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 AEST

Cardiac surgery can vary from being routine elective surgery to time-critical emergency surgery. The term encompasses a broad range of procedures carried out on patients from neonates to nonagenarians. In the 63 years since the first open heart surgery was performed using cardiopulmonary bypass enormous advances have been made in the field such that an average person presenting for coronary bypass grafting in 2016 can expect a very low chance of peri-operative morbidity or mortality. When things go wrong however they can go badly wrong and at the worst possible moment (see Murphy’s Law). This talk focuses on describing common complications encountered in the postoperative period, with a focus on anticipation, prevention and planning for rapid recognition and successful management of potentially life threatening complications.

Direct download: Deirdre_Murphy.mp3
Category:general -- posted at: 7:00am AEST

The practice of emergency medicine is no longer a one size fits all approach. Furthermore, most of your patients are not usually 'average' as described in journal articles. With more data, newer analytic techniques, and a better understanding of pathologies, we can isolate the exact and most appropriate therapies for our individual patients. We're already doing it, but we should be doing it better. Learn how to be systems thinkers and become better providers.

Using examples from emergency medicine, I will show how a comprehensive approach to patient care can be beneficial for guiding theories and therapies tailored for an individual. This concept of precision medicine allows us to incorporate all knowledge and processes in to one picture rather than segregating medical care in to buckets. We will also discuss some of the challenges in this type of thinking and best practices for translating in to your every day work.

Direct download: Napur.mp3
Category:general -- posted at: 7:00am AEST

When was your last paediatric/neonatal life support course update? Did it include the latest recommendations from the European Resuscitation Council (2015)? NO?! Well, let's have a look at the very latest consensus recommendations for the resuscitation of children in cardiorespiratory arrest and for neonates at birth - and explore any controversies therein.

Direct download: SMACC_Natalie_May_Arrested_Development.mp3
Category:general -- posted at: 7:00am AEST

You owe it to yourself (and to your patients) to learn about burnout and resilience in healthcare workers. This talk aims to be brutally honest, occasional humorous, and quite personal about the speaker's experience and what he learnt along the way. Burnout is shockingly common. Burnout is also bloody important when it comes to our productivity, empathy, culture, and even our outcomes. Fortunately there are internal and external strategies. This talk hopes to address them head-on, and without the usual BS. After all, you can't do well unless you are well.

Direct download: peter_brindley.mp3
Category:general -- posted at: 7:00am AEST

The number of published studies related to burnout, moral distress, conflicts, stressful conditions in the Intensive Care unit (ICU), is dramatically increasing over the last few years. Clinicians perceive the care as "inappropriate" when it clashes with their personal beliefs and knowledge. Care is considered “Disproportionate’ when the intervention or the action is perceived as too much or too little in relation to the expected prognosis in terms of survival or patient’s quality of life. ICU workers, who provide inappropriate or, more broadly, disproportionate care, are at risk for “burnout” and “moral distress”. This phenomenon is poorly investigated even if it could jeopardize patients’ quality of care and outcome. Similarly, no intervention has ever been tested with the aim of avoiding the mentioned threats. APPROPRICUS and DISPROPRICUS are European Society of Intensive Care Medicine (ESICM) studies performed over one day and one-month period respectively, in the ICU. Healthcare providers’ perception of care was measured as well as patients’ outcome. Results show that all healthcare providers in the ICU perceive every day both not appropriate and/or "Disproportionate care". Moreover, people within the ICU are so much accustomed to a disproportionate behavior that they don't consider it as deviant, despite the fact that it far exceeds their own rules. This phenomena is called "Social normalization of deviance” and people in one ICU grow more accustom to such behavior the more it occurs. Stress, conflicts, moral distress and burnout are driven by deviant behaviors and are proven to impair communication among the ICU staff. There is evidence in the medical and non-medical literature suggesting that the burn out leads to low performance and concentration. Good teamwork and an emphasis on clarifying ethical issues are associated with lower perception of inappropriateness of care, fewer conflicts, and smaller staff turnover rate.

Direct download: Francesca_Rubulotta.mp3
Category:general -- posted at: 7:00am AEST

Show me an intensivist that cares about bone! I do.
Critical illness is detrimental to bone health for various reasons – profound vitamin D deficiency, extreme immobilisation, inflammation, excessive cytokine levels, malnutrition, endocrine dysfunction and medication all may lead to accelerated bone turnover and rapid bone loss.
Today, many ICU patients are elderly, and therefore at substantial fracture risk even before critical illness. As an example, one year after a hip fragility fracture, 50 % of patients are either dead or independent. Bone health is therefore very important for morbidity and mortality of ICU survivors, adding up to the long-term sequelae after severe illness. Generally, osteoporosis remains underdiagnosed and therefore undertreated.
On the other hand, recent evidence suggests that osteoporotic patients previously treated with a bisphosphonate may have a survival benefit compared to other patients.
Furthermore, several publications in the last years showed that FGF-23, a phosphaturic, bone-derived hormone predicts outcome in the acute setting very accurately.

Overall, the link between critical illness and bone is strong in both directions and will be discussed in this talk.

Direct download: Karin_Amrein.mp3
Category:general -- posted at: 7:00am AEST

Paediatric major trauma is rare and terrifying. Seriously injured children need good care but a number of factors (the relatively unusual presentations, their size, the way they communicate, their parents..!) make looking after them feel a lot harder than it really is. So what do clinicians really need to know to look after paediatric major trauma? We need to understand differences in physiological responses to injury (and how these can fox our triage assessments), differences in patterns and mechanisms of injury (and how these correspond to the way we diagnose, image and manage injuries in children) and how we can best prepare ourselves to make sure we look after these children well.

Direct download: Natalie_May_Minor_Injuries_Major_Trauma.mp3
Category:general -- posted at: 7:00am AEST

Airway management in confined spaces conjures up images of intubating entrapped victims of motor vehicle crashes, but these challenges can be found from the bottom of caves and crevasses, inside road and air ambulances, during natural and man-made disasters and even in multiple areas of the hospital, such as cath labs and hybrid theatres. In this presentation, Ross addresses the locations and difficulties which can be anticipated, and then discusses the options, techniques and evidence available for managing airways in constrained places. Learning to cope (and then excel) in abnormal fashions and positions makes us better at managing airways in both emergency and routine situations. Ice-pick, BIADs, transillumination, inverted, tomahawk, reversed, blind, digital…if these words excite you, you need to come learn how getting into tight places will teach you how to get out of tight spots.

Direct download: 03_Ross_Hofmeyr_FINAL.mp3
Category:general -- posted at: 7:00am AEST

After a major formative experience at a life-threatening mass casualty incident (MCI), emergency physician Christina Hernon felt incredibly unprepared despite over 2 decades of training in emergency and first response.
Despite every first aid, first responder, and emergency course teaching students to ask, “Is the scene safe?” and instructing them not to enter an unsafe scene, all of this training is completely inadequate for those present the very moment an incident occurs, who are then amidst and surrounded by an unsecured and potentially unsafe scene.
Afterwards, she had an acute stress reaction exactly like after rough calls in prehospital Emergency Medical Services, yet was offered none of the typical supports offered to first responder agencies or hospital personnel.
Feeling somehow betrayed, but unsure what to be mad at, she tried to understand why she felt so unprepared and overlooked. In deconstructing and reflecting on the experience, she self-identified neither as bystander nor first responder, but as an on scene, immediately responding, victimized rescuer. Realizing that she didn’t fit into any already existing category, she uncovered a new group of rescuers and an undefined time period that we need to give attention to.
The Disaster Gap is the time between the moment an incident occurs, through the first call for help, and until the first of the clearheaded First Responders arrives. In this definable time gap, the only available rescuers are people who are on scene when the event happens, who may be traumatized by their experience themselves, and who, regardless of tools or training, take immediate action to help another person or make the situation better. These Immediate Responders are present at virtually every scene and have been for all of time, yet we know very little about them, their actions, their safety, their impact, and their recovery.
By trying to understand the Disaster Gap and Immediate Responders, we can improve training, preparedness, resilience, and recovery.

Direct download: 02_Christina_Hernon.mp3
Category:general -- posted at: 7:00am AEST

What can hospital specialties learn from teaching and training in prehospital and retrieval medicine? A medical education enthusiast's thoughts on the application of educational theory to the challenges of the prehospital environment, based around experiences at Sydney HEMS. Reflections on teaching and learning about patients, the environment, the team and the clinician herself - and how this educational experience will shape future challenges as an educator.

Direct download: Taking_Outdoor_Education_Indoors_Natalie_May.mp3
Category:general -- posted at: 7:00am AEST

Most hospitals develop a disaster plan, but few jurisdictions develop a plan for triaging or rationing scarce resources when the existing supply is overwhelmed. Rather than leaving individual health care workers to make these decisions, we should work together as a community of experts to develop ethical, practical and appropriate policies for triaging scarce resources during a disaster. Come and learn what the literature suggests, and join the global debate about this controversial topic.

Prefer a paper to a podcast?

Find solid overviews here:

1. Devereaux A V. Definitive care for the critically ill during a disaster: a framework for allocation of scarce resources in mass critical care. Task Force for Mass Critical Care summit meeting, January 26-27, 2007, Chicago, IL. Chest. 2008;133(5 Suppl):51S - 66S.
2. Christian M et al. Chapter 7. Critical care triage. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster. Intensive Care Med. 2010;36 Suppl 1:S55-S64. doi:10.1007/s00134-010-1765-0.

And nice reviews of the ethics here:

1. Upshur R SP. Stand on guard for thee: ethical considerations in preparedness planning for pandemic influenza: a report of the University of Toronto Joint Centre for Bioethics Pandemic Influenza Working Group. Univ Toronto Jt Cent Bioeth. 2005;(November).
2. Gostin LO, Powers M. What does social justice require for the public’s health? Public health ethics and policy imperatives. Health Aff (Millwood). 2006;25:1053-1060. doi:10.1377/hlthaff.25.4.1053.

Direct download: 01_Sara_Gray.mp3
Category:general -- posted at: 7:00am AEST

Does love have any place in critical care? If we love and care are we more vulnerable to burnout and compassion fatigue? Will we be identified as weak leaders, too ‘soft’ for the area? Are we supposed to love an environment full of carnage and suffering? Are we meant to ‘love’ our colleagues and see our team as an extended family? Should we ‘love’ our patients or is that a ‘boundary crosser’? Critical Care consistently looks internally to resolve the past and emerging problems when there is research across disciplines that will assist critical care environments to adapt to the changing landscape of ethics, new technologies, issues with teams and a need for leaders to be more than skilled clinicians. Love and humanism may hold the key? Drawing on theories and models that hold love and compassion at their core this talk will draw examples from couples counselling, family therapy, development of teams, acceptance and commitment therapy and some of the greatest leaders in history to provide an innovative framework that can create flourishing and wellbeing within critical care for both the patient and professional. Discover where love can take us in critical care. Exploring the developmental phases of love and critical care we can learn to use our passion and energy for the job as strength instead of as an allergen. We will be reminded from the greatest leaders of our time how to transform health care and working relationships into an environment of love, support and resilience. That if we can negotiate relationships with partners, in-laws, children and friends we have the skills and resources to manage, love and thrive at work. Love, connection and compassion have much to teach us, it is time we learned to listen

Direct download: 04_Liz_Crowe.mp3
Category:general -- posted at: 7:00am AEST

A voyage through the darkest places, sharing doubts and fears.

Direct download: 02_Ross_Fisher.mp3
Category:general -- posted at: 7:00am AEST

Agitation poses a direct threat to the safety of both patient and staff, as well as being an important manifestation of dangerous conditions that require rapid identification and treatment. Management of agitation consists primarily of physical and chemical restraint, and the details of how restraint is carried out–usually based more on tradition than considered plans or thoughtful protocols–directly determine case outcome. In this talk, we’ll discuss the initial approach to agitation, focusing on the appropriate role of physical restraint, as well as best practice technique for physical restraint. We will then deliberate the options for chemical sedation and propose a menu of the safest and most effective agents for a variety of common agitation scenarios. Some of the questions we will address include: What are the most important dangerous conditions that cause–or are caused by–agitation? What are dangerous restraint holds, and how can physical restraint be accomplished in the safest manner? In the initial management of an agitated patient, should chemical restraint be administered by the intravenous or intramuscular route? How do haloperidol and droperidol compare speed in efficacy when used for calming the agitated patient? How should providers manage concerns around prolonging the QT interval when using butyrophenones for sedation? Which benzodiazepine is preferred, as a treatment for agitation? How should neuroleptics and benzodiazepines be used as monotherapy or in combination? In which type of patient should ketamine be used as a sedation agent? How should ketamine be dosed for tranquilization, and what adverse effects should providers be mindful of when using ketamine for this indication? Can ketamine be used in patients with hyperdynamic vital signs? What is the role of crystalloids in managing the agitated patient? Once the agitated patient has been calmed, what are the primary, secondary and tertiary resuscitative maneuvers (diagnostics and therapeutic)?

Direct download: 03_Reuben_Strayer.mp3
Category:general -- posted at: 9:00pm AEST