SMACC

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

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 AEST

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 AEST

Sarah Yong is an impressive person. Advocacy, Training, Representation and being a new fellow of the College of Intensive Care to boot.

 

Theres a lot to talk about when you sit down with Dr Sarah Yong. Let’s make it easy by focussing on three big issues;

 

Gender issues; Women in Intensive Care Network. www.womenintensive.org

Training issues; The Critical Care Collaborative and the Victorian Primary Examination Course for CICM. www.vpecc.com

Representation issues; New Fellows Rep on the Board of the College of Intensive Care Medicine. www.cicm.org

Where to start?

Women in Intensive Care Network www.womenintensive.org @WomenIntensive

If my sources are correct there pretty much the same number of women and men out there in the world. Further it seems that there are roughly the same number of women and men presenting to intensive care units. This pattern does not repeat itself in terms of the Intensive Care doctors.

Let’s talk about this. Let’s listen to the people that are raising awareness about this. The Women in Intensive Care are talking about it and publishing about it too. You may have heard about the Medical Journal of Australia article; “Female representation at Australasian specialty conferences”.

Direct download: Sarah_Yong_CICM_ASM_2017.mp3
Category:general -- posted at: 8:11pm AEST

Rapid Sequence Airway (RSA) involves the same preparation and pharmacology as RSI with the immediate planned placement of an extraglottic device (EGD) instead of intubation. Like DSI, RSA is an alternative airway management strategy that may be ideal for preoxygenation of hypoxemic patients as well for prehospital and in-flight use. Depending on the chosen EGD, RSA can facilitate gastric decompression, positive pressure ventilation with PEEP delivered by a ventilator and endoscopic intubation. The speaker presents the evolution of this novel concept in New Mexico, reviews their clinical experience with RSA in both the prehospital and hospital settings and assesses the available literature.

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

Becoming competent in airway management requires good decision making and and technical skills. Ultimately what matters is how your clinical performance impacts patient outcomes. For this we need to have a clear understanding of what defines success ensuring that its more than just 'getting the tube'. Come to this talk and you'll experience a Canadian take on Guinness, adventure sports, flying a plane and how other factors including failure influence airway management outcomes.

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

Airway management is a fundamental responsibility and skill of all involved e.g. emergency physicians , anaesthetists and critical care physicians. We need airway algorithms because there is still severe morbidity and mortality related to airway management. (NAP 4 study, ASA Closed claims series)

The 2015 Difficult Airway Society guidelines, published in the British Journal of Anaesthesia in December 2015, provide a sequential series of plans (A to D) to be used when tracheal intubation fails. They are designed to promote patient safety by prioritising oxygenation and minimising trauma and they highlight the role of neuromuscular blockade in making airway management easier.

The guidelines recognise the difficulties in decision making during an emergency and stress importance of human factor training. The guidelines include steps to assist the anaesthetic team by providing a common stem of options (a simple algorithm) for maintaining oxygenation, limiting the number of airway intervention attempts, encouraging declaration of failure by placing a Supraglottic Airway Device and overtly recommending a time for stopping and thinking. They emphasise the importance of considering discontinuing anaesthesia and waking the patient up (if appropriate) when tracheal intubation has failed.

Videolaryngoscopy and second generation Supraglottic Airway Devices are recommended and all anaesthetists, intensivists and emergency medicine physicians, should be trained to use them. There is however limited evidence available relating to the management of the can’t intubate can’t oxygenate situation (CICO) PLAN D. However it is strongly recommended that all anaesthetists must be trained to perform a surgical cricothyroidotomy and a standard operating procedure for Front of Neck Access to the airway is described using a “scalpel bougie tube” technique.


Learning Objectives
• Importance of optimal preoxygenation.
• Best technique at laryngoscopy.
• Maximum of 3 attempts at laryngoscopy / intubation.
• Maximum of 3 attempts at placing a Supraglottic Airway Device.
• When tracheal intubation fails, waking the patient up is almost always the safest option.
• All practitioners involved in airway management need to learn the “scalpel bougie tube” method of cricothyroidotomy.

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

In the past two decades, airway management has been revolutionized by the development of video laryngoscopy, hyperangulated blade geometry, optical stylets, laryngeal masks, and a host of advances in airway pharmacology and technique. The core skill of airway management, however, remains laryngoscopy, whether or not the operator uses a blade with a camera at the end. In this presentation, we break down laryngoscopy into its discrete components and describe best practice technique at each step. We will start by describing common mistakes made in patient positioning; proposing a set of parameters the provider can use to guide positioning that is optimal for laryngoscopy, including the configuration of the patient in the bed, the bed height and head elevation, as well as provider stance. We then move into the effect of laryngoscope grip on operator catecholamine management and describe the optimal laryngoscope grip for emergency airway management. We next confront one of the core principles of RSI, the delay between medication administration and commencement of laryngoscopy, and propose an alternative approach that emphasizes early laryngoscopy with deliberate slowness. We turn our attention to the value of the jaw thrust–as performed by an assistant–during airway management, and then move into a step by step analysis of laryngoscopy as the blade moves into the mouth, down the tongue and ultimately to the glottis. We espouse suction as an underutilized device by emergency providers, and describe the two most important intra-laryngoscopy optimization maneuvers: optimization of the position of the head, and optimization of the position of the larynx. We discuss the value of using the gum elastic bougie for both difficult and routine intubations and describe pitfalls encountered when using the bougie (and how to manage them). We conclude by describing the 3-finger tracheal palpation method of endotracheal tube depth confirmation.

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

Delivering a presentation is a skill like any other yet few folk are actually develop this skill they merely copy those they observe and reach the same level of mediocrity. There is more to a presentation than your slides. The p cubed concept gives an understanding of presentation design that will change your presentations forever.

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