Anand Swaminathan and Iain Beardsell debate the use of thrombolytics in the treatment of submassive pulmonary embolism (PE). PE is a spectrum of disease. Patients should be treated differently depending on where they are on the spectrum. Subsegmental PE may need no treatment at all, whereas massive PE is unlikely to improve without thrombolytics. Anand argues for the use of thrombolytics. Evidently, time is critical when dealing with patients and Anand posits that thrombolytics gives the physici...
Jan 22, 2017•23 min
Ryan Wubben discusses the standards in Helicopter HEMS. He asks the question, what standards? The development of Helicopter EMS (HEMS, or as the Federal Aviation Administration recently coined it: “Helicopter Air Ambulance” or “HAA”) services in the United States has taken a different path in recent years compared to other countries. The widespread use of single engine, VFR only aircraft, owned and operated by for profit companies is a uniquely American phenomena. This is at odds with most other...
Jan 20, 2017•12 min
Natalie May & Roisin McNamara discuss a young person’s experience of critical illness. They are joined by Ema, an 11-year-old girl who had a scary time when she was diagnosed with tracheitis. Experiencing critical illness is scary for anyone. However, when you are a young person, this terrifying experience is amplified. Natalie and Roisin tell us what we as clinicians can do or think about differently to provide a better patient experience. Although she is young, Ema provides some salient po...
Jan 19, 2017•17 min
Maxime Valois and John Christian Fox argue the role of POCUS in critical care. Maxime makes the case for POCUS being a problem. POCUS changes everything. It has helped physicians throughout the world to make easier, more accurate and faster diagnoses. It has contributed to enhance the diagnostic possibilities in resource-scarce environments However, as it gains more widespread acceptance, its use is becoming more and more common. Maxime contests that this poses a problem. No longer is ultrasound...
Jan 18, 2017•26 min
Scott presents the argument that whilst Emergency Physicians are amazing, as it stands, Emergency Medicine is failing. Scott presents the system as it should be. This involves stabilising the critically ill before admission to the ICU, seeing sick patients in appropriate time and seeing the less sick patients as you can. The issue as it stands, is when this system breaks down. He talks about the ‘boxes’ which now includes the ‘not sick at all’ patient. This leads to Emergency Physician’s not doi...
Jan 16, 2017•25 min
Ashley Shreves: There are nearly 100 billion stars in the Milky Way – and almost that many articles published every year. Luckily for you, we read them all – or, at least, the ones in the domain of EM (Emergency Medicine). Catch up with where the new literature is leading you, leading you astray, or just plain bonkers. Sit back and let us inspire you to take your own deep dive into all the great foundational science. We'll swing through new stroke treatments, the ketamine blow-dart, the best med...
Jan 15, 2017•26 min
Ben Shippey discusses the important anaesthetic considerations in bariatric surgery. Obesity surgery can induce a strong response in healthcare professionals. These biases must be overcome to facilitate efficient and safe services. Evidently, Bariatric surgery provides many challenges. To begin with, healthcare professionals can associate negative thoughts with obesity. Secondly, these patients present complex respiratory and cardiovascular physiology that must be considered. Ben highlights thre...
Jan 09, 2017•28 min
John Carlisle asks the big question – what is the risk of surgery? It is a big question that holds implications for everyone involved in caring for patients. Like John, patients want to live a long and happy life. They would like to know whether the chances of living a long and happy life are enhanced by having surgery or not. They do not generally care whether they will be alive in 30 days or not. John explored whether or not we can accurately answer the question – what are the risks of a given...
Jan 08, 2017•24 min
Karim Brohi gives an insight into his mindset as a trauma surgeon, drawing on lessons from Zen philosophy. During this talk he discusses how we can develop the self confidence that helps us cope with stressful clinical situations. The word confidence is often talked about in a negative context, in terms of overconfidence or arrogance. Karim however uses this talk to highlight the importance of self-confidence. Self-confidence is important for you, your team, your department, and your healthcare ...
Jan 06, 2017•25 min
Haney Mallemat discusses the treatment for PEA cardiac arrest. Patients who present with pulseless electrical activity (PEA) arrest have a high mortality. The treatment of PEA requires finding and reversing the underlying cause; therefore a simple and rapid approach is required. Traditionally we were taught to use the H’s and the T’s, but this diagnostic tool is cumbersome and of questionable utility overall. Haney discusses the problems with the traditional H’s and T’s as well as focusing on ne...
Jan 04, 2017•23 min
John Greenwood takes a broad view on pulmonary hypertension and explores the heart-lung interactions that occur in this disease process. Pulmonary hypertension commonly occurs when managing a patient with an acute critical illness. Pulmonary hypertension has a devastating impact on cardiac function. Whilst we recognise the disease itself, we don't recognise the ‘upstream’ effects. John explains how it is these effects that may be causing the patient to crash. John, in this talk, helps you to und...
Jan 03, 2017•29 min
Michele Domico presents a talk on the pitfalls of common paediatric resuscitative manoeuvres in paediatric cardiac patients. Emergency and critical care physicians are all well accustomed to items such as oxygen, bolus adrenaline, intubation and cardioversion. However, as Michele explains, these ‘go to’ interventions may in fact be harmful for the paediatric cardiac patient presenting to the emergency department in extremis. Due to the physiology of certain complex congenital heart diseases, the...
Dec 27, 2016•26 min
Deirdre Murphy presents everything that can go wrong in cardiac surgery. Deirdre will impress on you that cardiac surgery is by no means a safe procedure! Murphy’s Law stipulates everything that can go wrong, will go wrong. Subsequently, Finagle’s corollary will tell us, it will be at the worst possible moment. In this talk Deirdre attempts to prove these theories in the world of cardiac surgery. Cardiac surgery can vary from being routine elective surgery to time-critical emergency surgery. The...
Dec 26, 2016•26 min
The practice of emergency medicine is no longer a one size fits all approach. Furthermore, most of your patients are not usually 'average' as described in journal articles. With more data, newer analytic techniques, and a better understanding of pathologies, we can isolate the exact and most appropriate therapies for our individual patients. We're already doing it, but we should be doing it better. Learn how to be systems thinkers and become better providers. Using examples from emergency medici...
Dec 25, 2016•23 min
When was your last paediatric/neonatal life support course update? Did it include the latest recommendations from the European Resuscitation Council (2015)? NO?! Well, let's have a look at the very latest consensus recommendations for the resuscitation of children in cardiorespiratory arrest and for neonates at birth - and explore any controversies therein.
Dec 22, 2016•12 min
Peter Brindley explains how burnout affects us all. It affects the cost, quality of care, organisational culture, performance and patient outcomes. Burnout is fatigue, loss of ideals, purposelessness, presentism and the sense of being under-appreciated. It is not tiredness, exhaustion, boredom, mid-life crisis, depression, PTSD, perfectionism or narcissism. Moreover, burnout involves the 4 C's: cutting corners, cynicism, callousness, and contempt. Peter explains when and why, and to whom a burno...
Dec 20, 2016•27 min
Francesca Rubulotta talks about disproportionate care in ICU. Disproportionate care is disproportionate in relation to the expected prognosis. Moreover, this can lead to moral distress among clinicians who think they are offering inappropriate care. There is mounting research and evidence pointing to the existence of disproportionate care. Furthermore, stress and burnout cause increased miscommunication and lead to low performance and concentration. Stress leads to absenteeism or in many cases, ...
Dec 19, 2016•25 min
Karin Amrein highlights the importance of bone health in ICU. Karin asks – do fractures matter? If the presentation is a hip fracture for elderly patients, then the answer is obviously, yes! However, Karin will describe why this answer should be a resounding yes for all patients who are admitted to the ICU. Critical illness affects bone. It is not a stretch to conceptualise this. However, Karin wants to impress on you that bone affects critical illness also! Bone is an endocrine organ, the large...
Dec 18, 2016•27 min
Natalie May gives you the break down of paediatric trauma. Paediatric trauma is relatively rare but terrifying. However, there are many ways we can think about paediatric trauma to make these challenging situations easier to face. Children are inherently portable. This means that they often turn up at peripheral, non-paediatric centres that are not major trauma centres. This highlights the importance of all physicians knowing how to deal with these cases. Anatomy and physiology of children is di...
Dec 15, 2016•13 min
Confined Space Airway Management in Emergency and Critical Care by Ross Hofmeyr Ross Hofmeyr discusses the ins and outs of managing an airway in a confined space. He details the challenges, the potential solutions and his top tips when faced with an airway in a less than ideal setting. Ross defines confined space airway management as airway management in an environment where access to the patient, normal positioning, and use of airway equipment is limited by physical constraints. Ultimately, the...
Dec 12, 2016•25 min
The Role of the Immediate Responder in Mass Casualty Trauma Christina Hernon describes a traumatic experience in gripping detail. In doing so, she shares her deeply personal insights into what it is to be an Immediate Responder. Christina suggests that the medical system must change to support these people. After a major formative experience at a life-threatening mass casualty incident, Christina felt incredibly unprepared despite over two decades of training in emergency and first response. Chr...
Dec 11, 2016•31 min
Natalie May brings the lessons she has learnt from Sydney HEMS training and teaches you how to apply them to your practice. What can hospital specialties learn from teaching and training in prehospital and retrieval medicine? Natalie, a self-described medical education enthusiast, gives you her thoughts on the application of educational theory to the challenges of the prehospital environment. Evidently, Natalie will discuss three domains of medical education – Induction, Competence and Culture. ...
Dec 08, 2016•12 min
Sara Gray tackles the controversial topic of disaster ethics in critical care. Most hospitals develop a disaster plan, but few jurisdictions develop a plan for triaging or rationing scarce resources when the existing supply is overwhelmed. Rather than leaving individual health care workers to make these decisions, we should work together as a community of experts to develop ethical, practical and appropriate policies for triaging scarce resources during a disaster. Healthcare resources are finit...
Dec 06, 2016•22 min
Liz Crowe believes that love can revolutionise the way we approach critical care. She wants every doctor to become love ambassadors for their critical care community and share love like nothing is holding them back. Liz believes that work life balance does not exist because we spend most of our time at work. Therefore, it is essential to love and be passionate about the work we do. Liz compares the feeling of being a novice in critical care to first being in love. Initially, there is fear and ex...
Dec 05, 2016•28 min
For Ross Fisher there are things that scare him. And he knows there are things that scare you too. Ross discusses the purpose and effect of fear in medicine and surgery. Whoever you are and whatever you do, there are things that you are afraid of. It is not stress, it's fear, it's real and it affects us. Ross wants you to know, it is okay to be afraid. Being afraid is recognising a threat and realising that there is a limitation to your ability, and that you have reached that point. Ross describ...
Dec 04, 2016•21 min
Resa Lewiss gives her insights into leadership. Through her experience training and working in Emergency Medicine and Critical Care, Resa has collated a series of pearls, pitfalls, and lessons shared by leaders. For Resa, there are leaders, and there are follows – more often than not, people know good leaders. Resa firmly believes that leaders look like leaders. She affirms that it is neither a male nor a female trait – despite what some may assume. Resa shares her lessons on leadership. 1) Ther...
Nov 29, 2016•27 min
Medical journals have many possible functions, but the main one for most is publishing science. They are actually better at campaigning and agenda setting, rather like the mass media. Journals are now beset with problems, including failing to include data, publishing lots of poor quality material, being slow to publish, publishing research that is either not reproducible or fraudulent, encouraging waste in the system, failing to be transparent, and exploiting academics. New ways of publishing sc...
Nov 28, 2016•1 hr 23 min
Antibiotic Use for Sepsis in Critical Care: Steve McGloughlin Steve McGloughlin presents his thoughts on antibiotics and their use in sepsis and critical care. Steve discusses the ABC of sepsis… the trouble is after A for Antibiotics there is not a whole lot else! In sepsis and severe infection, the goal is to change the trajectory of the patient, away from death and to a more favourable outcome. The tools that are currently on offer in critical care are pretty simple. There are things to suppor...
Nov 27, 2016•25 min
Per Bredmose discusses the use of inhaled nitric oxide (iNO) in retrieval medicine and critical care. He explains why iNO is useful for retrieval and transport of the critical respiratory failure patient. iNO is not a magic bullet, but rather a bridge that will help you get to where you need to go when treating a patient. Furthermore, it can be useful in both pre-hospital and in hospital care. What is nitric oxide? It is an endothelial derived potent short acting vasodilator mainly found in the ...
Nov 22, 2016•21 min
How do you diagnose death? In Critical Care we deal with death on a regular basis and although it seems black and white, that is often far from the truth. Patricia Gerritsen discusses what it means to be dead and how that knowledge can aid you in stopping a resuscitation effort. Patricia presents the degrees of death in her eyes as: Soon to be dead Reversibly dead Irreversibly dead Reversibly, irreversibly dead Changes occur following death that can be proof of death. But not always. Pallor mort...
Nov 21, 2016•24 min
