Coda Change

SMACCForce: Neemo

SMACCForce: Neemo by Marc O Griofa

Neuro Critical Care - Blood pressure and Intracranial Haemorrhage

Join Celia Bradford as she discusses blood pressure control in intracranial haemorrhage in neuro critical care. Intracranial haemorrhage risk factors include hypertension. The question becomes, what do you do with hypertension in the management of intracranial haemorrhage? Does blood pressure being high cause the bleed to be more severe or does a severe bleed cause increased blood pressure? It is a classic chicken or egg scenario. Celia takes you through two prominent trials in the area and give...

Medical Error - Learning from mistakes

The information we consume leads us to believe that failure isn’t an option. Stories and movie depictions of characters who avoid the odds at all costs, tell us that failure is unacceptable and should be avoided. We expect elite performance and hyper competence. In medicine, where we are responsible for the lives of our patients, it is easy to understand why we set the bar high for ourselves and somewhat expect ourselves never to fail. The reality is however, that this is all a myth. Any complex...

Cost effective high fidelity simulation training for performance

Laszlo Hetzman discusses cost effective high fidelity simulation training for performance in pre-hospital and hospital critical care. One the great benefits of simulation training is the diversity of training it provides for all levels of experience. Based on his own hugely positive experiences of simulation, Laszlo was compelled to implement effective simulation in his country. The trouble was budget constraints. However, with a little bit of lateral thinking, Laszlo will show you that low budg...

SMACCForce: Suspension Trauma - Discussion - Demo

SMACCForce: Suspension Trauma - Discussion - Demo by Jason van der Velde & Karel Habig

The culture of excellence in resuscitation

A study showed that 15% of healthcare responders hesitated to start CPR because they thought that they would harm the patient. 21% didn’t want to start defibrillation because they thought that they were doing something bad. Hesitation means time. We are harming the patient by not starting sooner. A culture of excellence in resuscitation relies on an excellent system, not excellent individuals. As individuals, we could have all of the training in the world but the reality is that all parts of the...

Simulation, assessment and technology in Medical Education

Simulation, assessment and technology in medical education. This session brings together a panel of educators with a track record of innovation and design in medical education. Chris Nickson, Daniel Cabrera, Jenny Rudolph, Sandra Viggers, Simon Carley, Victoria Brazil, Walter Eppich & Jesse Spurr join to discuss the past, present and most importantly the future of how we will teach and learn critical care. They address some burning questions including, what does it mean to be an educator? Is...

SMACCForce: Top 10 PHARM Papers of the last year

SMACCForce: Top 10 PHARM Papers of the last year by Conor Deasy & MJ Slabbert

Resuscitation for the Resuscitationist

Panelist participation in the "Resuscitation for the Resuscitationist" panel session.

Intracranial Haemorrhage and Anticoagulants in Critical Care

Jordan Bonomo delivers the run down on intracranial haemorrhage and anticoagulants in critical care. Jordan freely admits – this is not a simple topic. For the simple reason that intracranial haemorrhage (ICH) sucks – and that’s a problem. There are no treatments for it. Nothing seems to work. Add an anticoagulant and it is even worse. The mortality for an ICH is around 30-50%. With an anticoagulant onboard it goes up to 40-65%. So how do you manage an ICH in an anti-coagulated patient? The crit...

Resuscitation of Refractory Anaphylaxis

Daniel Cabrera wants you to play the game of anaphylaxis… a serious game! You are faced with a monster, with the name anaphylaxis. Daniel takes you through the resuscitation of refractory anaphylaxis. We do a terrible job managing anaphylaxis, missing 50% of the diagnoses, only giving epinephrine in 50% of the cases who need it. After the acute episode, only 40% of patient go home with an epinephrine auto-injector and only 20% get the appropriate follow up! 1-2% of the population will be affecte...

Physiologic targets for Traumatic Brain Injury in Neuro-Critical Care

Brandon Foreman takes you through physiological targets for traumatic brain injury in neuro-critical care. Intensivist and emergency medicine physicians already use physiology targets. They understand the complexity of these targets and the pitfalls of overreliance on any one parameter. This is also true for the use of physiology after traumatic brain injuries (TBI). TBI has never been defined by its physiology. In fact, specific targets of physiology to drive successful outcomes have all failed...

Processing emergency decisions in critical care

Numbers people, give me the NUMBERS! We need CONCRETE data points and percentages...! Go buy another machine to deliver the numbers and data points. We need it to be delivered by gadgets, gadgets that go ping and pong...more and more gadgets. Let’s plot it on graphs and write it into a protocol to then be memorised verbatim in training and dutifully regurgitated in medical exams. That makes us excellent clinicians right? Worthy of more numbers and a couple of extra letters behind our names. Medi...

Airway Ultrasound: Confirming Endotracheal Tube Placement

Intubation is one of the most important procedures that we perform. There are many immediate and bedside methods of confirming tube placement. Ben Smith and Jacob Avila present how to confirm endotracheal tube placement with airway ultrasound. There has been a bad trauma come into the Emergency Department. The patient has suffered a head injury with an obvious laceration. They are agitated and being physically aggressive to staff. To make matters worse, they are in a neck collar, and have little...

Peter Brindley interrogates: Scott Weingart

A no-holds barred series of 6 provocative medical interrogations. We challenge the state of research, social media, pharmacology, social work, women in medicine, medicine in the developed work, and the health of healthcare workers. It should be novel, it may get heated, and it is not scripted. Sometimes to comfort the afflicted you also need to afflict the comfortable. This is why no prisoners will be taken, no topic is out of bounds, and no ego will be pampered. It may even offend: you have bee...

Hardcore EM: EBM - Papers of the year

Hardcore EM: EBM - Papers of the year by Justin Morgenstern

SMACCForce: Bariatric Panel Discussion

SMACCForce: Bariatric Panel Discussion with Mark Forrest, Jason Van Der Velde, Phil Keating, Cameron O'Leary

Medics in Combat-Post Traumatic Stress

Ashley Liebig passionately discusses medics in combat and post traumatic stress. Ashley got a tattoo recently. It was for a friend with whom she served in the army. Although this infantryman was tough, and cool, after a horrible injury he lost his leg and “gained a life full of trauma and scar tissue… and chronic pain and wounds” This left Ashley with grief, and anger. She slipped into an overwhelming sadness. Simple tasks and emails were piling up and she did not care. She was behind on her wor...

Undiagnosed Paediatric Emergency Cardiac Disease

Most people think it is easy to spot the paediatric emergency – and this usually holds true. However, this is not so in undiagnosed paediatric emergency cardiac disease, as Michele Domico explains. She delves into the practical points on recognising children over one month of age with life threatening cardiac disease. No child comes in and says, “I have chest pain” or in any way alerts the Emergency Department providers to include some type of paediatric heart disease in the differential diagnos...

SMACCForce: "Out for blood"

"Out for blood" by Bill Hinckley

Lung Ultrasound in Critical Care and Resuscitation

Daniel Lichtenstein wants to make his past your future. Join him on a journey through the history of lung ultrasound in critical care and resuscitation. The scene is over 20 years ago in the desert of Mauritania. It is a noisy environment full of trucks and planes and motorbikes whipping up sand in a frenzy. You are attending a chest trauma and suspect a pneumothorax. However, in this chaotic environment, chest auscultation with a stethoscope is futile. Daniel describes a visual approach with a ...

Medical simulation can teach skills to manage challenging emotions

Emotion has a profound effect on decision-making. Chris Hicks demonstrates this as he discusses medical simulation and its ability to teach us skills to manage challenging emotions. As scientists and rational beings, we like to believe that we can control our emotions and make good decisions regardless of the context in which those decisions must be executed – The reality is, that is far from the truth. We rarely take the opportunity to deliberately examine how emotional valence can influence th...

Two New York Docs in the Resus Room

What is New York City style resuscitation? Reuben Strayer and Scott Weingart honed their chops in public hospitals in America’s largest city, where patients come from every country, speak every language, and manifest every physiologic derangement on earth. Preferring to ask neither permission nor forgiveness, Reuben and Scott have long challenged emergency medicine and critical care orthodoxy and developed lateral (though sometimes divergent) strategies in their approach to problems that arise i...

Reinventing Resuscitation Teams: Ashley Liebig

Doctors are usually the ones who rule the resuscitation. They are the ones in charge, the boss, the person giving all the instructions. By design, doctors rule the resus. But what if they didn’t? In order to optimise teams to be seamlessly effective at resuscitation, we need to change the way that resuscitation is done. We need to challenge healthcare to embrace a new model. Ashley Liebig proposes five key concepts for effective resuscitation: 1. Ergonomics should rule the resus. Where are all t...

Haemostatic resuscitation of haemorrhagic shock by Wolfgang Voelckel

Haemostatic resuscitation of haemorrhagic shock by Wolfgang Voelckel Haemostatic resuscitation of haemorrhagic shock is an area great leaps forward can be made, as Wolfgang Voelckel discusses. Exsanguination and brain injury are the leading causes of death after major trauma. During the last decades, significant progress has been made in the fight against haemorrhage. Nevertheless, the window of opportunity is still small and the golden hour of shock more fiction than fact. Hence, the majority o...

Sepsis, Brazil, Women in ICU… Who Cares? - Peter Brindley interrogates: Flavia Machado

A no-holes barred series of 6 provocative medical interrogations. We challenge the state of research, social media, pharmacology, social work, women in medicine, medicine in the developed work, and the health of healthcare workers. It should be novel, it may get heated, and it is not scripted. Sometimes to comfort the afflicted you also need to afflict the comfortable. This is why no prisoners will be taken, no topic is out of bounds, and no ego will be pampered. It may even offend: you have bee...

Ultrasound for Acute Pulmonary Embolus: Leanne Hartnett

Leanne Hartnett is a massive fan of bedside ultrasound. Here, she tells a story of using ultrasound for the diagnosis of acute pulmonary embolus and the decision-making process for management. This is the story of a 65-year-old man who was brought into the Emergency Department with acute shortness of breath and chest tightness. This was on a background of motor neuron disease, due to which he was confined to a wheelchair. Despite this he reported a good quality of life. He enjoyed getting out an...

Post Cardiac Surgery Resuscitation: Nikki Stamp

The arrested heart surgery patient is a unique beast in surgery and critical care. Dr Nikki Stamp gives a whirlwind tour of post cardiac surgery resuscitation. She will discuss how to spot the potential arrest, how to manage it and some special situations to be aware of in this special group of patients Post cardiac surgery resuscitation is complex. Nikki describes them as “brown trouser moments”. She highlights this with three cases. A15-year-old girl who exsanguinated on Day 12 after dissectio...

Neuroimaging Nibble CTP mismatch in Acute Ischemic Stroke - Ronan O'Leary

Management of Status Epilepticus in Neuro Critical care

Management of Status Epilepticus in Neuro Critical care Brandon Foreman talk about the management of status epilepticus in neuro critical care. What are seizures? Why is this important? There are 1 million ED visits due to seizures every year with a quarter getting admitted to the hospital. 1 in 10 people will have a seizure in their lifetime. It is common. Status epilepticus is defined as seizures lasting greater than 5 minutes or recurrent seizures without interval recovery back to baseline. P...