SMACC

Hardcore EM: Vasopressors in the ED by John Greenwood

Direct download: audio_johnp.mp3
Category:general -- posted at: 1:22pm AEDT

SMACCForce: Turning up the gain on prehospital ultrasound by Luke Regan

Direct download: turning_audio.mp3
Category:general -- posted at: 1:51pm AEDT

Hardcore ICU: Timing of neuroprognostication in postcardiac arrest management by Sara Gray

Direct download: audio_Sara_Gray.mp3
Category:general -- posted at: 1:16pm AEDT

A no-holds barred series of 6 provocative medical interrogations. We challenge the state of research, social media, pharmacology, social work, women in medicine, medicine in the developed work, and the health of healthcare workers. It should be novel, it may get heated, and it is not scripted. Sometimes to comfort the afflicted you also need to afflict the comfortable. This is why no prisoners will be taken, no topic is out of bounds, and no ego will be pampered. It may even offend: you have been warned.

Direct download: mix_14m20s_audio-joiner.com.mp3
Category:general -- posted at: 10:47am AEDT

SMACCForce: Telemedicine transcends borders in disaster response by Raed Arafat

Direct download: audio_raed.mp3
Category:general -- posted at: 3:30pm AEDT

Ultrasound is an important adjunct for caring for cardiac arrest patients, but trans-thoracic can deter from important hands-on compressions. TEE may solve that problem by providing high quality images of the heart without interruption in CPR. Additionally TEE provides useful information about compression depth and quality that no other diagnostic tool provides. TEE is already being used in some centers and its use continues to grow.

Direct download: mix_10m37s_audio-joiner.com.mp3
Category:general -- posted at: 12:36pm AEDT

Hardcore EM: How We Assess Risk by Pik Mukherji

Direct download: audio_1.mp3
Category:general -- posted at: 1:37pm AEDT

Neuro ICU: EEG - Brain monitoring beyond seizure detection by Brandon Foreman

Direct download: Foreman_new_file.mp3
Category:general -- posted at: 2:34pm AEDT

SMACCForce: Retrieval Medicine Lessons Relearned by Cliff Reid

Direct download: mix_9m41s_audio-joiner.com.mp3
Category:general -- posted at: 1:24pm AEDT

SMACCForce: Neemo by Marc O Griofa

Direct download: mix_15m07s_audio-joiner.com.mp3
Category:general -- posted at: 12:08pm AEDT

Neuro ICU: ICH: BP management (ATACH-2 trial) by Celia Bradford

Direct download: mix_9m14s_audio-joiner.com.mp3
Category:general -- posted at: 11:35am AEDT

Useful advice on how to fail at everything.

Direct download: mix_21m39s_audio-joiner.com.mp3
Category:general -- posted at: 4:23pm AEDT

SMACCForce: Training for high performance - low budget by Laszlo Hetzman

Direct download: mix_12m07s_audio-joiner.com.mp3
Category:general -- posted at: 2:41pm AEDT

SMACCForce: Suspension Trauma - Discussion - Demo by Jason van der Velde & Karel Habig

Direct download: mix_16m21s_audio-joiner.com.mp3
Category:general -- posted at: 2:00pm AEDT

SMACCForce: The culture of excellence in resuscitation by Maaret Castren

Direct download: mix_12m06s_audio-joiner.com.mp3
Category:general -- posted at: 12:36pm AEDT

This session brings together a panel of educators with a track record of innovation and design in medical education. The panel will explore the past, present and most importantly the future of how we will teach and learn critical care. We will explore the future changing role of the medical educator from one of information delivery and assessment to co-learner and developer. Will new technologies really change education or simply form adjuncts to traditional learning models. Get involved and tweet your questions to #SMACCMedEd

Direct download: mix_84m49s_audio-joiner.com.mp3
Category:general -- posted at: 8:39pm AEDT

SMACCForce: Top 10 PHARM Papers of the last year by Conor Deasy & MJ Slabbert

Direct download: mix_22m10s_audio-joiner.com.mp3
Category:general -- posted at: 7:14pm AEDT

Panelist participation in the "Resuscitation for the Resuscitationist" panel session.

Direct download: mix_72m13s_audio-joiner.com.mp3
Category:general -- posted at: 5:09pm AEDT

Neuro ICU: ICH: Reversal of anticoagulation (PATCH trial, NOACs, TPA) by Jordan Bonomo

Direct download: mix_17m39s_audio-joiner.com.mp3
Category:general -- posted at: 2:10pm AEDT

Anaphylaxis is a relatively common and potentially lethal emergency. Current definitions highlight the presence of allergic and allergic-like reactions with end organ damage. Diagnosis can be difficult, but present guidelines (FAAN) focus on sensitivity above specificity. The main aspects of management are early recognition and early epinephrine. First line treatment is intramuscular epinephrine, fluids and positioning. In refractory cases, increasing dose of epinephrine, norepinephrine, vasopressin, glucagon, methilene blue and ECMO are considerations. Patients with airway compromise require advanced management. Disposition depends on severity and access to follow-up. An epinephrine auto-injector is necessary. Biphasic reactions are rare but real, with unclear incidence.

Direct download: mix_20m38s_audio-joiner.com.mp3
Category:general -- posted at: 11:47am AEDT

Neuro ICU: TBI: Using physiology as a target

Direct download: mix_16m13s_audio-joiner.com.mp3
Category:general -- posted at: 3:58pm AEDT

Numbers people, give me the NUMBERS! We need CONCRETE data points and percentages...! Go, buy another “ping” machine to deliver the numbers and data points. We need it to be delivered by gadgets, gadgets that go ping and pong...more and more gadgets. Let’s plot it on graphs and write it into a protocol to then be memorised verbatim in training and dutifully regurgitated in medical exams. That makes us excellent clinicians right? Worthy of more numbers and a couple of extra letters behind our names.

Medicine is obsessed with numbers! The glorified science of modern medicine. A fictitious safety net.

What if I told you, your decision-making is far more complex than that? That, how I deal with an emergency also involve guts, prayers and yes, sometimes tricks. Does that make me reckless? A cowboy (girl) or a savant? Or am I just nudged by my unconsciousness. Are you? Whether you like it or not, how you deal with emergencies, how you deal with life is far more complex and “consciously unclear and uncertain” than what quantitative science would like. There is literally way more between heaven and earth than what meets the eye and your unconscious mind is filling in the gaps. So hold on and follow me down the rabbit hole...

Direct download: mix_20m20s_audio-joiner.com.mp3
Category:general -- posted at: 8:34am AEDT

Intubation is one of the most important procedures that we perform. There are many immediate and bedside methods of confirming tube placement, but we propose you try ultrasound. Here's why: You can use US in real time to guide the intubation, Its got excellent accuracy and there's no need to BVM the patient.

Direct download: mix_10m25s_audio-joiner.com.mp3
Category:general -- posted at: 3:10pm AEDT

A no-holds barred series of 6 provocative medical interrogations. We challenge the state of research, social media, pharmacology, social work, women in medicine, medicine in the developed work, and the health of healthcare workers. It should be novel, it may get heated, and it is not scripted. Sometimes to comfort the afflicted you also need to afflict the comfortable. This is why no prisoners will be taken, no topic is out of bounds, and no ego will be pampered. It may even offend: you have been warned.

Direct download: new_audio.mp3
Category:general -- posted at: 5:30pm AEDT

Hardcore EM: EBM - Papers of the year by Justin Morgenstern
 
Direct download: mix_34m27s_audio-joiner.com.mp3
Category:general -- posted at: 2:00pm AEDT

SMACCForce: Bariatric Panel Discussion with Mark Forrest, Jason Van Der Velde, Phil Keating, Cameron O'Leary

Direct download: mix_22m24s_audio-joiner.com.mp3
Category:general -- posted at: 11:22am AEDT

SMACCForce: Mental Health by Ashley Liebig

Direct download: mix_7m18s_audio-joiner.com.mp3
Category:general -- posted at: 3:53pm AEDT

There are several pediatric cardiac disease processes that get misdiagnosed because they present with other symptoms. No child comes in and says, “I have chest pain” or in any way alerts the Emergency Department providers to include some type of pediatric heart disease in the differential diagnosis. This talk will review the most commonly missed cardiac “zebras,” but that is not all. The presentation is meant to provide you with some helpful hints for when it is time to stray from the straight path and start entertaining a cardiac diagnosis in a sea of children complaining of respiratory, gastrointestinal and other symptoms.

Direct download: mix_17m33s_audio-joiner.com.mp3
Category:general -- posted at: 3:44pm AEDT

"Out for blood" by Bill Hinckley 

Direct download: mix_6m55s_audio-joiner.com.mp3
Category:general -- posted at: 2:19pm AEDT

Using a 1982 portable unit (ADR-4000), we could define, since 1985, a use of ultrasound devoted to the critically ill, different from the traditional one (radiological & cardiological). This technology was sufficient for making, at the bedside, a whole body approach, although a 1992 technology (Hitachi-405) was better for optic nerve assessment. Search for blood in trauma, inserting subclavian venous lines was a basis. The consideration of the lung (the main vital organ) allowed to change the rules of ultrasound. Lung ultrasound (in the critically ill: LUCI) showed its potential for not only allowing immediate diagnoses (pneumonia, pulmonary edema, pneumothorax and others), but mostly, associated to a simple venous approach, to simplify echocardiography. In the CEURF protocols, the heart analysis can be usually reduced to the right ventricle volume (the pericardium is apart). The potential of LUCI to show infra-clinical subtle signs of interstitial edema is the starting point of the FALLS-protocol for assessing a circulatory failure, providing this direct parameter of clinical volemia. The potential of LUCI to show the A-profile (ruling out pneumothorax) or the A’-profile (highly suggesting pneumothorax) is used in the SESAME-protocol, a very fast protocol in cardiac arrest assessment. The BLUE-protocol is a fast protocol assessing a respiratory failure, where only lungs and veins are on focus (the heart is not included). LUCI makes critical ultrasound a holistic discipline for all these reasons. LUCI shows its multifaceted potential from sophisticated ICUs to austere areas, from the elderly to the neonate, where the signs are the same, including ARDS in bariatric patients, and many less critical disciplines up to family medicine. A single, universal microconvex probe is used for our whole body approach. We do not use Doppler nor harmonics. The LUCIFLR project highly decreases medical irradiation. CEURF trains intensivists to this visual medicine since 1989

Direct download: mix_20m36s_audio-joiner.com.mp3
Category:general -- posted at: 3:57pm AEDT

Emotion has a profound effect on decision-making. As scientists and rational beings, we like to believe that we can control our emotions and make good decisions regardless of the context in which those decisions must be executed -- The reality is, that's far from the truth. Furthermore, we rarely take the opportunity to deliberately examine how emotional valence can influence the choices we make, or how we sort and process information as clinicians. Simulation-based training often provokes strong emotions, both positive and negative, whether we intend it to or not. Sim may be an ideal tool for eliciting challenging emotions -- anger, fear, anxiety, joy, prejudice -- and developing skills to manage them in real time. Breathe, make better decisions.

In Day Two of the Learning from Sim series, the story continues as our patient transitions from the pre-hospital to the emergency department.

Direct download: mix_12m53s_audio-joiner.com.mp3
Category:general -- posted at: 3:50pm AEDT

What is New York City style resuscitation? Reuben Strayer and Scott Weingart honed their chops in public hospitals in America’s largest city, where patients come from every country, speak every language, and manifest every physiologic derangement on earth. Preferring to ask neither permission nor forgiveness, Reuben and Scott have long challenged emergency medicine and critical care orthodoxy and developed lateral (though sometimes divergent) strategies in their approach to problems that arise in the care of the sometimes unwashed masses who tend to avoid presenting to medical attention until they’ve fallen off the Frank-Starling curve. Topics that may be discussed (or argued) include the use of epinephrine, the use of noninvasive ventilation, the management of recently intubated patients, the use of ketamine as an induction agent with and without a paralytic, and decision-making in badly injured trauma patients. Ad hominem attacks will be defined and probably employed. Though Weingart has a physical and intellectual disadvantage against the bigger, stronger, quicker, younger, and better-looking Strayer, these disparities will be muted by Natalie May’s capable moderation.

Direct download: mix_16m55s_audio-joiner.com.mp3
Category:general -- posted at: 12:59am AEDT

What if in just a few short hours we could take all that we have learned about resuscitation from FOAMed and apply it? What if we could turn an average community hospital ED into a high functioning team? What if we could do all of that in 2.5 hours? We’ll see.

Direct download: mix_18m00s_audio-joiner.com.mp3
Category:general -- posted at: 1:45pm AEDT

Exsanguination and brain injury are the leading causes of death after major trauma. During the last decades, significant progress has been made in the fight against haemorrhage. Nevertheless, the window of opportunity is still small, and the golden hour of shock more fiction than fact. Hence, the majority of trauma patients is still lost on the street and during the first hour after hospital admission. Moreover, trauma is an increasing epidemiologic burden worldwide. Pre-hospital emergency care plays an essential role when distances are long and immediate damage control is key. Since evidence of established interventions (i.e. fluid resuscitation or vasopressor use) is spare, we summarized currently available trauma care guidelines, and elaborated a best practice advice for massive bleeding comprising a five-step approach: First identification, on-going monitoring and appropriate notification of the receiving hospital. Second, control of haemorrhage by tourniquets and pelvic splints; and advanced interventions, such as emergency resuscitative thoracotomy and resuscitative endovascular balloon occlusion. Third, target controlled fluid resuscitation within the concept of hypotensive resuscitation in order to prevent hypovolemic cardiac arrest during the pre-hospital phase. Fourth, pharmacologic interventions employing vasopressor drugs and medication for coagulation management. Fifth, avoiding mistakes in anesthetized and ventilated patients with critical intravascular volume status, as well as means to counteract inadvertent hypothermia. Finally, a minimum data set allowing retrospective analysis and system comparison is needed.
In conclusion, code red protocols are key in order to reduce pre-hospital care to the max and to pave the way to major trauma care. Current concepts of trauma care with a strong focus on the C-ABC (Circulation-Airway-Breathing-Circulation) approach, hypotensive resuscitation, haemostatic resuscitation and damage control surgery improve survival after major trauma.

Direct download: mix_11m29s_audio-joiner.com.mp3
Category:general -- posted at: 1:52pm AEDT

A no-holes barred series of 6 provocative medical interrogations. We challenge the state of research, social media, pharmacology, social work, women in medicine, medicine in the developed work, and the health of healthcare workers. It should be novel, it may get heated, and it is not scripted. Sometimes to comfort the afflicted you also need to afflict the comfortable. This is why no prisoners will be taken, no topic is out of bounds, and no ego will be pampered. It may even offend: you have been warned.

Direct download: Flavia_Machado_.mp3
Category:general -- posted at: 7:00am AEDT

Bedside ultrasound can be super helpful in assessing and managing the sick patient. This learning opportunity that I'll be sharing at dasSMACC was provided to me by a lovely 65yr man who presented to ED late one Tuesday evening last year. From a brief history, examination and bedside echo we were able to diagnose him with acute pulmonary embolism with right heart strain and residual thrombus in his right atrium. This is an uncommon scenario but is associated with high mortality if left untreated or treated with anticoagulation alone, and patients have much better odds of surviving with thrombolysis or embolectomy.

Direct download: _Leanne_Hartnett.mp3
Category:general -- posted at: 7:00am AEDT

The arrested heart surgery patient is a unique beast in surgery and critical care. Dr Nikki Stamp will discuss how to spot the potential arrest, how to manage it and some special situations to be aware of in this special group of patients

Direct download: Nikki_Stamp_.mp3
Category:general -- posted at: 7:00am AEDT

Direct download: NeuroImaging_Nibble_22.mp3
Category:general -- posted at: 7:00am AEDT

Direct download: Management_of_Status_Epilepticus.mp3
Category:general -- posted at: 10:34am AEDT

There is a huge variation in our outcomes for cardiac arrest patients. Measuring your results makes it possible for you to know what to improve. Benchmarking showes you were to go to learn. You need to build a culture of excellence into your own system. Patients are not the same so we need to individualize also resuscitation.

Direct download: mix_10m38s_audio-joiner.com.mp3
Category:general -- posted at: 2:28pm AEDT

Resuscitation is complicated, but the solutions don't have to be. These are the psychological hacks that will help you conquer complexity and excel in dynamic environments.

Direct download: mix_21m57s_audio-joiner.com.mp3
Category:general -- posted at: 3:54pm AEDT

Neurologic airway manipulation is unforgiving; errors lead to hypoxia and secondary injury. Managing the airway with an eye towards success, the first time, every time, without allowing sats to drop below 90% is the holy grail of neuro airways. Selection of RSI techniques, DSI techniques, and pharmacologic management is critical for success. The TBI airway with ICP issues and the post tPA airway present unique problems and the failed extubation in the neurologic patient is as common as the day is long. We will explore the latest theories and data (if there are any) and debunk some common myths together during this session.

Direct download: Airway_management_in_Neurologic_Emergencies.mp3
Category:general -- posted at: 7:00am AEDT

“Meeting of the Tribes” brings together clinicians from a broad range of health professions--including medicine, nursing, social work, and physiotherapy--to explore interprofessional issues in critical care. In addition to their clinical work, panelists have unique perspectives on education, simulation, and resilience in healthcare. In discussing issues related to tribalism and their implications for interprofessional practice, we will explore what it will take to overcome a tribal mentality in the service of improved patient care. In this session, we will strive to: (a) present a snapshot of the status quo, (b) explore key issues and their implications for clinical practice, and (c) envision of future of enhanced interprofessional collaborative practice.

Direct download: A_MEETING_OF_THE_TRIBES_INTER-PROFESSIONAL_ISSUES_IN_CRITICAL_CARE.mp3
Category:general -- posted at: 7:00am AEDT

When/how to reverse coagulopathies for ICH/TBI? By Ronan O'Leary

Direct download: PATCH_trial_implications.mp3
Category:general -- posted at: 7:00am AEDT

Moderate panel discussion on FOAM Open Access Medical Publishing Data sharing

Direct download: PUBLISHING__THE_FUTURE_OF_CRITICAL_CARE.mp3
Category:general -- posted at: 7:00am AEDT

Who should pull the trigger on tPA for acute ischemic stroke? By Rhonda Cadena

Direct download: Who_should_pull_the_trigger_on_tPA.mp3
Category:general -- posted at: 7:00am AEDT

Bringing Lessons from MERT back home

Direct download: mix_13m00s_audio-joiner.com_1.mp3
Category:general -- posted at: 2:13pm AEDT

Debate: diagnosing Subarachnoid Haemorrhage: CT/LP vs. CT/CTA. Fernanda Bellolio vs Bill Knight

Direct download: Diagnosing_SAH_-_CT-LP_vs._CT-CTA.mp3
Category:general -- posted at: 7:00am AEDT

Direct download: Per_Bredmose.mp3
Category:general -- posted at: 7:00am AEDT

Humorous musical interpretation of life as a doctor, featuring singing at a piano.

Direct download: mix_20m47s_audio-joiner.com.mp3
Category:general -- posted at: 2:53pm AEDT

This talk is the start of a three day smacc journey into simulation, introducing Leah before she enters the hospital system, beginning where life happens - the prehospital world.
Simulation is a tool which allows us to rehearse our skills and scenarios before they happen in real life, to real people, our patients. Many clinicians dislike simulation, they know it is good for them, but find it challenging to drop into a world of manikins, fear performing in front of their peers and find debriefs uncomfortable.
This talk will consider the purpose of simulation and its role in providing a safe working environment for clinical care anywhere.

Direct download: Clare_Richmond.mp3
Category:general -- posted at: 7:00am AEDT

A talk about David Foster Wallace, evolution, and what do when the thrombolysis bisque hits the fan.

Direct download: mix_20m37s_audio-joiner.com.mp3
Category:general -- posted at: 11:36am AEDT

A no-holes barred series of 6 provocative medical interrogations. We challenge the state of research, social media, pharmacology, social work, women in medicine, medicine in the developed work, and the health of healthcare workers. It should be novel, it may get heated, and it is not scripted. Sometimes to comfort the afflicted you also need to afflict the comfortable. This is why no prisoners will be taken, no topic is out of bounds, and no ego will be pampered. It may even offend: you have been warned.

Direct download: mix_14m44s_audio-joiner.com.mp3
Category:general -- posted at: 10:47am AEDT

The scale of need, wide burden of disease, and complex systems challenges can at times be overwhelming in the global health arena. Focusing on small wins and long-term investment is key to programmatic success and sustainability. Training clinicians in bedside ultrasound effectively uses the same human resources to help shrink the gap between the broad imaging needs of a population and limited consultative capacity of radiology. The result is enhanced patient care, provider empowerment, and improved job satisfaction. Growing point-of-care ultrasound trainees into trainers themselves allows for local solutions to ongoing education needs and helps develop and address the most relevant home-grown research questions, results of which may have broader international practice implications. Building broader networks for bilateral point-of-care ultrasound training and research opportunities will be of global benefit.

Direct download: mix_11m45s_audio-joiner.com.mp3
Category:general -- posted at: 8:25pm AEDT

Driving pressure promises to be the key variable for optimisation of mechanical ventilation for preventing ventilator-induced lung injury. Find out what it is and why it matters in this talk.

Direct download: mix_24m30s_audio-joiner.com.mp3
Category:general -- posted at: 6:01pm AEDT

Emergency departments are at the forefront of dealing with the harmful effects of alcohol consumption. ED alcohol-related presentation data is not routinely collected in patient data sets. I will describe the outcomes of the ACEM Alcohol Harm (AHED) project. For the first on a national scale the project quantified the level and effect of alcohol harm presenting to emergency departments (EDs) in Australia and New Zealand. Over 100 EDs and more than 2000 ED clinicians have been involved. AHED provided an evidence base to advocate for measures to reduce alcohol harm I will demonstrate by how using evidence and anecdote clinicians are power witnesses and can influence culture and policy change.

Direct download: mix_20m28s_audio-joiner.com.mp3
Category:general -- posted at: 2:25pm AEDT

Over 85% of the world’s population live in Low and Middle Income countries. Health statistics in these countries are characterised by numerous deaths from treatable time-sensitive illnesses and injuries resulting from inadequacies in health systems; particularly Emergency Care.
However, across the world, Emergency Care continues to grow, and every country has a story to tell. There are similarities in our stories: the overwhelming sense of responsibility, the exhaustion and feeling of being undervalued. But there are also glaring differences in quality. Africa can be better and it should be.
2017 marks 10 years since the first Emergency Medicine Physician graduated in Africa. From one single Residency program in 2007, there are now 11 more in 9 of Africa’s 54 countries.
2009 saw the formation of The African Federation for Emergency Medicine (AFEM) supporting Emergency Care development across Africa. AFEM’s projects include:
The biennial African Conference on Emergency Medicine (AfCEM), the only scientific conference on African emergency care.
The Annual Consensus Conference that addresses various aspects and challenges of Emergency Care in Africa.
A quarterly international, peer-reviewed journal, publishing original research on topics relevant to Africa, freely available online and offering free publication support to African researchers through Author Assist.
Supadel, a peer-to-peer sponsorship program funds attendance of practitioners to AFEM-affiliated conferences on African soil, allowing them to network and learn valuable lessons in Emergency Care to improve systems in their countries.

Building and maintaining robust Emergency Care systems addressing community needs and improving the health of populations requires us to connect to each other and the world. For us to contribute to the world and for the world to support and contribute to programs and projects in Africa.
The African story is about everyday people connecting with each other to change themselves, improve their systems and transform lives.

For more details about the upcoming African Conference on Emergency Medicine On 7-9 November 2018, In Kigali-Rwanda, click here

To hear more about Supadel and sponsoring delegates to African Meetings, go here, and to see what we're doing in Sydney, read about SMACCReach here.

Direct download: mix_21m49s_audio-joiner.com.mp3
Category:general -- posted at: 10:25pm AEDT

"Mortality measured at a particular time point (landmark mortality) is often regarded as the gold standard outcome for randomised controlled trials in Intensive Care Medicine. An important limitation of many Intensive Care Medicine trials is that they hypothesize large and potentially implausible reductions in absolute mortality. This is a major problem in trial design for two reasons. Firstly, it makes false negative trial results more likely. Secondly, the less plausible a postulated mortality reduction is the more likely that a statistically significant mortality difference will represent a false positive. This is because a p-value is defined as the probability of finding a result equal to or more extreme than that actually observed, under the assumption that the null hypothesis is true. This means that the greater the pre-trial chance or prior probability that the null hypothesis is correct, the lower the chance that a p-value below a particular significance threshold will represent a true positive.

The biggest single problem with the current evidence base is that most hypotheses being tested have low prior probability. We need a new research paradigm to address this problem, particularly in relation to the fundamentals of Intensive Care Medicine. Intensive Care therapy is fundamentally about providing supportive care. Such care includes airway support, oxygen therapy, ventilation therapy, haemodynamic support, fluid therapy, temperature control, and nutritional therapy among others. Setting the goals for these therapies is what intensive care doctors do every day. At present, for most of these treatments, the level of evidence on which we are making our decisions is extremely limited. Moreover, the illusion of physiological gain may be leading us astray; making us believe we know the right thing to do when we really do not. We should be creating systems in our intensive care units that allow us to learn iteratively from every patient so that we can systematically reduce mortality over time by understanding how to optimise supportive care. Bayesian adaptive platform trials using response adaptive randomisation can improve the outcomes of patients with mathematical precision but require us, as doctors, to stop believing we know the answers when we really do not."

Direct download: Paul_Young_-.mp3
Category:general -- posted at: 7:00am AEDT

Endocarditis has been on the back burner for a while now. It is a disease that is evolving as new risk groups emerge and microbiology change. This talk will provide you with the framework to identify the disease and avoid the pitfalls in preventing you to nail down this diagnosis. After this talk you will neither be bored nor afraid of abnormal blood cultures and you will realized you don't need to fulfill SIRS criteria to be sexy.

Direct download: David_Carr.mp3
Category:general -- posted at: 7:00am AEDT

A no-holes barred series of 6 provocative medical interrogations. We challenge the state of research, social media, pharmacology, social work, women in medicine, medicine in the developed work, and the health of healthcare workers. It should be novel, it may get heated, and it is not scripted. Sometimes to comfort the afflicted you also need to afflict the comfortable. This is why no prisoners will be taken, no topic is out of bounds, and no ego will be pampered. It may even offend: you have been warned.

Direct download: Reuben_Strayer_--.mp3
Category:general -- posted at: 7:00am AEDT

South pole...North pole, hot...cold, on earth...in space, below the sea...on Mount Everest, alone and far, far away. Ultrasound will make these extreme environments less intimidating for the doctor by enhancing your diagnostic capability, honing your therapeutic management and fitting into your pocket. This is a brief tale of a journey to Antarctica with a Phillips Lumify ultrasound. Find your passion and reach for the stars.

Direct download: Gaynor_Prince_-.mp3
Category:general -- posted at: 7:00am AEDT

Academic programs are built on four main pillars: clinical excellence, research, education, and administration. These apply whether you build and design an u/s program or division, a simulation program, a toxicology or pre-hospital program and even an academic department. You never forget when your childhood dog dies. And I will never forget how all four of my childhood dogs died. These 4 tragic, dramatic, and traumatic experiences provided fantastic lessons on how an academic program can fail.

Direct download: Resa_Lewiss.mp3
Category:general -- posted at: 7:00am AEDT

Neuro Imaging Nibble: Subtle Sinus Venous Thrombosis by Brandon Foreman

Direct download: NeuroImaging_Nibble_2.mp3
Category:general -- posted at: 7:00am AEDT

Diagnosing a wake-up stroke by Fernanda Bellolio

Direct download: Diagnosing_a_wake-up_stroke.mp3
Category:general -- posted at: 7:00am AEDT

Critical care clinicians can change physiology with a number of tools. The can repeatedly, often and mercilessly change physiological variables. They can increase the blood pressure (or decrease it); they can increase cardiac output (or decrease it), they can increase cardiac filling pressures (or decrease them), they can increase glucose levels (or decrease them), they can increase positive fluid balance (or decrease it) and so on. This kind of “numerology” is attractive because the outcomes are tautological and clinicians feel powerful and effective. However, outside the obvious situations where physiology is so dangerously abnormal as to threaten life, such physiological manipulations have an unproven relationship with outcome. Importantly, patients do not care whether their cardiac output has been increased from 5L/min to 6 L/min. They only care whether they live or die, get out of hospital intact and return to their previous life. Thus, physiological gain is not patient centred. Moreover, all research focusing of the physiology of a specific intervention always and inevitably deals with the effect on a specific set of variables. For example and fluid bolus may or may not increase cardiac output for a while. Thus studies focus on identifying fluid responders for such purposes. However, no one studies the effect of such fluid bolus on anything other than hemodynamics. No one measures what the effect is on the immune system, cerebral edema, the glycocalyx, interstitial oxygen gradient, pulmonary congestion, body temperature, haemoglobin and white cell function etc. etc. Thus, all physiological studies are “blind” to the effects that their protagonists cannot or will not measure. In other words, the measurable is made important but the important may not be measured. Clinicians need to reflect on this before they become seduced by physiological manipulation.

Direct download: Rinaldo_Bellomo.mp3
Category:general -- posted at: 7:00am AEDT

Autoimmune versus infective encephalitis by Ronan O'Leary

Direct download: Autoimmune_vs._infective_encephalitis.mp3
Category:general -- posted at: 7:00am AEDT

Controversies in critical neuromuscular disease by Brandon Foreman

Direct download: Diagnosing_critical_neuromuscular_disease.mp3
Category:general -- posted at: 7:00am AEDT

We are all imperfect, this is the human condition. Pursuing a career in resuscitation means that some of our failures can lead to significant consequences, for our patients and ourselves. In medicine, we rarely talk about our short-comings, but this silence leads to isolation and shame. This likely contributes to our significant rates of burnout, anxiety, depression and suicide. We need to change the conversation and start talking about this issue; we need to break the silence.

We need to train in mindfulness, in self-compassion and in empathy. These skills may be just as important as learning the new evidence or guidelines for clinical care. Do you have a case that haunts you? So do the rest of us. Let’s start talking about it, and learning how to fail better.

Resources to consider:

1. www.Selfcompassion.org This is Dr Kristin Neff’s website, complete with a self-compassion quiz, and then exercises and resources for those who fail the quiz! She also has a book, if you prefer that format.
2. Pema Chodron. Fail, fail again, fail better. A short, and lovely commencement address with excellent advice for failing better. https://www.amazon.ca/Fail-Again-Better-Advice-Leaning/dp/1622035313
3. Angela Lee Duckworth. Grit. A marvelous book about the essence of perseverance. Or if you don’t like books, consider her TED talk at https://www.ted.com/talks/angela_lee_duckworth_grit_the_power_of_passion_and_perseverance
4. Brene Brown. The Gifts of Imperfection. A book about failure, and acceptance of failure. Again, if books aren’t your thing, she has a hugely popular TED talk about vulnerability: https://www.ted.com/talks/brene_brown_on_vulnerability and a website/online learning community: https://www.courageworks.com/

Direct download: Sara_Gray_-.mp3
Category:general -- posted at: 7:00am AEDT

Controversies in diagnosing meningitis by Rhonda Cadena

Direct download: Diagnosing_Meningitis.mp3
Category:general -- posted at: 7:00am AEDT

Neuro Imaging Nibble: Subtle Subarachnoid haemorrhage on CT by Jordan Bonomo

Direct download: Neuroimaging_Nibble.mp3
Category:general -- posted at: 7:00am AEDT

Jonathan and his wife Anna thought they were coming to the emergency department for a routine sickle cell pain crisis, but his illness takes him down an unexpected spiral of multi-system organ failure and critical illness. What was a routine patient encounter becomes a much more personal human interaction that causes the provider to question her perspective on chronically painful conditions and realize the effect our words and subtle actions have on our patients.

Direct download: Jessica_Mason.mp3
Category:general -- posted at: 7:00am AEDT

Trauma is an epidemic. It is globally the biggest killer in young people.This talk will outline the current deficits that exist in alerting and turning on the system in major trauma. I will outline how technology can not alone improve this but also improve response, add extra resources and moreover improve communication from roadside through to the resuscitation room.

Direct download: Brian_Burns.mp3
Category:general -- posted at: 7:00am AEDT

The meaning of 'everything' from the perspective of the patient, their family, their doctor and their health economist. We are all going to die; the only unknowns are when & how. If you can't choose life, choose dying well. And make sure you tell your resuscitationist/oncologist/intensivist.

Direct download: 04_Alex_Psirides.mp3
Category:general -- posted at: 1:33am AEDT

You've been resuscitating the patient for hours and finally caught up with volume. You come back on your next shift only to find your colleague has been diuresing them all day.

What the heck were they thinking!?! This normal response to colleagues when they miss the mark clinically gets in the way of improving their—and our—performance. It’s natural to judge, to assume our own method is best, and condemn “that idiot” for their wrong-headed approach. In fact, a host of research says we are programed to respond with exasperation and negative judgment. Expert-level critical care performance however, requires feedback, coaching, and collaboration. We have to harness the energy behind our righteous indignation into a spicy mixture of feedback for and curiosity about our colleagues. Paradoxically, our vexation, when channeled into a combination of good judgment plus curiosity can boost quality and collaboration in critical care. Using research on feedback, debriefing and interprofessional communication, this talk illuminates four steps for collaborating to improve performance: 1) Note performance gap, 2) Reset one’s reaction to the gap; 3) Explore the thinking behind the performance; 4) Tailor a win-win solution to their thinking and yours.

Direct download: Jenny_Rudolph.mp3
Category:general -- posted at: 1:26am AEDT

Sarah Yong is an impressive person. Advocacy, Training, Representation and being a new fellow of the College of Intensive Care to boot.

 

Theres a lot to talk about when you sit down with Dr Sarah Yong. Let’s make it easy by focussing on three big issues;

 

Gender issues; Women in Intensive Care Network. www.womenintensive.org

Training issues; The Critical Care Collaborative and the Victorian Primary Examination Course for CICM. www.vpecc.com

Representation issues; New Fellows Rep on the Board of the College of Intensive Care Medicine. www.cicm.org

Where to start?

Women in Intensive Care Network www.womenintensive.org @WomenIntensive

If my sources are correct there pretty much the same number of women and men out there in the world. Further it seems that there are roughly the same number of women and men presenting to intensive care units. This pattern does not repeat itself in terms of the Intensive Care doctors.

Let’s talk about this. Let’s listen to the people that are raising awareness about this. The Women in Intensive Care are talking about it and publishing about it too. You may have heard about the Medical Journal of Australia article; “Female representation at Australasian specialty conferences”.

Direct download: Sarah_Yong_CICM_ASM_2017.mp3
Category:general -- posted at: 8:11pm AEDT

Rapid Sequence Airway (RSA) involves the same preparation and pharmacology as RSI with the immediate planned placement of an extraglottic device (EGD) instead of intubation. Like DSI, RSA is an alternative airway management strategy that may be ideal for preoxygenation of hypoxemic patients as well for prehospital and in-flight use. Depending on the chosen EGD, RSA can facilitate gastric decompression, positive pressure ventilation with PEEP delivered by a ventilator and endoscopic intubation. The speaker presents the evolution of this novel concept in New Mexico, reviews their clinical experience with RSA in both the prehospital and hospital settings and assesses the available literature.

Direct download: Darren_Braude.mp3
Category:general -- posted at: 7:00am AEDT

Becoming competent in airway management requires good decision making and and technical skills. Ultimately what matters is how your clinical performance impacts patient outcomes. For this we need to have a clear understanding of what defines success ensuring that its more than just 'getting the tube'. Come to this talk and you'll experience a Canadian take on Guinness, adventure sports, flying a plane and how other factors including failure influence airway management outcomes.

Direct download: George_Kovacs.mp3
Category:general -- posted at: 7:00am AEDT

Airway management is a fundamental responsibility and skill of all involved e.g. emergency physicians , anaesthetists and critical care physicians. We need airway algorithms because there is still severe morbidity and mortality related to airway management. (NAP 4 study, ASA Closed claims series)

The 2015 Difficult Airway Society guidelines, published in the British Journal of Anaesthesia in December 2015, provide a sequential series of plans (A to D) to be used when tracheal intubation fails. They are designed to promote patient safety by prioritising oxygenation and minimising trauma and they highlight the role of neuromuscular blockade in making airway management easier.

The guidelines recognise the difficulties in decision making during an emergency and stress importance of human factor training. The guidelines include steps to assist the anaesthetic team by providing a common stem of options (a simple algorithm) for maintaining oxygenation, limiting the number of airway intervention attempts, encouraging declaration of failure by placing a Supraglottic Airway Device and overtly recommending a time for stopping and thinking. They emphasise the importance of considering discontinuing anaesthesia and waking the patient up (if appropriate) when tracheal intubation has failed.

Videolaryngoscopy and second generation Supraglottic Airway Devices are recommended and all anaesthetists, intensivists and emergency medicine physicians, should be trained to use them. There is however limited evidence available relating to the management of the can’t intubate can’t oxygenate situation (CICO) PLAN D. However it is strongly recommended that all anaesthetists must be trained to perform a surgical cricothyroidotomy and a standard operating procedure for Front of Neck Access to the airway is described using a “scalpel bougie tube” technique.


Learning Objectives
• Importance of optimal preoxygenation.
• Best technique at laryngoscopy.
• Maximum of 3 attempts at laryngoscopy / intubation.
• Maximum of 3 attempts at placing a Supraglottic Airway Device.
• When tracheal intubation fails, waking the patient up is almost always the safest option.
• All practitioners involved in airway management need to learn the “scalpel bougie tube” method of cricothyroidotomy.

Direct download: Ellen_OSullivan.mp3
Category:general -- posted at: 7:00am AEDT

In the past two decades, airway management has been revolutionized by the development of video laryngoscopy, hyperangulated blade geometry, optical stylets, laryngeal masks, and a host of advances in airway pharmacology and technique. The core skill of airway management, however, remains laryngoscopy, whether or not the operator uses a blade with a camera at the end. In this presentation, we break down laryngoscopy into its discrete components and describe best practice technique at each step. We will start by describing common mistakes made in patient positioning; proposing a set of parameters the provider can use to guide positioning that is optimal for laryngoscopy, including the configuration of the patient in the bed, the bed height and head elevation, as well as provider stance. We then move into the effect of laryngoscope grip on operator catecholamine management and describe the optimal laryngoscope grip for emergency airway management. We next confront one of the core principles of RSI, the delay between medication administration and commencement of laryngoscopy, and propose an alternative approach that emphasizes early laryngoscopy with deliberate slowness. We turn our attention to the value of the jaw thrust–as performed by an assistant–during airway management, and then move into a step by step analysis of laryngoscopy as the blade moves into the mouth, down the tongue and ultimately to the glottis. We espouse suction as an underutilized device by emergency providers, and describe the two most important intra-laryngoscopy optimization maneuvers: optimization of the position of the head, and optimization of the position of the larynx. We discuss the value of using the gum elastic bougie for both difficult and routine intubations and describe pitfalls encountered when using the bougie (and how to manage them). We conclude by describing the 3-finger tracheal palpation method of endotracheal tube depth confirmation.

Direct download: Reuben_Strayer.mp3
Category:general -- posted at: 7:00am AEDT

Delivering a presentation is a skill like any other yet few folk are actually develop this skill they merely copy those they observe and reach the same level of mediocrity. There is more to a presentation than your slides. The p cubed concept gives an understanding of presentation design that will change your presentations forever.

Direct download: Ross_Fisher.mp3
Category:general -- posted at: 7:00am AEDT

Musical genius Suman Biswas (@amateursuman) gave one of the most popular talks at SMACCDUB: A Prick with a Needle. The Anaesthetist from London, probably more famous for his satirical songwriting career, gives a poignant talk about communication.

Punctuated with some classic songs and delivered with his stand-up comic timing and panache, this is what SMACC is all about: an important message that could change your practice, delivered in a unique and unforgettable way.

Language warning.

Direct download: Suman_Biswas_2.mp3
Category:general -- posted at: 10:01am AEDT

We accept that knowledge translation is critical to the practice of emergency medicine, yet when it comes to the practice of BEING an emergency physician, we do always practice evidence-based medicine. We realized that the experiences of many female emergency physicians were similar but not shared, so we created an open access resource to address that. FemInEM was born out of the real but unfortunate truth that the gender pay gap is alive and well, and promotion of women through the academic pipeline is slow and women still experience unconscious bias at all levels of development. Malignant behavior runs rampant within medical training, and women are disproportionately affected by this reality. In addition, balancing work life and home life can pose extra challenges, especially for women. Numerous studies have shown even when working full time, women often carry more of the “care based” workload for home and family, compounding the “work-life conflict” felt by physicians regardless of gender.

We will share the journey of how FemInEM began as a blog but evolved quickly into a centralized resource for women needing advocates and champions. We will tell stories of how we are helping to change the conversation related to gender and equity in EM by highlighting the successful practices and programs in an open access format. By using the principles of FOAM and the power of social media, we are trying to move the needle on gender and medicine in a way that hasn’t been done before.

Direct download: Dara_Kass_Jenny_Beck-Esmay_Stacey_Poznanski.mp3
Category:general -- posted at: 7:00am AEDT

More than a hundred years ago Osler moved medical education to the bedside. Somehow today, most medical education still takes place in the lecture hall far away from patients.

Medical education is often thought of as a top to bottom process where experienced professors and clinicians provide information and feedback to novice learners, with the goal of increasing knowledge and adjusting behavior.

This approach to medical education can be effective, but may also only provide situational learning making what is learned in school today, outdated tomorrow.
Creating an environment where students can learn reflective practice that can evolve with them as they move from novices to experts may prevent situational experts and facilitate expert performance.

The continuous changing nature of modern healthcare also demands that students from an early educational age are provided with the skills needed to learn, work and adapt within a continuously evolving environment. These skills aren’t traditionally taught in medical school as learning in context is limited.

Therefore, the future of medical education should focus on helping students develop the skills needed to become their own learning choreographers who take responsibility for their own education, not only as students but also as lifelong learners as part of their continuous medical education.

The purpose of the talk is to answer some of the question that may arise when you allow medical students to choreograph their own education. How this process can be started with you as the educator, and can be done without compromising patient safety and maybe even improve patient outcome.

Direct download: Sandra_Viggers.mp3
Category:general -- posted at: 7:00am AEDT

Caring for the critically unwell is an important and difficult task. So preparing our people to meet this challenge should be all about excellence.

Too often, the structures and pressures that define medical training focus on competence rather than excellence. Competence is measurable. It can logged, assessed, and can be applied to across big organisations. But aspiring only to competence limits us - our patients need more. So can we learn from how other high-performance organisations train?

For Olympic teams, aiming for competence just isn’t good enough. These organisations develop their athletes over many years - equipping them, ready to deliver an excellent performance under pressure.

Successful coaching relationships operate on an individual level. They are long-term. They are flexible. And they are measured not by exams or assessments, but by whether the person being coached can perform in the real world.

Should you be thinking about being a coach rather than a trainer? And how can we move our focus from competence to excellence?

This talk will explore three aspects of high-performance coaching which have relevance for clinical educators:
⁃ Goal setting and commitment
⁃ The value and limitations of marginal gains theory
⁃ Self-compassion as a tool for achieving excellence.

Direct download: Tom_Evens.mp3
Category:general -- posted at: 7:00am AEDT

This will be a panel discussion with a focus on the different styles of training and education in prehospital care.

Direct download: Gareth_Davies.mp3
Category:general -- posted at: 7:00am AEDT

Wilderness and expedition medicine is the epitome of practical, pragmatic, minimalist and thoughtful care. Austere and extreme environments require special knowledge, critical thinking, innovative practice and sometimes cunning improvisation. Diagnosis in the wilderness relies heavily on clinical examination skills, monitoring and special investigations are very limited, and treatment options are determined by the breadth and depth of the individual practitioner’s hands-on skills. The implications of extreme environments – high pressures and altitude, frigid and sweltering temperatures, hypoxia and high-intensity endurance exercise – can provide us with great insight into the physiology of humans responding and adapting to critical illness. In this presentation, Ross shares trials and tribulations and draws on experiences from wilderness rescue, and expeditions around the world, which provide lessons for wilderness medics. Many of these lessons can be translated to insights into practicing better acute and critical care medicine in our day-to-day settings.

Direct download: Ross_Hofmeyr_2.mp3
Category:general -- posted at: 7:00am AEDT

After five months working in the ICU and ED of the Médecins Sans Frontières run Kunduz Trauma Centre (KTC) in northern Afghanistan, I found myself caught up in an eruption of war as the Taliban forcibly took control of Kunduz from the US backed Afghan Military. This marked the beginning of a challenging week of heavy conflict in which our hospital was the only facility providing impartial medical care to war wounded civilians and soldiers from both sides of the conflict. Despite the proximity of the rapidly changing front line, we believed the hospital was the safest place to be, as both warring parties had agreed to respect the protection provided to us under International Humanitarian law.

My work in KTC came to a grinding halt when a US Gunship fired over 200 missiles into our hospital, destroying the main building and killing 42 people including 14 of my colleagues. It was a scene of nightmarish horror that will forever be etched in my memory.

Since returning from Afghanistan, I have watched in shock as hospital after hospital in both Syria and Yemen has been bombed. Over 250 hospitals in Syria and 130 in Yemen have been attacked since the beginning of their respective conflicts, cataloguing a growing disregard for the rules of war. Despite the condemnation by the UN, the attacks on medical facilities continue, unabated.

Following an eye witness account of the attack on KTC, I will look more globally at the trend in hospital bombings, asking some important questions: Is international humanitarian law no longer respected by warring parties? Are we entering into a new paradigm of war where hospital attacks are a legitimate military tactic? What does this mean for the future of critical care delivery in war zones across the world?

Direct download: Kathleen_Thomas.mp3
Category:general -- posted at: 7:00am AEDT

The World Health Organization notes that 80-90% of all diagnostic problems could potentially be solved by basic radiograph (x-ray) and ultrasound (US) examinations; however, the problem is that two-thirds of the world’s population currently has no access to imaging technologies (1).

From refugee camps in Greece, to rural clinics in Australia, to Everest Base Camp, point-of-care ultrasound is one of the most powerful diagnostic and procedural tools in any austere clinical setting. This transformative technology allows front line providers who have direct responsibility for patient care to rule in or rule out diagnoses rapidly, and to ensure safety in performing procedures with real-time image guidance. For example, POCUS training just allowed a midwife to identify a massive amount of free intra-abdominal fluid in the 30 year-old Ugandan mother presenting to gynecology clinic with her third pregnancy and new abdominal pain. She notified the surgeon of her concern for a ruptured ectopic pregnancy and the patient was immediately taken to the operating theatre, and she survived. She related that before her ultrasound training, her practice of sending this patient to town for an ultrasound evaluation by the only radiologist in the district would have delayed definitive care, and may have resulted in death.

When I worked in an Ebola treatment unit one of my favorite patients who had been doing well suddenly spiked a fever to 40 degrees Celsius. His abdomen became rigid and I had no idea why. In a setting where no other imaging was possible, POCUS allowed me to see that there was an unexpected issue with his bowels. That knowledge led me to start him on antibiotics, and adjust care plans after I found similar in several other patients.

Ultrasound machines have become increasingly portable, user-friendly, and less expensive over the last decade. This is resulting in a growing presence in otherwise austere environments. POCUS trained clinicians can afford imaging capacity to health facilities that may have very limited on-site diagnostics. There is no ionizing radiation, nothing invasive, and it is cost-efficient (2,3). Human resources are consolidated; the clinician is the diagnostician. POCUS provides the potential to quickly narrow differential diagnoses by facilitating a look inside the body during the patient encounter, and research studies support its use to solve information gaps in resource-limited settings (4-10). Moreover, the potential for this digital technology to be shared – and to leverage global expertise and consultation – increases the range of application beyond one individual’s knowledge base.

References
1. World Health Organization Medical Devices: Managing the Mismatch, 2010. Accessed March 20, 2016. Available at:
http://apps.who.int/iris/bitstream/10665/44407/1/9789241564045_eng.pdf

2. Mercaldi CJ, Lanes SF. Ultrasound guidance decreases complications and improves the cost of care among patients undergoing thoracentesis and paracentesis. Chest 2013;143(2):532–8.

3. Adhikari S, Amini R, Stolz L, Blaivas M. Impact of point-of-care ultrasound on quality of care in clinical practice. Reports in Medical Imaging 2014; 7: 81-93.

4. Sippel S, Muruganandan K et al. Review article: use of ultrasound in the
developing world. International Journal of Emergency Medicine 2011; 4:72

5. Henwood PC, Beversluis D et al. Characterizing the limited use of point-of-care
ultrasound in Colombian emergency medicine residencies. International Journal
of Emergency Medicine 2014; 7:7

6. Deng D, Mingsong L et al. Ultrasonographic applications after mass casualty
incident caused by Wenchuan earthquake. Journal of Trauma 2010; 68: 1417-20

7. Fagenholz P, Gutman JA et al. Chest ultrasonography for the diagnosis and monitoring of high-altitude pulmonary edema. Chest 2007;131(4):1013-8

8. Shah SP, Epino H et al. Impact of the introduction of ultrasound services in a
limited resource setting: rural Rwanda 2008. BMC International Health and
Human Rights 2009; 9:4

9. Kotlyar S, Moore CL: Assessing the utility of ultrasound in Liberia. J Emerg
Trauma Shock 2008; 1(1): 10-14

10. Stein W, Katunda I, Butoto C: A two-level ultrasonographic service in a
maternity care unit of a rural district hospital in Tanzania. Trop Doct
2008; 38(2): 125-6


Direct download: 02_Trish_Henwood.mp3
Category:general -- posted at: 7:00am AEDT

The talk focuses on why clinicians miss the diagnosis on aortic dissection. It breaks down the key pearls on history and physical exam that guide you into correctly suspecting a dissection. Aortic dissection is a challenging diagnosis that you can not afford to miss. The talk aims to give you the framework to avoid missing the diagnosis. I want to raise the bar so that the standard of care is not to miss a dissection when it presents atypically. The talk will also highlight strategies on what to do when you suspect the diagnosis. It will guide you to order the right imaging tests and begin the treatment promptly. Sit back and be ready to see dissections in a different light.

Direct download: 01_David_Carr.mp3
Category:general -- posted at: 11:09pm AEDT

Gareth Grier discusses who should be intubated following severe trauma pre-hospital.

Direct download: Gareth_Grier.mp3
Category:general -- posted at: 11:02pm AEDT

This talk will look at current and previous pre oxygenation practices and some of the current research. It will also discuss the notion of commitment to evolution of practice, the breakdown of cognitive biases and how to move forward with adequate self reflected practice.

Direct download: Geoff_Healy.mp3
Category:general -- posted at: 7:00am AEDT

Modern acute care medicine is eye-wateringly complex and potentially dangerous. It really can't be delivered safely without deliberately addressing our teamwork (in both acute and chronic situations). Unfortunately, historically, human factors were commonly left to chance, and recently have been threatened by decerebrate checklists and meaningless psychobabble. Practical strategies exist (thank goodness!) and will be reviewed. We have much to learn, but must also avoid overly simple answers to exceedingly complex problems. It's time to get back to basics and away from the BS. Come be part of a practical revolution

Direct download: Peter_Brindley_2.mp3
Category:general -- posted at: 7:00am AEDT

Richard will cover the rationale and evidence for prehospital blood product transfusion in trauma, look at the available current and future options, suggest best clinical practice and highlight areas of future research.

Direct download: Lyon.mp3
Category:general -- posted at: 7:00am AEDT

Patients with TBI (traumatic brain injury) often have concomitant systemic injuries that complicate the management of the TBI. How does the practitioner balance the needs of the hypotensive resuscitation with CPP? How does ICP affect emergent operative needs? Thoracic injuries complicate cerebral oxygenation - are there effective management strategies? Where is the best place to care for these patients?

Direct download: W_knigh.mp3
Category:general -- posted at: 7:00am AEDT

Rory Staunton was a healthy 12-year old boy, known for his smile and his work standing up for others. A simple fall during basketball practice caused an abrasion on his arm, which is the suspected beginning of a cascade of events that led to his death from sepsis. Rory was seen by both his pediatrician and a local emergency department, and was sent home with a diagnosis of a viral illness. He returned the next day in septic shock and died shortly thereafter.
A review of the medical records revealed that there were errors that occurred during his emergency department visit. These errors were the focus of a controversial article in the New York Times, that included both details of the case, as well as the name of the physician that provided care. A backlash from the medical community occurred leading to multiple physician-written op-ed pieces, as well as over 1600 comments on the online version of the article.
This talk will attempt to move away from the controversy of the actual article and instead focus on how these common errors could have occurred during any busy shift and what we can do to prevent them in the future.
My intention in giving this talk is to continue to use this case to raise awareness of both pediatric sepsis and common medical error and hopefully lead to fewer outcomes like Rory’s.

Direct download: Jo_Anna_Leuck_2.mp3
Category:general -- posted at: 7:00am AEDT

Describing the importance of patient handover and the critical time when the pre-hospital practitioner will give this information to the receiving hospital staff. Using an analogy of the characters that appear in cowboy films, the preacher stands out as one who usually plays a small but significant role in getting his message across. We will compare this to the modern day practitioner and how they should achieve the objective of giving a good handover to the receivers, who may or may not be believers

Direct download: Kieran_Henry.mp3
Category:general -- posted at: 7:00am AEDT

Sepsis is the life-threatening condition that arises when the body's response to an infection damages its own tissues and organs. It can lead to shock, failure of multiple organs, and death. Organ failure and death are more likely if sepsis is not recognized early and not treated promptly. Sepsis is the leading cause of death from infection around the world and contributes to or causes half of all deaths occurring in hospitals in the USA.
Many people who survive severe sepsis recover completely and their lives return to normal. But some people, especially those who had pre-existing chronic diseases, may experience permanent organ damage, the common problems that afflict those who have recovered from sepsis have been termed the post-sepsis syndrome.
Longer term effects of sepsis include
• Sleep disturbance including insomnia
• Experiencing nightmares, hallucinations, flashbacks and panic attacks
• Muscle and joint pains which can be severe and disabling
• Extreme tiredness and fatigue
• Inability to concentrate
• Impaired mental (cognitive) functioning
• Loss of confidence and self-belief

Direct download: Simon_Finfer_edited.mp3
Category:general -- posted at: 7:00am AEDT

To cool or not to cool. Traumatic brain injury is a major cause of mortality and long term morbidity. Hypothermia has been suggested as a potential treatment to limit secondary brain injury and improve outcomes. However, this currently remains controversial. Despite many small studies and meta-analyses suggesting benefit this has not been reflected in the recent larger studies. This may have been due to significant methodological limitations. The Eurotheum study completed last year which examine hypothermia as a rescue therapy suggested that we should abandon hypothermia in our traumatically brain injured patients. Before our community discards this potentially beneficial treatment after almost 50 years of investigation it is important to understand the limitations of the previous studies and the opportunities that currently ongoing studies have to address this question.

Direct download: Alistair_Nicholl.mp3
Category:general -- posted at: 7:00am AEDT

It’s been two decades since NINDS and MAST and ECASS and the other clot-busting lore cluttering up your brain. Have we learned anything in the interim? Are we using tPA more safely, more appropriately – or just more? And, what now, of endovascular therapy, CT perfusion, and patient-level predictive modeling – are you ready for the next decade of evolution in stroke care?

In this talk, we’ll go into the most recent trial evidence relating to saving neurons, and whether we should be suspicious or celebratory of their outcomes. On one hand, we have clinicians putting the low-tech non-contrast CT in a mobile stroke unit to treat more patients, while other clinicians are using rapid MRI and CT perfusion to precisely target treatment. We’ve also seen endovascular treatment finally hit prime-time after years of false starts, and systems of stroke care re-organized around its delivery. The pace of practice change – and the reliability of the evidence – is enough to give you a stroke!

Finally, we’ll look at the clinical trials underway, which may produce zero, subtle, or huge changes in practice. At the minimum, we’ll at least get a handful of new acronyms to file away.

Direct download: Ryan_Radecki.mp3
Category:general -- posted at: 7:00am AEDT

Undertaking a decompressive crainectomy is perhaps one of the most challenging decisions we face within critical care, we don't know if we should do the operation, and even if we think we should we don't know when, or even how. Perhaps more importantly we don't do the operation, the neurosurgeons do, but we frequently put them in the position of doing the operation when we are at our wits end, or they do the operation without asking us when we still feel we have space to play. How can we resolve this, in a workplace environment which is already fraught with competing interests, beliefs, values and approaches? Evidence based medicine isn't going to provide an answer soon and it is unlikely that a superficial approach to improving teamwork will either. An important component will be the future structure of clinical training, our current systems reflect the way hospitals worked decades ago and the specialties we now have exist almost independently of the training which leads to consultant posts. Training should involve exposure to collegiate decision making and consensus building but this will be difficult to achieve within our current nationally co-ordinated training schemes.

Direct download: Ronan_OLeary.mp3
Category:general -- posted at: 7:00am AEDT