Diagnostic medicine is not simple – Casey Parker discusses the finer points of the diagnostic process in critical care. Diagnosis is not black and white. The world is not black and white. It is all shades of grey and about probability. One tool that clinicians have to deal with probability is Bayes’ theorem. Since it was first described in 1763 Bayes’ theorem has been applied, rejected, and rediscovered in many fields. Its use in medical diagnostics is a relatively recent phenomenon. This talk w...
Nov 20, 2016•21 min
Kate Prior conveys the lessons she has learnt working as a doctor as part of the Medical Emergency Response Team (MERT) in Afghanistan. “Unexpected survivors” are those patients who, according to their injury severity score, should die of their injuries but they survive against the odds. The years of conflict in Afghanistan saw increasing numbers of these grievously injured patients surviving to live a fulfilling life. How was this achieved? As Kate explains, it is sometimes necessary to reorder...
Nov 17, 2016•12 min
Peer review is at the heart of science. Yet, as Richard Smith explains in this talk, there are many problems with peer reviewed research. As Richard argues, peer review is not an evidence-based process, but rather a faith-based process. Is it time for something different? Peer review has two main functions: 1) Quality assurance and 2) Improving what is published. However, with that in mind, there is no evidence of effectiveness of peer review, and lots of evidence of its ineffectiveness. This is...
Nov 15, 2016•31 min
The exposure of fabricated numbers in published papers by eagle-eyed readers has been due to sporadic serendipity. I am going to describe a semi-automated method that you can take away with you to do some sleuthing. I am going to describe what I found when I analysed over 4500 papers.
Nov 14, 2016•15 min
Medicine is powered by knowledge, but how do we know what is true and what is not? How do we deal with uncertainty in a setting where outcomes are not closely related to known variables? For example, although there are a few people who have survived jumping or falling from an airplane at high altitude (http://zidbits.com/2010/12/can-you-survive-a-freefall-without-a-parachute/), it is a rare event. Thus, a test to determine how to prevent death from such a disaster would only take a small number ...
Nov 13, 2016•32 min
Jeff Drazen delivers a powerful message on the use of medical evidence in critical care. Medicine is powered by knowledge, but how do we know what is true and what is not? How do we deal with uncertainty in a setting where outcomes are not closely related to known variables? For example, although there are a few people who have survived jumping or falling from an airplane at high altitude, it is a rare event. Thus, a test to determine how to prevent death from such a disaster would only take a s...
Nov 13, 2016•32 min
Michael Perlmutter guides you through the prehospital diagnosis and treatment of sepsis. Sepsis is a difficult diagnosis to make. Even in the hospital, where a plethora of tests are available to assist the clinician. The diagnosis remains a challenging one, due to the very nature of sepsis. A shadowy shape-shifter notorious for its ability to hide in plain sight. For now, even in-hospital, there is no test with perfect sensitivity or specificity for sepsis. This is especially true in the prehosp...
Nov 10, 2016•12 min
Endothelium was once thought to be an inert organ. However, it plays an important role in multiple functions. These include coagulation, inflammation and determination of vascular permeability. He then gives a brief overview of the endothelial arrangement, function of the glycocalyx layer and how an injury causing a loss of the protective layer results in holes in the endothelium. The inflammatory cells enter via these holes and causes oedema in the affected organs leading to multiple pathologie...
Nov 08, 2016•25 min
Bill Knight explains the concept of death by neurological criteria and the complexities surrounding organ donation in such situations. Bill discusses the process of dying, the definition of death, how to approach the neurologically dead patient and how to consider organ donation. Death is a complex topic. Due to advancements in medical technology and processes, the definition of death is a challenging one. Bill talks at length about the definition of death by the neurological criteria. Dying is ...
Nov 06, 2016•32 min
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.
Nov 05, 2016•21 min
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...
Nov 03, 2016•11 min
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.
Oct 28, 2016•38 min
Trish Woods guides you through some clinical pearls in the intensive care management of neonates. The complex physiology of the transitioning required in the journey from foetal life to neonatal presents many challenges and scary moments. Trish helps you to navigate these challenges and to unlock the key to providing quality neonatal intensive care. Many things can go wrong in the neonatal period as babies transition to life in the real world. Trish highlights her thoughts on the use of positive...
Oct 27, 2016•10 min
Deirdre talks ‘bad blood’ – the complex world of critical care haematology. 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, there can be significant morbidity and mortality. Deirdre presents three patients to highlight these issues and what you can do about it. This acronym-busting talk will focus on some acquire...
Oct 25, 2016•23 min
Mervyn Singer discusses the use of biomarkers in critical care. Multiple biomarkers - physiological, biochemical, biological - can prognosticate early in critical illness, even in the ED. These biomarkers are numerous - lipids, progesterone, troponin, thyroid stimulating hormone, inflammatory cytokines, mitochondrial dysfunction… so on and so forth! Prognostication can happen as early as the Emergency Department. Studies from the States have found high levels of inflammatory cytokines can predic...
Oct 24, 2016•21 min
Jim Manning presents the how and why of adrenaline in cardiac arrest. The use of adrenaline in cardiac arrest resuscitation has been popular since the 1960s. Laboratory studies and anecdotal experience showed improved rates of return of spontaneous circulation (ROSC) with the use of adrenaline at small dosages. This led to the widespread adoption of adrenaline administration during cardiac arrest into every resuscitation guideline for decades to come. Extensive laboratory studies characterised t...
Oct 23, 2016•30 min
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 di...
Oct 22, 2016•25 min
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...
Oct 20, 2016•8 min
John Glasheen discusses the importance and challenges of trade-offs in prehospital critical care. Every Pre Hospital and Retrieval Medicine (PHARM) mission involves a series of complex decisions. These are made rapidly in a high-pressure environment. Excellent PHARM clinicians are invariably expert decision makers. 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 e...
Oct 20, 2016•11 min
A demonstration in the ECMO-CPR process and then going back to basics, to understand the need for such a process and how to design and develop it from scratch using simulation to cut lead time and highlight and remove issues prior to rolling out on the patients. Making E-CPR both possible and safer.
Oct 18, 2016•20 min
Sara Gray presents an incredible case highlighting the importance of resuscitative hysterotomy. The story is full of drama, moments that went well and moments that went poorly. It demonstrates the key points when considering this emergency lifesaving procedure. The case is a woman who is eight months pregnant and has an out of hospital cardiac arrest. The call comes in advising of an imminent arrival. This is where the preparation for a perinatal resuscitation and resuscitative hysterotomy begin...
Oct 17, 2016•23 min
David Halliwell presents the science of cardiopulmonary resuscitation. Resuscitation means lots of things to different people – compression, CPR, mouth to mouth, ventilation, return to normal and reanimation all come to mind. But how and why does resuscitation really work – let David explain. This talk uses a case study approach to discuss why resuscitation practitioners should focus upon technical accuracy when resuscitating, focussing on all the facets of a resuscitation, compression, decompre...
Oct 16, 2016•29 min
The child with the reduced conscious level presents a unique challenge to the Emergency provider - how can we recognise normal sleepiness versus pathology? Natalie May reminds us that, even if it's after bedtime, we have to take the time to wake children up fully as part of our routine assessment. She then explores the common pathologies - 5MF! - we need to consider in children with a reduced conscious level and how we can figure out which one is in front of us.
Oct 15, 2016•18 min
Pierre Carli expands on the prehospital and critical care responses to terrorist attacks. For retrieval medicine specialists and prehospital care providers, terrorist attacks are a new and unique threat. As Pierre impresses on you, terrorist attacks are not accidents. They are a targeted human activity whose purpose is to kill, injure, and inflict the maximum amount of human casualty as possible. They do this with the intention of disrupting society, spreading feelings of fear and panic and infl...
Oct 13, 2016•13 min
Ciaran McKenna discusses 3D printing of high fidelity simulation equipment. Simulation training is useful, but it is often a costly exercise. However, according to Ciaran McKenna, it doesn't have to be. Ciaran shares his experience of using 3D printing to create simulation equipment. According to Ciaran, anyone with basic computer skills is capable of making their own 3D solutions for simulation training. For example, he demonstrates how to design and print a basic mackintosh blade using 3D mode...
Oct 11, 2016•26 min
Diana Badcock begins the talk by discussing her decision to take up the role of Chief Medical Informatics Officer (CMIO). Diana was optimistic about taking this job. However, she left the job after a year. Though she failed in the job, Diana thinks she learnt a lot about failing with fortitude. Diana next talks about the death of her father who was very healthy throughout his life. Three months before his death, he went for a check-up as he was not feeling well. However, he was reassured by the ...
Oct 10, 2016•25 min
Resa Lewiss tells you how ultrasound improves resuscitation outcomes in critical care. Ultrasound helps you make more accurate diagnoses. It allows you to perform procedures with fewer complications, and ultrasound enables you to be more time and cost efficient. However, there may be more to ultrasound - Resa enlightens you. The ultrasound allows the clinician to interact with their patients. Further, Ultrasound enables patients to be integrated into their own care and it allows for an element o...
Oct 09, 2016•22 min
'"Think of the danger while things are going smoothly." Chicago's own Lisa McQueen picks apart the challenges of identifying those children who genuinely need sepsis resucitation in the "pre-shock phase" and explores the pathophysiology and treatment of shock in children.
Oct 08, 2016•24 min
Two simulations for prehospital care - tactical and motorcycle pit crew with a panel discussion debrief following. Demonstration and discussion of the medical response to these incidents.
Oct 06, 2016•31 min
Haney Mallemat informs you how technology is improving healthcare. Haney’s talk is grounded in a patient experience. Jim is a gentleman from a small farm in a rural area of United States. His farm is everything to him and his wife and daughter. When Jim got seriously sick, he had to have an extended stay in a major tertiary hospital. As a result, he and his family lost their farm, which was their world. Could Jim have been treated locally with the utilisation of technology? Haney thinks technolo...
Oct 04, 2016•26 min
