For the 30 years, clinical understanding of haemodynamic resuscitation has been based on physiological paradigms that focus on convective oxygen delivery. Most of these emphasise the role of cardiac output, haemoglobin and recommend interventions using synthetic agents such as dobutamine, synthetic colloids and blood transfusions. Markedly influenced by industry, these interventions and strategies hijacked critical thinking creating a belief in the utiliity of attaining short-term physiological surrogates for resuscitation that have little relevance in improving patient-centred outcomes. This 'physiological fallacy' has been demonstrated in high-quality RCTs of fluids, goal-directed therapy and catecholamines, that paradoxically inform the interpretation of new insights in the physiological basis of health and disease.

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

Scott Weingart's opening talk at SMACCdub was on meditation: vipassana and stoic negative contemplation. Visit Scott's personal Blog EMCrit

Direct download: 02_Scott_Weingart_.mp3
Category:general -- posted at: 11:00am AEST

2016 is the 30th anniversary of ischaemic preconditioning. Remote ischaemic preconditioning is the magical offspring of ischaemic preconditioning and refers to the phenomenon whereby brief periods of ischaemia in one organ can protect other organs from subsequent prolonged ischaemic insults. In theory, remote ischaemic preconditioning can be induced by temporarily interrupting the blood supply to an extremity using a blood pressure cuff.

In experimental models this technique is effective in reducing ischaemia / reperfusion injury when applied after ischaemia but before reperfusion. As a result the technique has a wide range of potential clinical implications including:
1. Heart surgery with cardiopulmonary bypass
2. Planned percutaneous coronary interventions
3. Acute myocardial infarction
4. CBA being treated with lysis or clot retrieval
5. Carotid endarterectomy surgery
6. Hypoxic ischaemic encephalopathy
7. Organ transplantation
8. abdominal aortic aneurysm surgery

While this technique is not yet ready for clinical application, it remains an exciting potential therapeutic modality for the future.

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

Combining academic activity with pre- and in-hospital clinical practice is hard work. So why should you do it? Are you a strong believer that care should be evidence-based and that this principle also pertains to pre-hospital practice? Do you believe that the nature of the pre-hospital environment does not allow automatic extrapolation of in-hospital evidence to the field? Do you believe in the relevance of critically appraisal of practice to identify areas of improvement, areas of harm, and to optimise a resource-effective practice? If so, lets discuss how to do pre-hospital research

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

All diseases exist on a spectrum. Although the pathophysiology and relative illness of patients on the spectrum are different, we often apply the concepts of management of one of the spectrum to the other end. This can be extremely deleterious to our patients. For example, we cannot treat CHF exacerbations, acute pulmonary edema and cardiogenic shock with the same approach (i.e. no role for loop diuretics early in APE). Thin-slicing disease into a spectrum allows us to tailor our management to our patients and maximize good outcomes.

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

This talk will outline the current state of play in terms of the 'silver tsunami' of elderly patients attending our EDs. What the evidence is for managing them effectively within the ED, and how we could manage them better. It will focus on the effective and efficient delivery of services for the elderly within the ED, the need for training and specialist skills and research to deliver improved care.

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

The key to dystopian literature is the backstory. These brutal, terrifying worlds are grim forecasts of the future, spawned from the choices and actions of the present. In critical care medicine we make rafts of decisions everyday - not all of them ideal. This talk looks at a projection into the future, both fictional and real, based on those small decisions, actions, and processes.

Direct download: 1984_Dystopian_Literature_and_Emergency_Medicine.mp3
Category:general -- posted at: 7:00am AEST

The farm is a dangerous workplace. Accidents have an unusually high morbidity and mortality not only for the worker but also his/her family members. The reasons are multi-factorial but are the result of a complex interaction of environment, equipment, and human factors. Tractors are involved in the vast majority of agricultural deaths. No other industry uses 70-year-old machinery operated by workers whose age ranges from 10 to 90. How can we prevent such incidents?

Today’s presentation is from my viewpoint as a prehospital physician (who is a wannabe farmer & tractor mechanic) and longtime resident of an agricultural community. We will examine the details of a life threatening accident involving one of my neighbors which perfectly illustrates the multifaceted nature of agricultural trauma

Direct download: 04_Mike_Abernethy.mp3
Category:general -- posted at: 3:00pm AEST

In the busy world of emergency medicine it's easy to focus on the here and now, there is always something that demands immediate attention. What of the future? How will demographics, workforce, technology, finance and politics affect the practice of emergency medicine? This talk explores these issues and charts a future that will be very different to today.

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

John Hinds' tragic death has affected many people all over the world. In the inaugural John Hinds Plenary session at SMACCDUB, John's partner Janet and his mentor Fred MacSorley celebrate John's life in a fitting tribute to the man that has become a legend.

Category:general -- posted at: 1:30pm AEST