php?/community/    
--Forwarded Message Attachment--From: farcpr at gmail.comSubject: Re: Intubation post GM seizure: when ?Date: Sun, 18 May 2008 10:50:02 -0400To: trauma-list at trauma.orgGravity is not JUST a good idea, it's the law. On Sun, May 18, 2008 at 10:38 AM, Pret Bjorn <p.bjorn at netzero.net> wrote: > This is silly.  I need to cite references for the effects of gravity on> secretions?>> The treatment for a post ictal patient is to turn him on his side, observe> him closely, and expect for him to wake up.  Millions of people grow to old> age with seizure disorders with thanks to this simple advice.  We don't> train families to tube them, because there is ZERO indication for it.>> Nobody is going to be faulted over reasonable and prudent care.>  Intubation,> on the other hand, is neither a reasonable nor prudent modality in this> context, and any consequences arising there from will carry a stiff civil> penalty and expose the provider as an abject doofus.>> Pret>>>>>>> -----Original Message-----> From: trauma-list-bounces at trauma.org [mailto:> trauma-list-bounces at trauma.org]>  On Behalf Of Ivan Hronek> Sent: Saturday, May 17, 2008 10:33 AM> To: Trauma &amp; Critical Care mailing list> Cc: Anesthideas at yahoogroups.com; ccm-l at ccm-l.org> Subject: Intubation post GM seizure: when ?>> Piet, why do you put them in the recovery position ?> To please the authors of textbooks ?> To prevent aspiration ?> Is the recovery position a sufficient protection from aspiration in a> patient with a full stomach ?> The answer is:no, it is not.> If a "post-ictal" patient after a seizure aspirates under your care, you> are> going to be faulted.> Matthias, if the patient can be woken up, it is not coma, it is stupor, or> sleep, then obviously there's no need to intubate as gag reflex will be> present.> If you cannot wake the patient up within minutes after a seizure, they are> no "sleeping" but they are in a coma. Comatose patients most of the time> have no protective reflexes. That's why we intubate patients with a GCS < 8> - to protect them from aspiration.> A coma is a coma in the sense there will be no protective laryngeal> reflexes> present with risk of aspiration.> The etiology of the coma from that viewpoint is irrelevant. The fact that> everyone around the world considers the "post-ictal" state immune to> aspiration and don't intubate is amazing. It is amazing how thoughtless we> can be.>> Ivan Hronek>> MD>     Nobody cares if you can't dance well. Just get up and dance. Great> dancers are not great because of their technique. They are great because of> their passion. Martha Graham> ________________________________>> Confidentiality Notice: This transmission and any attached documents may be> confidential and contain information protected by State and Federal Medical> Privacy statutes and is legally privileged. They are intended for use only> by the addressee. If you are not the intended recipient of this> transmission, or an agent of the intended recipient, you are prohibited> from> reading, disclosing, printing, saving, copying, using, or otherwise> disseminating any information contained in this transmission. If you> received this transmission in error, please accept our apologies and notify> me at  ivanhronek at yahoo.comand delete the entire message and its> attachments. Thank you. Disclaimer: this message contains the personal> views> of the author. The author will not be responsible in any way for procedures> or approaches perfomed in the way suggested in this note.> ________________________________>>>>> ----- Original Message ----> From: "Bjorn, Pret" <pbjorn at emh.org>> To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>> Sent: Saturday, May 17, 2008 5:37:30 AM> Subject: RE: Intubation post GM seizure: when ?>> Agreed.  Simple seizures should be placed in a recovery position and> watched.  Bear in mind that they've survived x many years with a seizure> disorder which has hopefully not required repeated intubation.  The post> ictal phase is transient, and as such carries no indication for> intubation.>> Pret Bjorn RN> Bangor, ME USA>> -----Original Message-----> From: trauma-list-bounces at trauma.org> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Mathias Kalkum> Sent: Saturday, May 17, 2008 5:56 AM>  To: Trauma &amp; Critical Care mailing list> Subject: Re: Intubation post GM seizure: when ?>>> Ivan,>> you are still confusing me. What are we talking about? Are we talking> about GM seizures after trauma (be it head or whatever)? Are we talking> about GM seizures after poisoning? Or are we talking about epilepsy?>> In the first two entities our treatment has to take into account the> underlying pathology, in the later we have to simply accept that> postictal sleep is by no means what you like to call coma. Please do not>> make analogies where there are none (or, at least, show us the data!).>> Take care!>> Mathias> --> trauma-list : TRAUMA.ORG <http://trauma.org/>> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/>>> --> trauma-list : TRAUMA.ORG <http://trauma.org/>> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/>> SFMC, Los Angeles, CA> http://health.groups.yahoo.com/group/Anesthideas/>>>>> --> trauma-list : TRAUMA.ORG <http://trauma.org/>> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/>>>> --> trauma-list : TRAUMA.ORG <http://trauma.org/>> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/>   -- V/R Forrest RobletoR House Health & Safetywww.RHouseTraining.comFRobleto at RhouseTraining.com609-792-9047"I teach because I have to. In all the jobs I've had to pay my way throughlife, only teaching has (as of today) not left an empty feeling. This is mycalling; and sometimes I feel that I chose to teach as much as teachingchose me."Unknown 
--Forwarded Message Attachment--From: medic0947969 at yahoo.comSubject: Re: Pacing Vs. Airway ManagementDate: Sun, 18 May 2008 12:02:39 -0700To: trauma-list at trauma.orgAn interesting discussion     I was just following along trying to keep my big mouth shut, but can no longer resist. The often forgotten nasopharyngeal is a quick and easy way to manage the airway, particularly if the patient regains consciousness from pacing. Pacing is the overwhelming consensus here for this patient's CHB. But if I might raise a question with the pacing option. I have seen patients secondary to an MI with HR ~ 56, systolic bp ~80 who were paced to death. Some years later I was advised not to pace said patients by an accomplished EM. So while this is obviously a CHB, would pacing really be in the best interest if a MI is suspected? If so, what is the determining factor on when pacing a MI patient (diagnosed with 12 lead) detrimental? If a B-Blocker OD is suspected as some have mentioned, wouldn't glucagon be the pharm of choice perhaps prior to pacing? Also as is popular here on the list to suggest 80 is a reasonable systolic bp for a trauma patient that will profuse centrally, how is this situation other than a form of hypovolemic shock? Why would raising the prehospital BP be advisable in this case? Of course I have not seen what the ventricular rate of this patient was anywhere.      Mike         
--Forwarded Message Attachment--From: cvmmorris at gmail.comSubject: Warning, Will Rogers!!CC: Date: Sun, 18 May 2008 15:24:22 -0400To: acc-circle at listserve.com; PAFORUM at mc.duke.edu; trauma-list at trauma.orgThis past week, I noticed a $350 debit from my bank account to BarclayMastercard-- unrelated to any of my usual bills and supposedly posted on aday I was out of town., Interest skyrocketing, I reviewed my account andnoticed almost $2000 gone since January, starting with a modest $1.74 andescalating to a (post holidays) $635. So this past week has been spent doingmy usual-- work, church, home, preparing for a talk this next week and yetwas also required to close my bank account of 20 years, and cancel all myautomatic payments of which I was SO proud. Mastercard management has been terrific, and even that nasty Saturdaymorning phone call from a clerk demanding my bank account information for a$45 "due payment" was tolerable in retrospect. I have been told most of the world uses safeguards that would not allow thisoccurring, but the US still is a decade or so behind. Bottom line people--reconcile your accounts every month and watch for those pesky aberrancies. Iknow that from now on, I will!! C M Morris 
--Forwarded Message Attachment--From: cvmmorris at gmail.comSubject: Warning, Will Rogers!!CC: Date: Sun, 18 May 2008 16:53:16 -0400To: acc-circle at listserve.com; PAFORUM at mc.duke.edu; trauma-list at trauma.orgBob and Jeff-- Yah-- part of that process was to report the issue to the FTC and request my3 credit reports. Perhaps I am lucky as ~$500 has already been credited back to me from mybank. And IF I lost the $1500, I consider that an inexpensive lesson--comparatively. Barclays says they will find it.. We will see. CMM On Sun, May 18, 2008 at 4:32 PM, J. Robert Franks <jrfranks at usa.net> wrote: > Charlene (and group)->   Can you get WPTF (Raleigh AM station @ 680)? Clark Howard has a fine> program about consumer finances and protection M-F 9-noon, though I usually> listen to the podcasts from iTunes...>   He'll tell you to check all your financial reports (only takes a few> minutes, when you get caught up), freeze your credit reports (NO KIDDING),> and> quit wasting money on credit watch services.>> bob franks> Goldsboro, NC> Damn! A thousand bux is a thousand bux.>>> ------ Original Message ------> Received: Sun, 18 May 2008 03:25:23 PM EDT> From: "Charlene M Morris" <cvmmorris at gmail.com>> To: "ACC Circle" <acc-circle at listserve.com>, "PA Forum" <> PAFORUM at mc.duke.edu>,>        "Trauma &, Critical Care mailing list" <trauma-list at trauma.org>> Subject: [ACC-Circle] Warning, Will Rogers!!>> > WELCOME TO THE ACC-CIRCLE DISCUSSION LIST!> > Strength in Unity: Join the ACC today: http://www.amcollege.org> >> > *********************************************************> > This past week, I noticed a $350 debit from my bank account to Barclay> > Mastercard-- unrelated to any of my usual bills and supposedly posted on> a> > day I was out of town., Interest skyrocketing, I reviewed my account and> > noticed almost $2000 gone since January, starting with a modest $1.74 and> > escalating to a (post holidays) $635. So this past week has been spent> doing> > my usual-- work, church, home, preparing for a talk this next week and> yet> > was also required to close my bank account of 20 years, and cancel all my> > automatic payments of which I was SO proud.> >> > Mastercard management has been terrific, and even that nasty Saturday> > morning phone call from a clerk demanding my bank account information for> a> > $45 "due payment" was tolerable in retrospect.> >> > I have been told most of the world uses safeguards that would not allow> this> > occurring, but the US still is a decade or so behind. Bottom line> people--> > reconcile your accounts every month and watch for those pesky> aberrancies.> I> > know that from now on, I will!!> >> > C M Morris> > *********************************************************> > TO UNSUBSCRIBE OR CHANGE YOUR OPTIONS GO TO:> > ACC-Circle mailing list> > http://mailman.listserve.com/listmanager/listinfo/acc-circle> > NOTE: To post a reply to the entire list, use your email program's *Reply> To> All* button; To reply to the sender only, use your email program's *Reply*> button.> > NEED TO UNSUBSCRIBE?? *Please unsubscribe me* messages posted to the list> are IGNORED. Go the the list web page to set your options.> > PROBLEMS? Email the list administrator at acc-circle-owner at listserve.com> >> > Wear your professions patch proudly. If enough of us do, we will have a> great PR campaign. WE NOW ALSO HAVE PINS.@$5.00 EACH> > http://amcollege.org/Patches.html> >> > Friends, do your hands lack that dishpan look? Get BRIGHT-O--makes old> bodies new. (This message brought to you by Howard, Fine, and Howard.)> >> >>>>> 
--Forwarded Message Attachment--From: karim at trauma.orgSubject: Trauma-List - Stay on Target! (was Pacing Vs. Airway Management & GM seizures)Date: Sun, 18 May 2008 22:20:13 +0100To: trauma-list at trauma.orgDear all A gentle reminder that this is a trauma-list, and trauma should be the focusof discussions.  There are anaesthesia and paramedic discussion groups forthis kind of thing. In general, cross-posting to lists is a bad idea too.  Pick the list that'smost appropriate to your case/question.  Otherwise things just get confusing- especially for us list-owners. Thanks Karim On Sun, May 18, 2008 at 2:43 AM, mark miller <markandjac at optusnet.com.au>wrote: > This scenario should be treated in the same manner as a VF arrest. You have> a (potentially) readily reversible origin of LOC/airway threat (ie CHB> induced hypotension). Fix the brain perfusion first and you may avert the> need to intubate. Intubation itself could precipitate asystole here.>> TC Pacing is an option but seems to be rarely done (in NSW) pre-hospital> and> poorly tolerated. Despite ischaemia, I'd start with small doses of 1:10,000> adrenaline (say 10mcg increments) and volume loading. No harm in> atropinisation but commonly fails. He isn't being poisoned by his GP> (industrial strength BBlocker and CaCBlocker combos are a common cause of> this situation around here, esp in the elderly) so nothing to reverse in> that regard. Reperfusion may be in order after you fix this problem.>> This is similar to airway management in the postictal patient. I agree with> Bill G, Treat the underlying, commonly reversible, cause of LOC and give> them time to "awaken" (on their side, with a nurse and with suction> available). This , I believe, is a safer and much less resource intensive> option than subjecting them all unnecessarily to RSI and later extubation> in> ED or ICU. The aspiration risk seems small, possibly less (anecdote) than> the risks posed by intubation becoming "standard of Care" and a whole lot> of> inexperienced airway operators feeling obliged to tube these guys.>> Mark Miller> FACEM>>> -----Original Message-----> From: Gavin SUTTON [mailto:Gsutton at pgwc.gov.za]> Sent: Saturday, 17 May 2008 7:22 AM> To: trauma-list at trauma.org> Subject: Pacing Vs. Airway Management>> Just a question if I may...>> Pre-hospital case, 55 year-old male patient with Hx of IHD and> hypertension.> He is on pharmapress and Isordil. He has defaulted for 6 months. His EKG> shows a sinus rhythm of 110 with ischemia. While the paramedics are> treating> the patient, he becomes unresponsive, the ECG shows 3rd degree HB and he> has> a BP of 80 systolic. He has very poor tidal volume.>> What would you do?>> 1. Begin external pacing immediately> 2. Sort out the patient's airway first (intubation) and ventilate with a> bag-valve-mask resuscitator - 100% O2, and then begin external pacing if no> improvement> 3. Transport to hospital while maintaining basic airway techniques and> ventilation- 45 minutes away>> Many thanks>> Gavin>> Gavin Sutton> Head: Department of Training> Emergency Medical Services> Western Cape Department of Health> South Africa>> Tel. +27 21 938-4118> Fax.+27 21 938-4269>> "No trees were killed in the sending of this message, but a large number> of electrons were terribly inconvenienced">>>>>>> "All views or opinions expressed in this electronic message and its> attachments are the view of the sender and do not necessarily reflect the> views and opinions of the Provincial Government of the Western Cape ("the> PGWC').> No employee of the PGWC is entitled to conclude a binding contract on> behalf> of the PGWC unless he/she is an accounting officer of the PGWC, or his or> her authorised representative.>> The information contained in this message and its attachments may be> confidential or privileged and is for the use of the named recipient only,> except where the sender specifically states otherwise.>> If you are not the intended recipient you may not copy or deliver this> message to anyone.">>> --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/> 
--Forwarded Message Attachment--From: Jeffry.Kashuk at dhha.orgSubject: Reminder-Rocky Mountain EM-Trauma /Mass casualty day, Breckenridge, CODate: Mon, 12 May 2008 22:51:49 -0600To: trauma-list at trauma.org*****35th annual Rocky Mountain Emergency Medicine- Trauma Conference,June 24-27, 2008 Breckenridge, CO A reminder that we are a little over a month away from thiscomprehensive conference, featuring a special one day seminar this year,Tuesday, June 24,  on the hospital response to terrorist events. In caseyou missed Dr.Karim Brohi's outstanding presentation in Las Vegas atDr.Mattox's conference, you can hear him again here. In addition, listento international experts in mass casualty preparation and managementfrom Israel, London, and the US military. Learn how YOU can effectivelyprepare your hospital for the consequences of world terror. Other expertpresentations led by Ernest "Gene" Moore, MD..... Enjoy all of this in the cool serene setting of the Colorado rockymountains...Register now!.... Jeffry L. Kashuk, M.D, FACSSurgery, Trauma, Surgical Critical CareDenver Health Medical Center777 Bannock St, MC 0206Denver, CO 80204Ph 303-436-6558Fax 303-436-6572Cell 303-653-5700  -----Original Message-----From: trauma-list-bounces at trauma.org[mailto:trauma-list-bounces at trauma.org] On Behalf Oftrauma-list-request at trauma.orgSent: Monday,May 12,2008 10:25 PMTo: trauma-list at trauma.orgSubject: trauma-list Digest, Vol 59, Issue 17 Send trauma-list mailing list submissions to	trauma-list at trauma.org To subscribe or unsubscribe via the World Wide Web, visit	http://list.mistral.net/mailman/listinfo/trauma-listor, via email, send a message with subject or body 'help' to	trauma-list-request at trauma.org You can reach the person managing the list at	trauma-list-owner at trauma.org When replying, please edit your Subject line so it is more specific than"Re: Contents of trauma-list digest..." The Denver Health email system has made the following annotations --------------------------------------------------------------------- CONFIDENTIALITY NOTICE - This e-mail transmission, and any documents, files or previous e-mail messages attached to it may contain information that is confidential or legally privileged.  If you are not the intended recipient, or a person responsible for delivering it to the intended recipient, you are hereby notified that you must not read this transmission and that any disclosure, copying, printing, distribution or use of any of the information contained in or attached to this transmission is STRICTLY PROHIBITED.  If you have received this transmission in error, please immediately notify the sender by telephone or return e-mail and delete the original transmission and its attachments without reading or saving in any manner.  Thank you. --------------------------------------------------------------------- 
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