SMACC (general)

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 AEST

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 AEST

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 AEST

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 AEST

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 AEST

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 AEST

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 AEST

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

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

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 AEST