SMACC (general)

Alex -PRO- :

The application of ‘CPR-for-all’ is the ultimate evidence drift. A treatment that is completely appropriate for dropping dead whilst running a marathon has almost no place in acute healthcare facilities where chronic irreversible complex co-morbidities abound. 90% of doctors would not choose CPR for themselves, yet 100% are trained in how to administer it to patients. Defaulting to ‘CPR-for-all’ removes a patients’ ability to provide informed consent for assault whilst they die from another disease. Remember - 2 weeks in ICU can spare you 5 minutes of difficult conversation.

 

Sara -CON- :

Across the globe, patients are assumed to be full code to allow for prompt resuscitation, until code status can be discussed and clarified. There are numerous excellent reasons for this. Can you imagine if our systems decreed that DNR was the default? “Let’s not shock that VF, until we can clarify his code status.” Or, “let’s not resuscitate that child, after all, DNR is the default and her mother isn’t here yet!” Making DNR the default is not a good solution to ICU or hospital over-crowding. Let’s not mandate DNR, let’s mandate having reasonable code discussions early and often.

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

In a 2 min rant about medical tribalism, Dr. van der Velde questions which medical specialty, if any, owns prehospital physician response. What is more important: skillset or specialty? Is there a role for tiers of physician response? Is there a future in a stand-alone specialty?

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

Critical care practice in and out of hospital is a demanding field of medicine. It attracts a certain type of personality - the warrior: Those who want to do more, be more, work harder, evolve, innovate, be there for the big jobs, the complicated challenges. In a life that is becoming 24/7 and technology that can provide interventions and care in the this field of medicine that was only dreamt off a few years ago has become a reality, but also led to incredible high demands on our time, energy and dedication. We are dedicated to our cause, to our patients, to our services, but in the process, we are working longer hours, dealing with more complicated cases, higher demands and having more difficult advance care conversations. We work long shifts, live on caffeine but preach "first do no harm". We neglect quality sleep, good diets and in the process of trying to save others, might be killing ourselves. Fatigue is a killer and it is sneaking up on us like an enemy unseen. Whether you know if or not, you are in a battle for your own life.

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

Fight, Flight and (more commonly) Freeze are common reactions when faced with the critically ill child. In this talk i will discuss recognising these states and developing techniques to prevent and recover from them

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

Flavia Machado and Paul Young present the top 10 ICU trials of the recent past SMACC style. Their list of trials includes a number that challenge dogma and establish interesting new lines of scientific enquiry. In addition, they also include all the recent clinical trials that should change your practice. If you want to know what’s new in critical care then this is the talk for you.

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

Anand Swaminathan - PRO -

PE is a spectrum of disease and patients on different parts of the spectrum should be treated differently. Subsegmental PE may need no treatment at all whereas massive PE is unlikely to improve without lytics. Between these ends of the spectrum lies the submassive PE - hemodynamically stable but with signs of RV strain portending worse long-term functional outcomes for patients and possible early deterioration. These patients should all be considered for systemic thrombolysis to improve outcomes.

 

Iain Beardsell - CON -

Some of the most difficult topics in medicine attract considerable debate, The use of thrombolysis for submassive PE is one of these. In this "Con" argument I attempt to highlight some of the most pertinent evidence against the use of thrombolysis.

Direct download: Anand_Swaminathan___Iain_Beardsell.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_Wubben1.mp3
Category:general -- posted at: 7:00am AEDT

What if they things that healthcare practitioners think are important aren't the same things that patients think are important? Natalie May & Roisin McNamara talk to a patient - a young person who attended the Emergency Department with impending airway obstruction necessitating emergent intubation and intensive care admission - about her experiences of the Emergency Department and ICU, what was good about the care she experienced and what we as clinicians can do or think about differently to provide a better patient experience to those children and young people who need us most.

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

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