SMACC

Daniel Kornhall's is an introduction to snow avalanche physiology and the realities of mountain rescue.

Dying in an avalanche is an extremely rare cause of death but for us who live in mountain regions and who enjoy winter mountain sports it is a thing that needs to be dealt with. The overall mortality in avalanche incidents is roughly 20% but this increases to 50% in the buried victims, which is why my talk, and most avalanche medicine, focuses on the buried victims. Asphyxia causes the vast majority of deaths, accounting for roughly 80% with trauma in second place at 20%. Hypothermia as the primary cause of death in avalanche victims is extremely uncommon. Asphyxiation causes a dramatic plunge in survival from 80% down to 30% within the first half our of avalanche burial. This is why timely location and extrication of the victim is of vital importance.

Kornhall explains why organised rescue service rarely, if ever, manage to get to the victim within this critical asphyxia phase. Survival rather depends on immediate bystander or companion rescue. Extrication times can be reduced by being properly equipped with avalanche transceivers, quality snow shovels and avalanche probes.

Kornhall briefly discusses the avalanche airbag, a fairly recent innovation that may reduce the likelihood of being buried if you get avalanched. In the last part of my talk i describe modern extrication techniques and how implementing these into rescue training dramatically improves extrication times. 

Direct download: Avalanche_Daniel_Kornhall.mp3
Category:general -- posted at: 6:30am AEST

Two legends of medical education, doctors Johnathan Sherbino and Robert Cooney go head to head debating whether assessment is a barrier to learning. Sherbino argues that assessment is in fact a first essential step in the learning process.

Direct download: Rob_Cooney_vs_Jonathan_Sherbino_-_Assessment_is_a_Barrier_to_Learning.mp3
Category:general -- posted at: 6:30am AEST

TBA

Direct download: Andrew_Naidech-_.mp3
Category:general -- posted at: 1:30pm AEST

Making Teams Work - Chris Hicks

In Chris Hicks talk Making Teams work, Hicks discusses the systematic failures in training ourselves and our trainees for chaotic situations. He challenges the assumptions that people learn over time by osmosis (by just watching) and debunks the idea that by watching physicians will become skilled at soft non-technical skills.
 
Hicks goes on to discuss what makes a high performing team - touching on; 
  • Shared mental model of team and task. 
  • Implicit co-ordination/communication
  • And, how to create this in an ad hoc team.  
 
Hicks then discusses emergency specific team training and the results they are seeing by implementing programs such as; CREW Training - Crisis Resources Emergency Workers, Stress Inoculation Training and Mental Simulation Training. Hicks finished by explaining how best physicians and medical staff can implement these trainings and skills into the real world practice. 
Direct download: Chris_Hicks_-_Making_Teams_Work.mp3
Category:general -- posted at: 5:00am AEST

TBA

Direct download: Day_3_C28_Mark_Crislip.mp3
Category:general -- posted at: 6:30am AEST

Rapid response systems (RRSs) have become a routine part of the way patients are managed in general wards of acute care hospitals. They have been adopted by national health and safety organisations in North America, Canada, the United Kingdom and Australia and are increasingly being used in other parts of the world.

Studies have almost universally shown significant reductions in outcome indicators such as mortality (up to one third) and cardiac arrest rates (up to 50%). However the validity of these outcomes is questionable as most of these studies are single-centre, before-and-after studies conducted by one or two clinical champions in Rapid Response.

This presentation reveals that the implementation of an Intensivist led Rapid Response Team in an Australian quaternary hospital did not demonstrate such dramatic results. In fact, after one year of service the standardised mortality ratio and the in-hospital cardiac arrest rate remained similar.

The presentation explores some of the operational impacts of a RRS including the replacement of critical thinking with reliance on protocols and the progressive super-specialisation of medical teams. Despite these impacts and relatively static patient outcome data, the service has rapidly become an integral part of the hospital.

Barriers between Intensive Care and ward staff have broken down and quality outcome results have consistently shown ward nurses and doctors feel better prepared, educated and supported in managing clinical deterioration. These surprising results raise the question; should we place more value in quality outcomes?

Direct download: Day_2_C13_Sarah_Webb.mp3
Category:general -- posted at: 1:30pm AEST


Poisons and novel agents are a moving target in the clinical arena. This talk begins with a historical look at decontamination and pitfalls that have been discovered along the way. The advent of intubation and critical care was a major boon in the improvement in mortality from poisoning. The Scandinavian Method is described and is an important lesion to this day. The rise of antidotes is mentioned.

 

Emerging drugs are highlighted in the context of where we have come from. The phenylethylamine compound structure and corresponding variants are described. The importance of the principles of supportive care as learned in the Scandinavian method is emphasized. Other emerging topics including synthetic cannabinoids, and anti-NMDA receptor antagonists are discussed. Emerging interventions of prescription naloxone, and ED ECMO are outlined. High vigilance for new agents, and innovative treatments will enable clinicians deal with these evolving trends.

Direct download: Steve_Aks.mp3
Category:general -- posted at: 6:00am AEST

Is There a Doctor on the Plane?

Summary by: Joe Lex

How Common Are In-Flight Emergencies?
• Occur on one in every 600 flights
• 44,000 of 2.75B airline passengers / year

What Are Most Common Emergencies
• Lightheadedness or fainting ~37%
• Respiratory problems ~12%
• Nausea or vomiting ~10%
• Cardiac symptoms ~8%
• Seizures ~6%
• Other Emergencies
• Laceration ~0.3%
• Cardiac arrest ~0.3%
• Ear pain ~0.4%
• Obstetrical or gynecological symptoms ~0.5%
• Headache ~1%

Who Responds to the Call?
• Physician passenger responds in ~48%
• Nurse passenger responds in ~20%
• EMT passenger responds in ~5%

Minimum first aid kits on commercial airliners
16 Adhesive bandage compressors, 1 in
20 Antiseptic Swabs
10 Ammonia Inhalants
8 Bandage compressors, 4 in
5 Triangular bandage compressors, 40 in
1 Arm splint, non inflatable
1 Leg splint, non inflatable
4 Roller bandage, 4 in
2 Adhesive tape, 1 in standard roll
1 Bandage Scissors
2 Protective latex gloves pair
2 Insect sting relief pad
2 Triple antibiotic ointment
2 First Aid/burn cream, 9 gm.
2 Povidone iodine infection control wipes
2 Alcohol cleansing pads
2 Gauze dressing pad 2" x 2" in
2 Motion Sickness Tab
4 Ibuprofen tablets
4 Non Aspirin Tablets
2 Sunscreen lotion towelette
2 Trauma pads 5 x 9 in (12,7 x 22,8 cm)
1 Survival rescue blanket
1 Pelican case 1170 waterproof
1 Emergency first aid guide (American Red Cross)

Required medications on flights
• Antihistamine – tablets and injectable
• Atropine 0.5 mg injectable
• Aspirin tablets 325mg
• Bronchodilator MDI
• Dextrose 50% injectable
• Epinephrine 1:1000 and 1:10,000
• Nitroglycerin tablets
• Lidocaine injectable
• IV needle
• 500ml Saline injectable

All crewmembers are trained for common emergencies. For each flight attendant
¥ Instruction to include performance drills in the proper use of automated external defibrillators
¥ Instruction to include performance drills in cardiopulmonary resuscitation
¥ Recurrent training … at least once eve

Direct download: Day_1_C10_Joe_Lex.mp3
Category:general -- posted at: 9:14am AEST

Don't Forget A & B!

Over 500,000 patients per year suffer sudden cardiac arrest. Despite advances in our understanding and management of cardiac arrest, less than 15% of patients survive to hospital discharge with meaningful neurologic survival. In recent years, the focus of cardiac arrest resuscitation has been the delivery of high-quality chest compressions and early defibrillation for those with a shockable rhythm. As a result, airway interventions and ventilation now follow attempts to optimize circulation in cardiac arrest patients. Though high-quality CPR and early defibrillation are essential in the initial stages of resuscitation, advanced airway placement and appropriate ventilation are critical to overall patient survival.

Dr. Winters' discusses the current literature on the timing of advanced airway placement, oxygenation, and ventilation for the cardiac arrest patient. In addition, he discusses optimal targets for oxygenation and ventilation in the patient with return of spontaneous circulation from sudden cardiac arrest.

Direct download: Day_2_C13_Mike_Winters.mp3
Category:general -- posted at: 5:30am AEST