SMACC

Greg Kelly focuses on transferable skills from adult practice applicable to the collapsed neonate, taking us first through a systematic approach to the common underlying causes and the physiology behind them. He outlines a comprehensive approach to the clapped out baby even when the underlying cause isn't immediately clear and reassures us that there are plenty of simple interventions we can undertake.

Direct download: Greg_Kelly.mp3
Category:general -- posted at: 12:00pm AEDT

Allow me to introduce to you this extraordinarily talented doctor. John Hinds became involved in our motorcycle racing medical team as a medical student and progressed to inspirational teacher and natural leader. He had a burning passion for improving the care of the injured and on qualification it was evident he was destined for greatness within the world of critical care. In his role as Delta 7 for the Northern Ireland Ambulance Service and as a travelling doctor at motorcycle races in Ireland Doc John brought the highest standards of care and compassion to the most unfortunate at their hour of greatest need. I took this young man as my pupil teaching him the role of motorcycle doctor and quickly realised this exceptional doctor was truly special. In truth the pupil quickly became the master and I had the privilege of 15 years of working alongside him as his wingman.

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

Where does the abdominal assessment occur when you manage a paediatric trauma patient? Warwick Teague challenges us to stop just leaving it to the paediatric surgeon as he talks us through his approach to the abdomen in a paediatric trauma, including the key aspects of assessment and treatment - so simple, he says, even a surgeon can do it.

Direct download: Warwick_Teague.mp3
Category:general -- posted at: 5:30am AEDT

Neonates are a nightmare.. until you appreciate the physiological transitioning required in the journey from fetal to neonatal state in the big outside world. Learn to understand the challenges faced by not-quite-ready-yet premature babies to those with critical physiology gone wrong and unlock the key to providing quality neonatal intensive care. Take the fear out of caring for newborns and in performing emergency care procedures. Don’t fly blind, use your tuned in clinical awareness and tools such as point of care lung and cardiac ultrasound. Apply your revised empathy and understanding of a journey you once made and learn how to think again like a baby!

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

Critically ill patients frequently have activation of inflammatory and clotting pathways. These are likely adaptive responses in the human. When they run riot or the fine balance between pro- and anti-inflammatory states is shifted however there can be significant morbidity and mortality. This acronym-busting talk will focus on some acquired haematological disorders in critically ill patients.
Disseminated Intravascular Coagulation (DIC) is a clinical and laboratory diagnosis that affects about 1% of hospitalised patients. At the most severe end it is associated with bleeding and/or thrombotic complications.
Disorders such as thrombotic thrombocytopenia purpura (TTP) and other forms of micro-angiopathic hemolytic anemia (MAHA) will also be described including the role of ADAMST13.
HIT is an uncommon but important conditions which is difficult to diagnose in a critically ill patient. An approach to HIT is discussed.
Have you always wondered about NETs (neutrophil extracellular traps) and their importance?
If so this whistle-stop tour of non-malignant hematology in the ICU is for you!

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

Multiple biomarkers - physiological, biochemical, biological - can prognosticate early in critical illness, even in the ED. This implies the die is already cast (literally as well as figuratively) so we are simply prolonging death is those predetermined to die. We thus need to adopt a completely different strategy for such patients. This also applies to trial design, especially where survival is the endpoint.

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

The use of adrenaline in cardiac arrest resuscitation has been advocated since the 1960s. Laboratory studies and anecdotal experience showed improved rates of return of spontaneous circulation (ROSC) with the use of adrenaline at a dosage of approximately 0.01 mg/kg. This led to the widespread adoption of adrenaline administration during cardiac arrest into every resuscitation guideline for decades to come. Extensive laboratory studies characterized the beneficial physiological effects of adrenaline during cardiac arrest and closed-chest cardiopulmonary resuscitation (CC-CPR). Adrenaline administered during CC-CPR results in peripheral arterial vasoconstriction that raises the aortic pressure, particularly during the relaxation phase of CC-CPR. This increase in aortic pressure results in an increased aortic to right atrial pressure gradient that drives blood flow to the myocardium during CC-CPR. This pressure gradient is known as the coronary perfusion pressure (CPP) and has been shown to correlate with ROSC in both laboratory investigations and clinical studies. During the 1990s, the use of “high-dose” adrenaline showed increased rates of ROSC compared to “standard-dose” adrenaline. However, it was subsequently recognized that larger doses of adrenaline did not result in improved survival. Furthermore, questions have been raised as to whether or not “standard-dose” adrenaline improves survival from cardiac arrest. Recent meta-analyses have raised serious questions about the value of adrenaline, showing a benefit for achieving ROSC but no clear evidence of improved long-term survival. Controlled clinical trials to address this question are now underway. However, there is another important issue that needs to be addressed: the “route” of administration. With the growing interest in endovascular resuscitation, the use of intra-aortic adrenaline titration offers a means of rapidly and effectively delivering adrenaline to peripheral arterial effector sites while providing arterial pressure and CPP monitoring to guide titration of adrenaline doses to achieve an optimal hemodynamic effects while avoiding excessive adrenaline doses.

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

Congenital heart disease isn't just diagnosed in the antenatal period and during post-natal examination. Nick Pigott takes us through the three main presentations of congenital heart disease (shock, cyanosis and heart failure) and reassures us that treating these patients is simpler than we think, urging us to consider cardiac disease in the sick newborn. He covers duct-dependent lesions, structural obstructive lesions, immediate resuscitation, the usefulness of physical examination, a deeper dive into hyperplastic left heart syndrome, the known cardiac patients (and what to do with them) and the paediatric cardiology wonder-drug: Prostaglandin infusion.

Direct download: Nick_Pigott_.mp3
Category:general -- posted at: 12:00pm AEDT

Working in a Paediatric Emergency Department that has 52,000 attendances per year, means that at this point I have fallen into almost every possible pitfall associated with communicating with children and their parents, whether it be the seriously ill or the efficient disposition of the worried well and everything in between. The art of appearing to take all the time in the world whilst managing large volumes of patients can be challenging at times. It can be difficult to separate your emotional response to a patient and their parents from your professional assessment. I hope that by hightlighting mistakes I have encountered along the way that others will learn from them.

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

Every Pre Hospital and Retrieval Medicine (PHARM) mission involves a series of complex decisions, which must be rapidly made in a fluid and often pressured environment. Excellent PHARM clinicians are invariably expert decision makers, and the ability to identify, accept and manage trade offs is a key skill in prehospital and retrieval medicine.

Some of these trade offs are obvious, and the best options are clear – for example aircraft and crew safety cannot be compromised regardless of the clinical situation on scene. Other choices are far more complex, and require rapid and accurate cognitive appraisal of a dynamic and often incomplete information set.

Interventions performed on scene, and the order in which they are performed involves a balance of the patient’s immediate requirements against how much it will cost in time and risk. During a mission, each decision to do something leads to another layer of decisions on how and where it should be done. This often results in a trade off between principle and preference. Decisions on which team member should perform a particular procedure must balance competence, training opportunity and the concurrent performance of other tasks.

Every mission is a continuous efficiency-thoroughness trade off, and each individual decision must be made to positively affect overall patient care. There is often no single ideal solution to these trade offs, and each decision must be tailored to the circumstances at a given point in time.

The way in which the clinician manages these trade-offs is vital both for effective patient care the overall performance of the mission. Excellence in PHARM is a function of training and experience, with expert clinicians operating within a robust system that allows for flexibility - protocols are powerful but individual insight is indispensible.

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