SMACC

This will be a panel discussion with a focus on the different styles of training and education in prehospital care.

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

Wilderness and expedition medicine is the epitome of practical, pragmatic, minimalist and thoughtful care. Austere and extreme environments require special knowledge, critical thinking, innovative practice and sometimes cunning improvisation. Diagnosis in the wilderness relies heavily on clinical examination skills, monitoring and special investigations are very limited, and treatment options are determined by the breadth and depth of the individual practitioner’s hands-on skills. The implications of extreme environments – high pressures and altitude, frigid and sweltering temperatures, hypoxia and high-intensity endurance exercise – can provide us with great insight into the physiology of humans responding and adapting to critical illness. In this presentation, Ross shares trials and tribulations and draws on experiences from wilderness rescue, and expeditions around the world, which provide lessons for wilderness medics. Many of these lessons can be translated to insights into practicing better acute and critical care medicine in our day-to-day settings.

Direct download: Ross_Hofmeyr_2.mp3
Category:general -- posted at: 7:00am AEST

After five months working in the ICU and ED of the Médecins Sans Frontières run Kunduz Trauma Centre (KTC) in northern Afghanistan, I found myself caught up in an eruption of war as the Taliban forcibly took control of Kunduz from the US backed Afghan Military. This marked the beginning of a challenging week of heavy conflict in which our hospital was the only facility providing impartial medical care to war wounded civilians and soldiers from both sides of the conflict. Despite the proximity of the rapidly changing front line, we believed the hospital was the safest place to be, as both warring parties had agreed to respect the protection provided to us under International Humanitarian law.

My work in KTC came to a grinding halt when a US Gunship fired over 200 missiles into our hospital, destroying the main building and killing 42 people including 14 of my colleagues. It was a scene of nightmarish horror that will forever be etched in my memory.

Since returning from Afghanistan, I have watched in shock as hospital after hospital in both Syria and Yemen has been bombed. Over 250 hospitals in Syria and 130 in Yemen have been attacked since the beginning of their respective conflicts, cataloguing a growing disregard for the rules of war. Despite the condemnation by the UN, the attacks on medical facilities continue, unabated.

Following an eye witness account of the attack on KTC, I will look more globally at the trend in hospital bombings, asking some important questions: Is international humanitarian law no longer respected by warring parties? Are we entering into a new paradigm of war where hospital attacks are a legitimate military tactic? What does this mean for the future of critical care delivery in war zones across the world?

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

The World Health Organization notes that 80-90% of all diagnostic problems could potentially be solved by basic radiograph (x-ray) and ultrasound (US) examinations; however, the problem is that two-thirds of the world’s population currently has no access to imaging technologies (1).

From refugee camps in Greece, to rural clinics in Australia, to Everest Base Camp, point-of-care ultrasound is one of the most powerful diagnostic and procedural tools in any austere clinical setting. This transformative technology allows front line providers who have direct responsibility for patient care to rule in or rule out diagnoses rapidly, and to ensure safety in performing procedures with real-time image guidance. For example, POCUS training just allowed a midwife to identify a massive amount of free intra-abdominal fluid in the 30 year-old Ugandan mother presenting to gynecology clinic with her third pregnancy and new abdominal pain. She notified the surgeon of her concern for a ruptured ectopic pregnancy and the patient was immediately taken to the operating theatre, and she survived. She related that before her ultrasound training, her practice of sending this patient to town for an ultrasound evaluation by the only radiologist in the district would have delayed definitive care, and may have resulted in death.

When I worked in an Ebola treatment unit one of my favorite patients who had been doing well suddenly spiked a fever to 40 degrees Celsius. His abdomen became rigid and I had no idea why. In a setting where no other imaging was possible, POCUS allowed me to see that there was an unexpected issue with his bowels. That knowledge led me to start him on antibiotics, and adjust care plans after I found similar in several other patients.

Ultrasound machines have become increasingly portable, user-friendly, and less expensive over the last decade. This is resulting in a growing presence in otherwise austere environments. POCUS trained clinicians can afford imaging capacity to health facilities that may have very limited on-site diagnostics. There is no ionizing radiation, nothing invasive, and it is cost-efficient (2,3). Human resources are consolidated; the clinician is the diagnostician. POCUS provides the potential to quickly narrow differential diagnoses by facilitating a look inside the body during the patient encounter, and research studies support its use to solve information gaps in resource-limited settings (4-10). Moreover, the potential for this digital technology to be shared – and to leverage global expertise and consultation – increases the range of application beyond one individual’s knowledge base.

References
1. World Health Organization Medical Devices: Managing the Mismatch, 2010. Accessed March 20, 2016. Available at:
http://apps.who.int/iris/bitstream/10665/44407/1/9789241564045_eng.pdf

2. Mercaldi CJ, Lanes SF. Ultrasound guidance decreases complications and improves the cost of care among patients undergoing thoracentesis and paracentesis. Chest 2013;143(2):532–8.

3. Adhikari S, Amini R, Stolz L, Blaivas M. Impact of point-of-care ultrasound on quality of care in clinical practice. Reports in Medical Imaging 2014; 7: 81-93.

4. Sippel S, Muruganandan K et al. Review article: use of ultrasound in the
developing world. International Journal of Emergency Medicine 2011; 4:72

5. Henwood PC, Beversluis D et al. Characterizing the limited use of point-of-care
ultrasound in Colombian emergency medicine residencies. International Journal
of Emergency Medicine 2014; 7:7

6. Deng D, Mingsong L et al. Ultrasonographic applications after mass casualty
incident caused by Wenchuan earthquake. Journal of Trauma 2010; 68: 1417-20

7. Fagenholz P, Gutman JA et al. Chest ultrasonography for the diagnosis and monitoring of high-altitude pulmonary edema. Chest 2007;131(4):1013-8

8. Shah SP, Epino H et al. Impact of the introduction of ultrasound services in a
limited resource setting: rural Rwanda 2008. BMC International Health and
Human Rights 2009; 9:4

9. Kotlyar S, Moore CL: Assessing the utility of ultrasound in Liberia. J Emerg
Trauma Shock 2008; 1(1): 10-14

10. Stein W, Katunda I, Butoto C: A two-level ultrasonographic service in a
maternity care unit of a rural district hospital in Tanzania. Trop Doct
2008; 38(2): 125-6


Direct download: 02_Trish_Henwood.mp3
Category:general -- posted at: 7:00am AEST

The talk focuses on why clinicians miss the diagnosis on aortic dissection. It breaks down the key pearls on history and physical exam that guide you into correctly suspecting a dissection. Aortic dissection is a challenging diagnosis that you can not afford to miss. The talk aims to give you the framework to avoid missing the diagnosis. I want to raise the bar so that the standard of care is not to miss a dissection when it presents atypically. The talk will also highlight strategies on what to do when you suspect the diagnosis. It will guide you to order the right imaging tests and begin the treatment promptly. Sit back and be ready to see dissections in a different light.

Direct download: 01_David_Carr.mp3
Category:general -- posted at: 11:09pm AEST

Gareth Grier discusses who should be intubated following severe trauma pre-hospital.

Direct download: Gareth_Grier.mp3
Category:general -- posted at: 11:02pm AEST

This talk will look at current and previous pre oxygenation practices and some of the current research. It will also discuss the notion of commitment to evolution of practice, the breakdown of cognitive biases and how to move forward with adequate self reflected practice.

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

Modern acute care medicine is eye-wateringly complex and potentially dangerous. It really can't be delivered safely without deliberately addressing our teamwork (in both acute and chronic situations). Unfortunately, historically, human factors were commonly left to chance, and recently have been threatened by decerebrate checklists and meaningless psychobabble. Practical strategies exist (thank goodness!) and will be reviewed. We have much to learn, but must also avoid overly simple answers to exceedingly complex problems. It's time to get back to basics and away from the BS. Come be part of a practical revolution

Direct download: Peter_Brindley_2.mp3
Category:general -- posted at: 7:00am AEST

Richard will cover the rationale and evidence for prehospital blood product transfusion in trauma, look at the available current and future options, suggest best clinical practice and highlight areas of future research.

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

Patients with TBI (traumatic brain injury) often have concomitant systemic injuries that complicate the management of the TBI. How does the practitioner balance the needs of the hypotensive resuscitation with CPP? How does ICP affect emergent operative needs? Thoracic injuries complicate cerebral oxygenation - are there effective management strategies? Where is the best place to care for these patients?

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