SMACC

Technology (tech) makes our lives in many ways, yet that same technology is lacking from healthcare. Many of the things that are used in our daily lives can be applied to providing better healthcare to our patients and bring specialized care to any corner of the planet. This talk will discuss some of the ways such technology is being used and ideas for care in the future.

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

As many other emerging countries, Brazil has two completely different healthcare systems, a private system restricted to those who are insured and a public system free-of-charge available for everyone. As anywhere, there are lots of boring things in our daily routine. Some of them will piss you off regardless if you are working for a very nice private ICU or for an overcrowded public one. Deal with the assistant physicians, with our own colleagues and other healthcare professionals is not exactly easy and fun. Can you imagine something more repetitive than a checklist? However, some will be different. To decide who will get the last free bed? Put a patient in ECMO knowing how much it will cost? Having a fight after finally finding our ward colleagues to get a patient discharged? To discharge a patient knowing that he will come back because we don’t have step-down units? Yes, that is sometimes just too much! And this just all in a day’s work in a public ICU in Brazil.

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

Providing a service to the critically ill depends on a number of essential building blocks: Trained staff, diagnostics, equipment, drugs, guidelines and processes. Compromise one element and maintaining quality of care becomes precarious.
Jenga is a game of physical and mental skill. Using real cases see how removing one block at a time may see even the seasoned clinician struggle to perform well. Welcome to Fiji Critical Care Jenga.

Direct download: Fiji_Critical_Care_Jenga.mp3
Category:general -- posted at: 7:00pm AEST

The paediatric airway terrifies many of us: at the smaccMINI paediatric critical care workshop, Fran Lockie explores some real-life examples of airway challenges and considerations. He takes us through the concept of the "airway bundle" and how teamworking and communication is key to improving paediatric airway care, emphasising the concepts we can borrow from adult practice to offload some of our cognitive burden and outlining the key components of first-class post-intubation care, with pitfalls and pearls of wisdom from his experiences as a prehospital clinician. Phil Hyde follows on with the nuance of assessing paediatric ventilation, starting with simple interventions and exploring the factors that make big differences for children in respiratory distress.

Direct download: Fran_Lockie__Phil_Hyde_.mp3
Category:general -- posted at: 12:00pm AEST

An eight minute summary of the evidence and clinical considerations regarding decompressive craniectomy, discussion of some controversies, and presentation of a decision matrix to use when considering surgery in your patient with malignant middle cerebral artery infarction.

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

In 2010, 400 children died from lead encephalopathy in the largest lead poisoning outbreak ever recorded, affecting more than 5000 children in Zamfara state, Northern Nigeria. The outbreak is ongoing. The source is dust from artisanal gold mining, a major economic boon to a remote and rural population much in need.

The response to the Zamfara outbreak is unprecedented and requires a nuanced interpretation of 'critical care'. Key life-saving activities include multi-level advocacy to address source control, management of inter-current outbreaks of cholera, measles and meningitis, addressing the logistical challenges of large-scale environmental remediation and navigation of an increasingly difficult security context. The situation is so dynamic and dense that knowing which way is up, or which way might cause inadvertent harm, is an ever present challenge.

This is the story of the Zamfara outbreak and response, but more importantly it is the story of the people affected, whose lives have been changed by a forgotten outbreak and whose deaths’ engender no outrage.

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

The medical non-governmental organisation ALIMA (Alliance for International Medical Action) in collaboration with the Guinean Ministry of Health opened and ran the Ebola treatment centre (ETC), in Nzerekore, Guinea during the recent outbreak of Ebola virus disease in West Africa. This paper will describe the issues faced in treatment of the evolving phases of the illness and the aero-medical evacuation of health workers with suspected Ebola virus disease. The difficulties of participating in a trial of experimental therapy during an epidemic of a highly contagious disease, with a terrified local population will be explored. An approach to working with the local community to optimise engagement and minimise stigma, to allow an appropriate public health response will be illustrated. Issues arising from ensuring safe handling and burial of corpses while maintaining respect and dignity for the dead person and their loved ones will be outlined. The stresses and strains of day to day life for the Ebola treatment team will also be shared. Sadly, the ETC has recently been re-opened due to a new cluster of cases.

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

There is a rich literature showing excess stress - psychological, pharmacological or physiological - results in similar physical and cognitive manifestations. Critical illness is the perfect example of this manifestation of decompensated stress ("allostatic overload"). Failed organs frequently look normal histologically yet are functionally inactive, despite many varied insults/stressors triggering the failure. These organs regain their functionality prior to patient recovery suggesting, in most cases, reversibility. If this hypothesis were true, de-stressing manoeuvres should improve outcomes ... and they do, at least in specific human conditions and animal models. Grasping this concept offers a much more holistic approach than we use at present and may lead to improved outcomes.

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

Recently published national guidelines and case series evidence supports a standardised management protocol for pre-hospital traumatic cardiac arrest (TCA) in adults due to penetrating trauma. However, the pathophysiology of pre-hospital TCA in children is different, as the mechanism is typically blunt trauma with concealed haemorrhage, and as such caution must be applied to direct extrapolation of adult guidelines in this situation. This talk will describe some recent paediatric TCA cases, review of the relevant evidence, and suggest a decision framework to support the pre-hospital team.

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

Out-of-hospital cardiac arrest (OHCA) is common and carries a high mortality rate. In Victoria, Australia approximately 50% of patients with an initial cardiac rhythm of VF achieve a return of spontaneous circulation (ROSC) and 30% overall survive to hospital discharge. Currently, OHCA patients who have achieved ROSC but who remain unconscious routinely receive 100% oxygen for several hours in the ambulance, ED, cardiac catheterisation laboratory until admission to ICU. However, there is now evidence from laboratory studies and preliminary observational clinical studies that the administration of 100% oxygen during the first few hours following resuscitation may increase both cardiac and neurological injury. Clinical trials are underway to test whether titrated oxygen to a target oxygen saturation of 90-94% in the immediate hours after ROSC results in improved outcomes compared with 100% oxygen.

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