SMACC

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

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