SMACC

PRO

 

Point-of-care ultrasound (POCUS) is gaining widespread acceptance in the various medical sub-specialties and is progressively being integrated in pre-graduate medical curriculums around the world. It has helped physicians throughout the world to make easier, more accurate and faster diagnoses. It has contributed to enhance the diagnostic possibilities in resource-scarce environments.

As it is gaining widespread acceptance, the use of POCUS is currently shifting from the hands of motivated technology-eager early adopters to those of just about every physician, trainee and student entering the house of medicine. This scientific revolution will inevitably change the way medicine is practiced in the years to come. Of all times, many problems and difficulties have been created by such shifts in scientific dogmas.

Research and use of fancier, new or more advanced applications are likely to help the global advancement of POCUS and even medicine in general. But as POCUS, enters fully in its stage of normal science, this will inevitably induce some degree of scientific esotericism. This has been the case of all past scientific revolutions. However, in a world in full acceleration where knowledge translation times are dropping, the side effects of normal scientific activity can be expected to be somewhat magnified in comparison with previous medical and scientific revolutions.

The importance of defining and understanding test characteristics, like specificity and sensitivity, is a major challenge that many physicians using POCUS are already facing. And the widespread integration of POCUS in medicine will need to take into account the pressures of decision-making in a naturalistic setting (in the clinical setting) and the human factors governing the use of this technology. This is critical if we want POCUS to grow better in the midst of its own revolution.

Point-of-care ultrasound is already generating some important difficulties. If these go unattended, I believe POCUS itself might rapidly be a problem.

 

CON

POCUS is a problem? Really? For who? Maybe a radiologist holding down their turf in a small hospital that has been shielded from the world wide web. Will paint a broad picture of the wide multi-specialty impact POCUS has made in clinical care citing key references and case examples.

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

Simon:

I am presenting the opposing view to Scott Weingart who thinks that emergency medicine is a failed paradigm. He's wrong of course. For a starter, millions of people can't be wrong. Sure, it's not the same as when we started, but such dynamism and adaptation is something to be celebrated not vilified.

Emergency Medicine will never die. It will forever adapt and survive.

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

Ashley Shreves:

There are nearly 100 billion stars in the Milky Way – and almost that many articles published every year. Luckily for you, we read them all – or, at least, the ones in the domain of EM (Emergency Medicine). Catch up with where the new literature is leading you, leading you astray, or just plain bonkers. Sit back and let us inspire you to take your own deep dive into all the great foundational science. We'll swing through new stroke treatments, the ketamine blow-dart, the best medications for reanimating the dead, and many more!

Ryan Radecki:

It has been exciting and surprising year in the EM literature. We'll be hitting all the highlights and letting you know what's hot and what's not. Topics to be addressed include, but are not limited to, abscess management, medications for renal colic, imaging for subarachnoid, new anticoagulant reversal agents, use of opiates, and the diagnosis of PE

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

Obesity surgery can induce strong responses in healthcare professionals. These biases must be overcome to allow efficient and safe services. The obese patient presents some challenges to the anaesthetist, some of which are underestimated, others overestimated. Building a team to deliver a new service presented significant obstacles which were overcome successfully to deliver complex surgery in high risk patients with a medical length of stay of 36 hours, and a minimal complication rate.

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

I want to live a life that is both happy and long. If I have a structural disease that could be fixed with an operation - for instance a cancer or an aortic aneurysm - I'd like to know whether my long and happy life is more likely with or without surgery. And I don't just want to know whether I'll be alive or dead in 30 days, which is the most common published metric of surgical success or failure. I have developed a tool that accurately predicts survival years after repair of abdominal aortic aneurysm and that helps patients decide whether to have surgery or not. The tool also explains how one piece of research has been misunderstood, a misunderstanding that has resulted in two general mistakes: surgeons operating on aneurysms when they should not; surgeons not operating on aneurysms when they should.

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

Karim Brohi brings gives his perspective on the mindset of a trauma surgeon. He talks about how we can develop the self confidence that helps us cope with stressful clinical situations. It's an amusing and honest talk with plenty of Karim's self deprecating wit. If you like this talk, check out Scott Weingart's Kettlebells for the Brain, Cliff Reid's Making Things Happen and Oli Flower's Lessons from the Cage.

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

The development of Helicopter EMS (HEMS, or as the Federal Aviation Administration recently coined it: “Helicopter Air Ambulance” or “HAA”) services in the United States has taken a decidedly different path in recent years compared to those in other countries. The wide spread use of single engine, VFR only aircraft, owned and operated by for profit companies is a uniquely American phenomena; at odds with most other countries who have developed HEMS programs around the world. This has resulted in significant direct competition between HEMS programs, as well as highly questionable billing practices that have started to garner attention. The origins of this development, including the use of the US “Airline Deregulation Act” to prevent states from regulating HEMS programs will be examined. More recent efforts in the US to tie reimbursement and program accreditation to the levels of care provided and minimum standards of equipment are still nascent at this time. Efforts by the US National Transportation Safety Board (NTSB) to mandate improved safety equipment standards have been met with resistance by the industry and the FAA. This has resulted in wide variability in US HEMS programs and the adoption of IFR standards, mandating NVG use, twin-engine aircraft and risk assessment strategies. There is also increasing scrutiny being placed on appropriate utilization criteria in the face of skyrocketing bills and questionable billing practices by for-profit companies.

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

Patients who present with pulseless electrical activity (PEA) arrest have a high mortality. The treatment of PEA requires finding and reversing the underlying cause, therefore a simple and rapid approach is required. Traditionally we were taught to use the H's and the T's, but this diagnostic tool is cumbersome and of questionable utility overall.

This talk will discuss the problems with the traditional H's and T's as well as focusing on newer approaches to PEA arrest. The speaker will discuss tools such as bedside ultrasound and using the width of the QRS complex to rapidly workup and treat patients in PEA arrest.

Direct download: Haney_Mallemat.mp3
Category:general -- posted at: 10:53am AEDT

Pulmonary hypertension (PH) is commonly encountered when managing the patient with an acute critical illness. The impact of PH on cardiac function can be devastating if it is not quickly recognized. The goal of this talk is to arm clinicians with some simple techniques to predict and assess for complications of PH, identify the resuscitation targets in a crashing patient with PH, and finally review some major pitfalls in the management of the patient with PH.

Direct download: 1John_Greenwood.mp3
Category:general -- posted at: 12:00pm AEDT

Your most favorite resuscitation items such as oxygen, bolus epinephrine, intubation and cardioversion may in fact be harmful for the pediatric cardiac patient presenting to the emergency department in extremis. Due to the physiology of certain complex congenital heart diseases, the usual resuscitation maneuvers may in fact kill the patient instead of helping.
Supplemental oxygen can worsen the pulmonary to systemic blood flow ratio in single ventricle patients and cause them to have rising lactate levels and cardiac arrest from low systemic cardiac output.
Intubation and positive pressure ventilation may impede pulmonary blood flow in patients with a Glenn shunt and the patient can become more desaturated. With increasing PEEP and higher respiratory rates the patients will continue to deteriorate and desaturate.
Regular dosing of epinephrine boluses in patients with single ventricle physiology who are dwindling (nearly arresting), can actually worsen their systemic output by increasing systemic vascular resistance and promoting pulmonary overcirculation.
Cardioversion of a previously healthy pediatric patient might be tempting when you see what looks like a stable ventricular tachycardia. This wide complex rhythm has fooled many people into shocking it. You might in fact be dealing with something else and can make the patient infinitely worse by shocking.

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