Working in a Paediatric Emergency Department that has 52,000 attendances per year, means that at this point I have fallen into almost every possible pitfall associated with communicating with children and their parents, whether it be the seriously ill or the efficient disposition of the worried well and everything in between. The art of appearing to take all the time in the world whilst managing large volumes of patients can be challenging at times. It can be difficult to separate your emotional response to a patient and their parents from your professional assessment. I hope that by hightlighting mistakes I have encountered along the way that others will learn from them.

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

Every Pre Hospital and Retrieval Medicine (PHARM) mission involves a series of complex decisions, which must be rapidly made in a fluid and often pressured environment. Excellent PHARM clinicians are invariably expert decision makers, and the ability to identify, accept and manage trade offs is a key skill in prehospital and retrieval medicine.

Some of these trade offs are obvious, and the best options are clear – for example aircraft and crew safety cannot be compromised regardless of the clinical situation on scene. Other choices are far more complex, and require rapid and accurate cognitive appraisal of a dynamic and often incomplete information set.

Interventions performed on scene, and the order in which they are performed involves a balance of the patient’s immediate requirements against how much it will cost in time and risk. During a mission, each decision to do something leads to another layer of decisions on how and where it should be done. This often results in a trade off between principle and preference. Decisions on which team member should perform a particular procedure must balance competence, training opportunity and the concurrent performance of other tasks.

Every mission is a continuous efficiency-thoroughness trade off, and each individual decision must be made to positively affect overall patient care. There is often no single ideal solution to these trade offs, and each decision must be tailored to the circumstances at a given point in time.

The way in which the clinician manages these trade-offs is vital both for effective patient care the overall performance of the mission. Excellence in PHARM is a function of training and experience, with expert clinicians operating within a robust system that allows for flexibility - protocols are powerful but individual insight is indispensible.

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

A demonstration in the ECMO-CPR process and then going back to basics, to understand the need for such a process and how to design and develop it from scratch using simulation to cut lead time and highlight and remove issues prior to rolling out on the patients. Making E-CPR both possible and safer.

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

This session will review the latest evidence for resuscitative hysterotomy (aka perimortem cesearean section), in light of the latest ACLS guidelines. Is there really evidence for the 4 minute rule? How fast do we need to do this? Terrified of this risky procedure? Come learn some practical tips for getting through this as effectively as possible. No time for the whole podcast? Check out these quick links and references:
• This one has many details of the procedure itself.
• Great review of the procedure, nice FOAM resources at the end
• Includes links to the videos below.
• Prefer a review article? This is a great review of the science on maternal cardiac arrest and PMCD (PMID 24797653)
• An excellent review of published cases is here (PMID 22613275), describing the details of timing of PMCD as it relates to maternal and neonatal survival

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

This talk uses a case study approach to discuss why resuscitation practitioners should focus upon technical accuracy when resuscitating, focussing on all of the facets of a resuscitation, compression, decompression, trans-thoracic impedance. It suggests that many of the smallest of subtleties can have a dramatic effect on patient survival.
We focus on the physiological effects of Manual Chest Compression and use historical reference to underpin modern techniques.

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

The child with the reduced conscious level presents a unique challenge to the Emergency provider - how can we recognise normal sleepiness versus pathology? Natalie May reminds us that, even if it's after bedtime, we have to take the time to wake children up fully as part of our routine assessment. She then explores the common pathologies - 5MF! - we need to consider in children with a reduced conscious level and how we can figure out which one is in front of us.

Direct download: Natalie_May.mp3
Category:general -- posted at: 12:00pm AEDT

For retrieval medicine specialists and pre hospital care providers, terrorist attack is one the new threat! Terrorist attack is not an accident: It is a human activity whose purpose is to kill, injure, the maximum casualties to disrupt society, to spread the feeling of fear of panic and insecurity in the population. Terrorism is not blind, it is an organized strategy, much more complex than any natural or technological disaster. To oppose an aggressive strategy a static plan is not enough, you must develop a counter strategy comprehensive and adaptable to multiple scenarios. Effective leadership, combining the expertise of the Police, Rescue and Emergency Care allows a customized solution using the elements prepared in advance. One of the worst threats is the multiple sites multi-modal attack, like in Mumbai or in Paris. To face such a complex situation you may need:
- Improvement of pre hospital and in hospital organization for massive casualties. Alert shared by all services, close coordination between Rescue Police and Emergency care, backup on a regional basis, strategic allocation of resources and keeping reserve for the next attack are some of the options that may be extremely helpful.
- Improvement of care for injuries related to military weapons: Major penetrating trauma caused by powerful (kamikaze) bombings and assaults riffles. Management of these victims is very different of the care of a multiple trauma patient after a traffic accident. Adaptation of the principles of the military “damage control” to civilian practice is mandatory. From the scene to the operating room and the critical care unit all actions must be coordinated to prevent the death triad: Hypothermia, coagulopathy and acidosis.
The action of Health Care Services is not limited to medical care, it is also a first step of resilience: By maintaining the quality and the organization of care despite surprise, violence and aggression you oppose directly the objectives of terrorism.

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

Discover how 3D scanning and printing can be used to develop low cost but high fidelity simulation training equipment. An introduction to free, open access Design software and affordable Compact 3D scanners. Cut out the middle men and save your department $$$ by making your own training manikins. Surgical airway trainer, central line insertion phantom, even an ultra-low cost video laryngoscope can easily be created without learning how to use complex 3D software packages.

It’s natural that as doctors we fear failure. In Health, never has so much been asked by so many of so few. Every day feels like a battle zone. Engage a Chief Medical Informatics Officer (CMIO) to introduce technology. That will save us. Established with structure, status and enough support to create and translate innovative models of change in the mindsets of clinicians and healthcare politicians alike, this role could work. However reality is so different. So lets understand failing early to succeed sooner, simplifing and standardising the clinical arena for clinician interoperability, and driving clinician inclusion in the business of health.

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

In the evaluation of an emergency and critical care patient, the provider accounts for the chief complaint, the relevant history and the physical examination. With the evolution of Point-of-Care Ultrasound protocols and algorithms, such as the RUSH protocol or the BLUE protocol, the provider now can organize differential diagnoses and treatment options by integrating point-of-care ultrasound interpretations. However, these are not absolutes. These are probabilities. Although we are following recipes, we must never forget to be creative.

And, we actually crave creativity.

Studies support that handwork such as gardening, wood working, knitting can decrease stress, anxiety, and improve your mood. Perhaps work which requires meaningful hand use may contribute to your creativity- to your following algorithms and delivering more optimal patient centered care. Emergency and critical care medicine can be formulaic- following an algorithm, a pathway, or a protocol. Point-of-care ultrasound may offer the ability to be creative and increase the accuracy of diagnoses and treatment plans.

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