Two legends of medical education, doctors Johnathan Sherbino and Robert Cooney go head to head debating whether assessment is a barrier to learning. Sherbino argues that assessment is in fact a first essential step in the learning process.
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Making Teams Work - Chris Hicks In Chris Hicks talk Making Teams work, Hicks discusses the systematic failures in training ourselves and our trainees for chaotic situations. He challenges the assumptions that people learn over time by osmosis (by just watching) and debunks the idea that by watching physicians will become skilled at soft non-technical skills. Hicks goes on to discuss what makes a high performing team - touching on; Shared mental model of team and task. Implicit co-ordination/comm...
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Rapid response systems (RRSs) have become a routine part of the way patients are managed in general wards of acute care hospitals. They have been adopted by national health and safety organisations in North America, Canada, the United Kingdom and Australia and are increasingly being used in other parts of the world. Studies have almost universally shown significant reductions in outcome indicators such as mortality (up to one third) and cardiac arrest rates (up to 50%). However the validity of t...
Poisons and novel agents are a moving target in the clinical arena. This talk begins with a historical look at decontamination and pitfalls that have been discovered along the way. The advent of intubation and critical care was a major boon in the improvement in mortality from poisoning. The Scandinavian Method is described and is an important lesion to this day. The rise of antidotes is mentioned. Emerging drugs are highlighted in the context of where we have come from. The phenylethylamine com...
Is There a Doctor on the Plane? Summary by: Joe Lex How Common Are In-Flight Emergencies? • Occur on one in every 600 flights • 44,000 of 2.75B airline passengers / year What Are Most Common Emergencies • Lightheadedness or fainting ~37% • Respiratory problems ~12% • Nausea or vomiting ~10% • Cardiac symptoms ~8% • Seizures ~6% • Other Emergencies • Laceration ~0.3% • Cardiac arrest ~0.3% • Ear pain ~0.4% • Obstetrical or gynecological symptoms ~0.5% • Headache ~1% Who Responds to the Call? • Ph...
Don't Forget A & B! Over 500,000 patients per year suffer sudden cardiac arrest. Despite advances in our understanding and management of cardiac arrest, less than 15% of patients survive to hospital discharge with meaningful neurologic survival. In recent years, the focus of cardiac arrest resuscitation has been the delivery of high-quality chest compressions and early defibrillation for those with a shockable rhythm. As a result, airway interventions and ventilation now follow attempts to o...
Lisa McQueen - Pearl or Fecalith? Summary by: Lisa McQueen I’ve long been a fan of David Newman’s “Pseudoaxioms,” those medical proclamations handed down from generation to generation despite growing evidence that they are false. In this talk, I turn a critical eye toward common pseudoaxioms in pediatrics. Does aspirin really cause Reye syndrome? Should you routinely use atropine in preparation for neonatal intubation? Join me in an exploration of these and other pseudoaxioms. I may even debunk ...
ECMO or extracorporeal membrane oxygenation has shown promise in the use of cardiac arrest patients. Zack Shinar and his crew from San Diego have lead the way in emergency physician initiated ECMO for patients in cardiac arrest. In this lecture he explains briefly how ECMO works, what their outcomes have been and where ECMO is moving. Initially 5 of their first 8 patients were neurologically intact survivors. Their first patient had over an hour of downtime when cardiac bypass was initiated. He ...
Goodbye GCS! Summary by: Mark Wilson Consciousness comprises “wakefulness” (that’s the brain stem, opening your eyes component) and “content” (that’s the supratentorial, thinking, “someone’s home” component). You can have wakefulness without content (e.g. persistent vegetative state) but not content without wakefulness. Describing a “level” of consciousness, converting this multifaceted human brain ability into a linear scale was possibly the biggest neuroscience break through of the 20th Centur...
One of the many things that we, as intensivists or emergency physicians, do better than anyone in the business is obtain the emergent airway. We are usually introduced to our patients on the worst days of their lives and even though we may sometimes wish for it, we do not have the option to reschedule our intubations. Smashed, bloody, distorted, edematous airways secondary to trauma, anaphylaxis, and GI bleeds are the commonality not the exception. We manage those airways routinely with nary a c...
This talk will cover what we should do for patients who are considered too sick to have emergency surgery. These patients provide major management challenges in Critical Care. Do we admit them to intensive care to optimise them prior to emergency surgery or should we get on with surgery and resuscitate them intraoperatively? Should the surgery, if undertaken, be limited to damgae control surgery or operative resuscitation, or should more definitive surgical procedures be undertaken. There often ...
Error is almost inevitable in our clinical practice so we should be prepared to help and prepare those individuals involved for the benefit of them, our systems and our patients. Do you remember that patient you saw last night?': A phrase the strikes terror into the hearts of all physicians. The prospect of a patient coming to harm as a result of a mistake is terrifying but it can and does happen. The consequences for the patient and their family are often tragic but what of the clinicians who m...
In 2013, ~500,000 children in sub-Saharan Africa died as a direct result of Plasmodium falciparum malaria, accounting for 90% of global malaria mortality. The scale-up of control efforts has led to some reductions in malaria incidence in parts of Africa, but countries where transmission is high malaria continues to be a major public health problem. Early optimism that the most promising malaria vaccine candidate (RTS,S) would reduce the burden of malaria proved premature since following (3-dose)...
Resuscitation- what's the point. Cardiopulmonary resuscitation (CPR) is unique as the only medical intervention performed on anyone without explicit contrary documentation. Therefore, CPR need to be understood in terms of societal expectations, legal mandates and professional duties. We also need to understand not just the the likelihood of survival, but also the likelihood of disability and the cost (both literally and figuratively) to patients, healthcare workers, and to an already stretched h...
The management of the septic patient in ICU is a recurrent topic for debate amongst intensivists. The decision of if and/or when to give blood transfusions is one of the key sources of contention. Dr Anders Perner is one of the most qualified people to weigh in on this debate. In this talk from SMACC Chicago, he delivers his stance on when to pull the transfusion trigger. Dr Anders Perner is an Intensive Care Specialist at Rigshospitalet and a professor in intensive care at Copenhagen University...
Simulation is one of the most important advances in healthcare education and skills training of our generation. We now have simulation mannequins that can blink, breath, or even give birth thus allowing us to practice scenarios and skills before we encounter them in real patients. However, these sim dummies are not real people and so it is all too easy to dehumanize the scenario. According to Dr Phil Hyde, Director of Children’s Major Trauma and Southampton Children’s Hospital, it is this lack o...
Are you ready for this rumble in the urban jungle?? Chris Ho vs Joe Bellezzo in the no holds barred debate about whether ECMO CPR is a step too far? The next cage match from SMACC Chicago. Chris and Joe are the director and vice-director respectively, of Emergency Medicine at Sharp Memorial Hospital in San Diego, California. They are two of the leading experts in ECPR, with Joe being one of the key players behind EDECMO. On a day-to-day basis, they are friends and colleagues, working together in...
Working night shifts is a part of medicine that we have come to accept. We work these shift because generations of people before us had done it. But could working night shifts have negative consequences? Night shifts have been shown to be detrimental to patient safety by increasing errors in medication administration and direct patient care. Working night shifts may negatively affect our health by increasing the risks of substance abuse, obesity, social relationships, and certain malignancies. F...
Patients are at risk – from the moment they begin their healthcare journey. They are at risk of bad outcomes (as defined by us) and of bad experience (as can only be defined by them) Patient safety experts like James Reason, and groups like the Institute for Healthcare Improvement (IHI) have prompted us to think about systems and complexity as sources of error – and supported strategies to remove predictable human fallibility as far as possible. This is important to make healthcare safer. Vic Br...
In this talk from SMACC Chicago 2015, Larry Chu takes a step back from the clinical side of things to discuss Innovating Medical Education. Dr Larry Chu is an Associate Professor of Anaesthesiology and the Executive Director of Stanford Medicine X. Medicine X is an initiative from the Stanford AIM lab. It is a project aimed at promoting new ideas for the future of medicine, healthcare and education using emerging technologies. It focuses on empowering patients to participated in their own health...
What is the problem? Delivering bad news and having an end of life conversation are core skills for any practitioner who deals with critically ill patients. Current data show that while 22% of deaths in the USA now occur in ICU, 54% of families surveyed have a poor understanding of patient’s diagnosis, treatment plan and prognosis. Dr. Kate Granger found this out first hand while admitted to hospital in the UK and started the #hellomynameis campaign. What is the evidence? While families feel mor...
Pain in children is often under treated due to practitioners lacking the knowledge or confidence to be aggressive enough. This is partly due to the lack of structure presented in pain managment and it is frequently made to seem more complex than it is. Almost all acute pain in children can be dealt with by a simple stepwise regime using a small number of common, established and easy to use drugs. Likewise, procedural sedation can be safely and simply performed with simple regimes....
Advances in understanding the cardiopulmonary physiology during CPR, perfusion and reperfusion of the brain, and advancing technologies have made possible directed and customised resuscitation of cardiac arrest. We will present where current CPR fails, and what it may look like in the future.
Phil Hyde vs Greg Kelly - We Should Perform Therapeutic Hypothermia (T32– 34C) for Children After Cardiac Arrest The recent publication of THAPCA-OH filled an important gap in our knowledge. THAPCA does not support cooling children after cardiac arrest which was a common practice until recently in many units. It is illustrative to look at how a practice became routine with no supporting evidence at it raises questions about what questions we ask and how we operate in the absence of good evidence...
Working in a remote hospital often means working without the aid of formal medical imaging or Labs. So does this mean that we must compromise on our patient’s care? No. Bedside Ultrasound has changed the way I diagnose, treat and care for patients in this paradigm.This talk will explore the utility and a practical approach to bedside sonography for range of clinical situations: trauma, fracture management, sepsis diagnosis and resuscitation, Paediatric fever and bowel obstruction – all without X...
Preparing your hospital for a disaster Sara Gray Synopsis: This talk will highlight essential components of hospital-based disaster planning. We will discuss tips for planning training exercises, getting funding, and effective debriefing. Preparedness really matters, find out why! Objectives:1. Discuss essential components of a disaster plana.All hazardsb.IMS structures. Should your plan be long or short? 2.Talk about training exercisesa.Low fidelity versus high fidelity exercises.Getting fundin...
Improved patient outcomes as the goal of training. With this philosophy in mind, Bill Hinkley shares his three pillars of training; train yourself, train as a team, train others. Advice from an inspiring educator on how to build a personal learning network, tips on training as a team and how influential passionate educators are to teaching others.
