SMACC

Neuro Imaging Nibble: Subtle Sinus Venous Thrombosis by Brandon Foreman

Direct download: NeuroImaging_Nibble_2.mp3
Category:general -- posted at: 7:00am AEST

Diagnosing a wake-up stroke by Fernanda Bellolio

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

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 AEST

Autoimmune versus infective encephalitis by Ronan O'Leary

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

Controversies in critical neuromuscular disease by Brandon Foreman

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

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 AEST

Controversies in diagnosing meningitis by Rhonda Cadena

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

Neuro Imaging Nibble: Subtle Subarachnoid haemorrhage on CT by Jordan Bonomo

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

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 AEST

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 AEST