SMACC

A voyage through the darkest places, sharing doubts and fears.

Direct download: 02_Ross_Fisher.mp3
Category:general -- posted at: 7:00am AEDT

Agitation poses a direct threat to the safety of both patient and staff, as well as being an important manifestation of dangerous conditions that require rapid identification and treatment. Management of agitation consists primarily of physical and chemical restraint, and the details of how restraint is carried out–usually based more on tradition than considered plans or thoughtful protocols–directly determine case outcome. In this talk, we’ll discuss the initial approach to agitation, focusing on the appropriate role of physical restraint, as well as best practice technique for physical restraint. We will then deliberate the options for chemical sedation and propose a menu of the safest and most effective agents for a variety of common agitation scenarios. Some of the questions we will address include: What are the most important dangerous conditions that cause–or are caused by–agitation? What are dangerous restraint holds, and how can physical restraint be accomplished in the safest manner? In the initial management of an agitated patient, should chemical restraint be administered by the intravenous or intramuscular route? How do haloperidol and droperidol compare speed in efficacy when used for calming the agitated patient? How should providers manage concerns around prolonging the QT interval when using butyrophenones for sedation? Which benzodiazepine is preferred, as a treatment for agitation? How should neuroleptics and benzodiazepines be used as monotherapy or in combination? In which type of patient should ketamine be used as a sedation agent? How should ketamine be dosed for tranquilization, and what adverse effects should providers be mindful of when using ketamine for this indication? Can ketamine be used in patients with hyperdynamic vital signs? What is the role of crystalloids in managing the agitated patient? Once the agitated patient has been calmed, what are the primary, secondary and tertiary resuscitative maneuvers (diagnostics and therapeutic)?

Direct download: 03_Reuben_Strayer.mp3
Category:general -- posted at: 9:00pm AEDT

In this talk I will summarize the pearls, pitfalls, and lessons shared by leaders in my own life, both inside and outside of medicine. In my experience, leadership is not a particularly male or female quality. It is a trait of an individual. Individuals tend to dichotomize into leaders and into followers. And people know good leaders “You know the way you know about a good melon” When Harry Met Sally

I will share with the audience my lessons and personal examples on leadership. Some of these include 1. There is never a need to publicly embarrass someone. Always give the person an out and speak in private. 2. Make a decision. Being indecisive is perceived worse than making a wrong choice. 3. Know your strengths and build on those. Know your weaknesses and identify people for whom those are strengths and bring them onto your team 4. “People may forget what you say, they may forget what you do, but they will never forget the way you make them feel.” Maya Angelou 5. Leaders must be comfortable with solitude 6. Leaders are not afraid to ask for what they need.

Direct download: 01_Resa_Lewiss.mp3
Category:general -- posted at: 7:00am AEDT

Medical journals have many possible functions, but the main one for most is publishing science. They are actually better at campaigning and agenda setting, rather like the mass media. Journals are now beset with problems, including failing to include data, publishing lots of poor quality material, being slow to publish, publishing research that is either not reproducible or fraudulent, encouraging waste in the system, failing to be transparent, and exploiting academics. New ways of publishing science are appearing, and a better system would be for the grant proposal, protocol, and full data to be published on a database with the whole process transparent.

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

Sepsis is incredibly dangerous for our patients and very topical in ICU and Emergency. In intensive care and emergency medicine we rightly dissect and discuss extensively how best to resuscitate patients, Airway, Breathing, Circulation – the ABC! Our training focuses on the urgency and adequacy of resuscitation and the provision of excellent supportive care. However, for the critically ill, especially in sepsis, we have very few therapies available that actually change the natural history of illness and can cure our patients. Surely that is what being a doctor is all about – helping people and changing the course of their illness – giving the patient a chance to survive!

Over 75% of patients in ICU will receive antibiotics and the choice, timing and dose will directly influence your patients chance of surviving. Antibiotics are one of the few truly disease modifying therapies we have available and by far the one we utilize the most.

In addition, no other therapy is important to not only get right for the patient you are treating but, in the case of antibiotics, the therapy for one patient may influence other patients. Attention to correct antibiotic use might save the patient in front of you. However thoughtless antibiotic use might make it harder to save the next patient by increasing antibiotic resistance in your unit.

How and why must we get antibiotics right?

Direct download: 04_Steve_McGloughlin.mp3
Category:general -- posted at: 7:00am AEDT

Inhaled nitric oxide, iNO, is usefull for retrieval and transport of the critical respiratory failure patient. Also, there is a well documented role in the retrieval of the newborn with pulm HT, PPHN or resp failure. Its used in retrieval as well as ICU settings.

Direct download: 03_Per_Bredmose.mp3
Category:general -- posted at: 7:00am AEDT

In Critical Care we deal with death on a regular basis and although it seems an ‘on or off’ issue where you are either dead or you are not, nothing is more true. Not only physicians but scientists, philosophers, writers and theologians have been debating about the subject for as long as we have become aware of the concept of death.
To try to create order from chaos I divide the deceased in 5 categories:
The soon to be dead,
The reversibly dead,
The irreversibly dead
The walking dead (although this group I will leave to Hollywood to educate us about)
and the most curious group
The reversibly, irreversibly dead.
They are the patients of whom we think they are irreversibly dead, we stop our resuscitation efforts, and then they have return of spontaneous circulation. This is known as the Lazarus phenomenon and although many case reports have been published about this phenomenon over the years, presumably it’s only the tip of the iceberg.
In providing Critical Care we sometimes need to make immediate decisions on who’s dead and who’s not. Yet decisions about whether further treatment of patients is futile or not can only be made when one is aware of the limits of extremes in physiology that are survivable. Although not every patient should be treated up to these physiological limits, knowing these extremes can help in making an informed decision of whether to continue treatment.

Direct download: 02_Patricia_Gerritsen.mp3
Category:general -- posted at: 7:00am AEDT

In Critical Care we deal with death on a regular basis and although it seems an ‘on or off’ issue where you are either dead or you are not, nothing is more true. Not only physicians but scientists, philosophers, writers and theologians have been debating about the subject for as long as we have become aware of the concept of death.
To try to create order from chaos I divide the deceased in 5 categories:
The soon to be dead,
The reversibly dead,
The irreversibly dead
The walking dead (although this group I will leave to Hollywood to educate us about)
and the most curious group
The reversibly, irreversibly dead.
They are the patients of whom we think they are irreversibly dead, we stop our resuscitation efforts, and then they have return of spontaneous circulation. This is known as the Lazarus phenomenon and although many case reports have been published about this phenomenon over the years, presumably it’s only the tip of the iceberg.
In providing Critical Care we sometimes need to make immediate decisions on who’s dead and who’s not. Yet decisions about whether further treatment of patients is futile or not can only be made when one is aware of the limits of extremes in physiology that are survivable. Although not every patient should be treated up to these physiological limits, knowing these extremes can help in making an informed decision of whether to continue treatment.

Direct download: 02_Patricia_Gerritsen.mp3
Category:general -- posted at: 7:00am AEDT

Since it was first described in 1763 Bayes' theorem has been applied, rejected and rediscovered in many fields. It's use in medical diagnostics is a relatively recent phenomenon. This talk will review the history of Bayes in medicine. We will then explore how Emergency doctors can practically apply these ideas in daily practice. How can we estimate pretest probability? How does Gestalt work? How can we use likelihood ratios to understand our diagnostic testing and the results? We will explore the threshold model of diagnostic reasoning and its application to patient-centred, shared decision making. Bayesian reasoning will be illustrated with common diagnostic dilemmas: subarachnoid haemorrhage, chest pain, cervical trauma, appendicitis, pulmonary emboli and tonsillitis.

Direct download: 01_Casey_Parker.mp3
Category:general -- posted at: 7:00am AEDT

"Unexpected survivors" are those patients who, according to their injury severity score, should die of their injuries but they survive against the odds.. The years of conflict in Afghanistan saw increasing numbers of these grievously injured patients surviving to live a fulfilling life. How was this achieved? This talk will cover rewriting the ABCDE of ATLS, the delivery of self and buddy first aid, the use of novel haemostatics and tourniquets, rapid delivery of specialist pre-hospital emergency care by physician-led teams, AKA the Medical Emergency Response Team or MERT, with high quality pre-hospital interventions such as io access, blood transfusion, RSI, analgesia and how these lessons learned from the battlefield can be translated in to civilian practice. However, sometimes the very best we can do isn’t enough, because of the catastrophic nature of the patient’s injuries and a vital lesson learned is to how to cope when your best just isn't good enough.

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