SMACC

Improved patient outcomes as the goal of training. With this philosophy in mind, Bill Hinkley shares his three pillars of training; train yourself, train as a team, train others.

Advice from an inspiring educator on how to build a personal learning network, tips on training as a team and how influential passionate educators are to teaching others.

Direct download: Bill_Hinckley-_The_Right_Stuff-_Training_in_PHARM.mp3
Category:audio -- posted at: 6:00am AEDT

Sonowars continues to find new ways to make Ultrasound teaching exciting, inspirational and most importantly informative. The team of James Rippey, Matt Dawson, Mike Mallin and Andrian Goudie are back with an all-star supporting cast. Keep an eye out for the light sabre, simulating ultrasound guided venous canulation as well as the mechanical bull ultrasound challenge. Things are bound to get a little crazy when these guys get fired up.

Direct download: SONOWARS2015.mp3
Category:general -- posted at: 6:00am AEDT

The host response to injury is inflammation.

The inflammatory response may have been naturally selected over millions of years of evolution to give the injured tissue the best chance of healing and recovering. On the other hand, over the last 50 years animal models of traumatic brain injury (TBI) suggest that fever, occurring as part of the inflammatory response, may be harmful to neuronal recovery. Some observational clinical studies support this. However we lack high quality clinical trials.At present clinicians commonly use drugs and physical cooling techniques to suppress fever after TBI and stroke.

These approaches have costs and can be resource intensive, as well as be associated with side-effects. We will share with you some of the results from our program in this area. We will discuss ...

What is normothermia?

How effective are the interventions we use?

What temperature do/should we target? What do we achieve?

Surely we need a reliable answer to the question of whether the strict maintenance of normothermia (36-37°C) reduces disability and death after TBI?

References1.Saxena M, Andrews PJ, Cheng A, Deol K, Hammond N. Modest cooling therapies (35ºC to 37.5ºC) for traumatic brain injury. Cochrane Database of Systematic Reviews 2014.2.Saxena M, Young P, Pilcher D, et al. Early temperature and mortality in critically ill patients with acute neurological diseases: trauma and stroke differ from infection. Intensive Care Med 2015:1-10.3.Young P, Saxena MK, Beasley CRW, et al. Early peak temperature and mortality in critically ill patients with or without infection. Intensive Care Med 2011;38:437-44.4.Saxena MK, Taylor CB, Hammond NE, et al. Temperature management in patients with acute neurological lesions: an Australian and New Zealand point prevalence study. Crit Care Reusc 2013;15:110-8.5.Saxena MK, Taylor C, Hammond N, et al. A Multi-Centre Audit of Temperature Patterns After Traumatic Brain Injury. . Crit Care Reusc 2015 (June);17:129-34.

Direct download: Manoj_Saxena_-_Temperature_and_TBI-_Time_for_PARITY.mp3
Category:general -- posted at: 6:30am AEDT

Making Transitions of Care Safe - Pat Croskerry

Summary by: Pat Croskerry

It is now well recognized that transferring the care of a patient from one caregiver to another is a vulnerable point in a patient’s care and a potential threat to patient safety. There may be many intra-disciplinary and inter-disciplinary transition points in the ED during an individual patient’s care. The process requires that each participant communicates well with others to establish an accurate shared mental representation of the important issues.

To minimize transition failures, the process should be trained and standardized, recognized as a multi-professional activity, defined by who should be present, where and when it should occur, and have an end-point that is a clear plan for the ongoing care of the patient. The reliability, consistency, and efficacy of the transition should be a hallmark of departmental culture.


Training should be provided in how the process works and how it fails. The broad distinction between the transfer of poor information (unwarranted opinions, stereotyping, stigmatization, gratuitous comments, overconfidence, and other cognitive biases) and poor transfer of information (unstructured, casual setting, rushed/fatigued, interruptions/distractions, limited input from others, verbal only, degraded narrative skills) should be recognized. It is important to reliably express the amount of certainty attached to what is actually known at transfer so that recipients clearly understand what is expected of them.


The vulnerability of human memory should be recognized and strategies used to deal with it (SBAR, I-PASS and others). There should be awareness of particular biases in communication at transition time. Serial position effects describe how primacy (information presented at the beginning) and recency (the last information to be presented) may influence what is perceived and retained. It is important to be aware of specific biases that operate at transition time: framing, fundamental attribution error, search satisficing and others) and consider strategies to mitigate them.

 

Direct download: Pat_Croskerry_-_Making_Transitions_of_Care_Safe.mp3
Category:general -- posted at: 6:00am AEDT

The master of Dogmalysis himself, Cliff Reid, challenges current practices in prehospital and emergency medicine. Warning listeners to be skeptical, Cliff dissects the dogma of acute crush injuries and spinal immobilization. He also explores the false dichotomy of “scoop and run vs. stay and play”. Cliff reminds us that “not to challenge current practice is intellectually lazy”.

Direct download: Cliff_Reid_SMACCFORCE_.mp3
Category:general -- posted at: 6:00am AEDT

Kevin Fong is an astrophysicist, astronaut and anaesthetist who gives an incredibly entertaining talk about human space exploration and our dreams of a manned mission to MARS. This is a mission that stands on the boundary between science fiction and science fact. A mission that would be a minimum of 1000 days in length and which would be twice as long as any previous manned space mission.

Fong focuses on the the incredibly destructive effects of such prolonged weightlessness on the human body. He outlines the somewhat predictable effects of this on the muscles and bones, but surprises us with the changes in vestibular balance, linear acceleronomy, baroreceptor calibration and probably most frighteningly the psychological effects of prolonged isolation in space. Despite considerable work in the area of human adaptation for space and the ongoing development of counter-measures these physiological challenges remain largely unsolved.

In essence Fong explains, to overcome the detrimental physiological effects of prolonged weightlessness engineers need to design a craft capeable of generating 1G of gravitational force to mimick earth's gravity. This could require a craft the size of the London EYE rotating four times per minute. Perhaps if this can be achieved, astronauts might arrive at MARS after 30 months in space in a physcial state capeable of allowing them to stand upright and walk from the landing craft.

Direct download: Medicine_for_Mars_by_Kevin_Fong.mp3
Category:general -- posted at: 6:00am AEDT

A pair of outrageously high heels next to a pair of tattered combat boots, set the stage for Ashley’s talk on the stress of PHARM.

Ashley draws on lessons learned in combat to support her theory of mental health survival. She emphasizes the importance of critical incident recognition, response and elimination of stigma associated with seeking help.

Direct download: Ashley_Liebig_SMACCFORCE.mp3
Category:general -- posted at: 6:00am AEDT

Bouncing Back from the Beach – Cutting to Air to secure an Emergency Surgical Airway

Summary by: Thomas Dolven

To handle airways means being prepared to handle them all the way. You need to be prepared for a cannot intubate cannot oxygenate CICO scenario. The common, final end point of airway management in a is the emergency surgical airway, the cricothyroidotomy.

So how to prepare?
Often, it is not being taught right. This is a rare procedure under high stress and time sensitive. And most importantly, it is a bloody procedure that will be blind. You cannot use your eyes. So it needs a simple technique without fine motor skills, and it must be tactile. Your finger is the perfect tool for this task, and will guide you through it. The video of my personal real world experience is backed by available empirical evidence and lab training. There will never be an RCT, this is the best evidence we will have. So read NAPP4 and the case series article on the scalpel-finger-tube technique.

Read these available articles, train, and remember these two key points:
1) There will be blood. But that’s OK, because.
2) Your finger can see.