Acts of violence against paramedics is disgraceful but not doing anything about it is much worse. From DAS SMACC, Craig Wylie speaks to us about violence against paramedics in South Africa. In the four years leading up to this talk in 2017, there were 250 attacks against paramedics. In a neighbourhood where there can be up to 100 gunshots in three hours, this almost shouldn’t be surprising. Craig tells a story where he was called out to an emergency where his colleagues were under attack. His fi...
Feb 20, 2019•12 min
Communication is something that we all do every day. Communication in healthcare however, isn’t the same as communicating in other areas of our lives. The nature of what we talk about is difficult, particularly when we are delivering bad news. This is amplified even further when communicating with children in medicine. How do we make their experience as enjoyable as possible, whilst communicating effectively with their families? One such way is to acknowledge the role of culture in communication...
Feb 19, 2019•22 min
From DAS SMACC, Charles Larson and Andrew Beck discuss intubating sick kids - small holes, big problems. When intubating a critically ill child we fear that they are going to arrest on induction and we consider the skill required to intubate in difficult circumstances. The most important thing to remember is that we will never be so good that we won’t make mistakes. The greatest critical care physicians are those that have good skills but that are also able to identify what might go wrong. Under...
Feb 18, 2019•34 min
SMACCForce: Silver Care - Panel by Conor Deasy, Gregor Prosen, Mark Wilson, Raed Arafat, Cheryl Cameron
Feb 13, 2019•24 min
Matt Morgan describes critical care physiology through history. Matt’s story begins in Copenhagen, 1952, when an 11-year-old girl in developed acute and severe polio. The last iron lung had been used. So, a young anaesthetist, Bjørn Ibsen, organised a tracheostomy and positive pressure ventilation (PPV) and changed the world. From that point we have discovered and understood the physiology of traumatic brain injury, mechanics of PPV, HFOV, APRV and echo to name a few. However, Matt contends that...
Feb 13, 2019•19 min
Join Timo de Raad as he discusses the complexities of CPR in paediatric congenital cardiac disease. Timo introduces the listener to Emma, a 4-year-old cheerful and playful girl. Emma was born with hypoplastic left heart syndrome – a condition where the left side of the heart is poorly formed. As a result, the heart cannot support adequate circulation around the body. 5 out of 10 000 live births in the Netherlands have this congenital heart defect. Timo was there for Emma’s birth, and he was ther...
Feb 12, 2019•20 min
Camilla Strom discusses the outcomes for elderly patients in the intensive care. Camilla recognises a persistent “negative vibe” when people talk about elderly patients. This is inappropriate. We should acknowledge older patients for what they are! They are survival masters. This group of people have experience wars, famines, and recessions. They have seen many failures and successes in their long lives. They have overcome all in their path to be where they are today. Healthcare is facing an onc...
Feb 10, 2019•18 min
Manu Malbrain presents the four phases of intravenous fluid therapy. He takes you through the big questions of fluids - What, when, why and how? To Manu, there are four Ds of fluid therapy: Drug, dose, duration, and de-escalation Drug Fluids are drugs. This means, like any drugs, consideration must be taken about the type, indication, contraindication, and adverse effects of fluids whenever prescribing them. The evidence suggests that we should stop using starches in sepsis, albumin in TBI and s...
Feb 10, 2019•21 min
When looking into someone’s abdomen, the first thing you'll notice is that it almost looks like there is nothing there. For Dr. Lauren Westafer, the gut looks like a black box. There's a lot of gas which makes it hard to see arteries and organs. In this podcast, Lauren discusses point of care Intestinal Ultrasound. To do an intestinal ultrasound, first, rub the curvilinear probe over the abdomen... That's it as far as technique is concerned! There is nothing overly complicated for such a useful ...
Feb 07, 2019•21 min
Neil starts off by telling us a story about a plane that took off from JFK and flew to Portland. As they approached to land, they realised that they had a problem with the undercarriage. Instead of listening and taking advice from the flight engineer, who was on board and aware of the problem, the pilot chose to continue to fly the plane around in circles. This led to the plane eventually running out of fuel and a subsequent plane crash. Tragically, the plane crash killed multiple passengers on ...
Feb 01, 2019•12 min
Cognitive offloading for critical care retrieval by Stephen Hearns Everyone’s cognitive capacity is limited. It is easy to become overloaded and subsequently for our performance to be impacted. In medicine however, an overloaded cognitive capacity could be the difference between life and death. There is little room for healthcare professionals to be unfocused, yet retrieval medicine is comprised of unpredictability, critical time pressures and fast-paced emergency responses. Let’s face it, there...
Jan 30, 2019•11 min
Critical care is viewed from different perspectives. How to clinicians, patients and families experience this life changing part of the health care system?
Jan 21, 2019•1 hr 23 min
Jack Iwashyna discusses his research into persistent critical illness in the ICU. While much of resuscitation focuses on the dramatic early minutes to hours of critical illness, many patients stay for days or weeks in the ICU. Jack wants to know, why do patients get stuck in the ICU, and what might we do better to improve their care? Jack became an ICU doctor because he loved drama. He wanted to find the golden hour. The golden hour describes the time to intervene, to make a difference, and to s...
Jan 16, 2019•21 min
After getting his chance to interrogate SMACC Superstars the people finally get their chance to get their own back as everyman Iain Beardsell asks the questions that everyone wants an answer to. Covering a wide range of topics it will focus on Peter's previous SMACC talks, including subjects such as teamwork and burn out and no doubt reliving his interviews across the week.
Jan 13, 2019•16 min
The ethics of incidental findings: James Rippey Ultrasound is an incredibly useful tool for clinicians. According to James Rippey, there are two main groups of clinicians who use ultrasound. First, there are the POCUS providers, who have a specific, focused question and use the ultrasound machines accordingly. Then, there are the ultrasound experts, who look beyond the specific questions and embrace ultrasound as a valuable diagnostic tool. The advancement of high quality, handheld ultrasound ma...
Jan 10, 2019•13 min
Critical Care survivors: Margaret Herridge In this podcast, Margaret Herridge considers this well-known quote from Nietzsche, “That which doesn’t kill us makes us stronger.” But… Does it? What about our patients who suffer from a critical illness? The continuum of critical illness and what lies ahead for recovery should not be underestimated. Post critical illness, it is not uncommon for patients to suffer from a functional disability, a neuropsychological disability, or a decline in their gener...
Jan 09, 2019•20 min
David Menon discusses the complex and fraught world of managing traumatic brain injury (TBI) in the ICU. In particular, David discusses the management of intracranial pressure and cerebral perfusion pressure in these patients. Although the Brain Trauma Foundation provides guidelines for the management of severe TBI, including targets for ICP and CCP, there is no Level 1 recommendation for the use of any intervention to modulate ICP/CCP. General principles remain simple in theory, if not in pract...
Jan 08, 2019•23 min
We regularly have difficult conversations in critical care. We deal with sick and complex patients who may be at the end of life. The families we talk to may be in a state of shock and acute grief, unable to think clearly and make important decisions. Moreover, patient safety incidents and other challenging issues such as organ and tissue donation may further complicate the patient journey. In this talk by Jon Gatward, we follow the story of Leah and the difficult conversations that were needed ...
Jan 07, 2019•18 min
Failure is something that even the very best in the industry regularly experience. In safety critical roles, that failure can ultimately lead to death and maiming. So how do we accept failure? Martin Bromiley explores how we can understand and learn from our failures and difficult moments. He identifies the essential behaviours and mindsets that will help us make sense of those complex moments. One such mindset is being confident that you have the skills to do the job but also humble enough to k...
Jan 03, 2019•20 min
SMACCForce: CRM Panel Discussion with Clare Richmond, Neil Jeffers (Pilot), Per Bredmose, Mike Lauria, Tom Evens
Dec 28, 2018•26 min
From DAS SMACC, Vera Sistenich explains why it is critical that we care about the global refugee crisis. The global refugee crisis exemplifies some of the greatest challenges facing our global institutions and liberal world order today. From human rights, to xenophobia, sexism and economic protectionism, terrorism and climate change. National and international responses to the refugee crisis are sculpting moral and political norms around the globe. It is critical that we care about the refugee c...
Dec 19, 2018•25 min
John Greenwood discusses the use of vasopressors in the emergency room. His talk focuses on three areas. First, he reviews vasopressors and categorises them based on resuscitation end points. Secondly, he addresses the concept of “pressor angst” and how it can significantly impact patient mortality. Finally, he will empower you to start vasopressors early in patients with distributive shock and sepsis. The tale of a 45-year-old lady with sepsis in the context of pneumonia is retold. John asks - ...
Dec 14, 2018•21 min
Luke Regan presents the emerging evidence for prehospital ultrasound and telehealth in his talk from the SMACC stage. Luke has a personal interest in improving prehospital care. He lives in the north of Scotland. It is an austere and challenging environment, far from technology. Compounding this, it is underserviced and there is an absence of critical care with no critical in reach. Unfortunately, the morbidity and mortality of the area does not match the spread of care. Therefore, it is one of ...
Dec 12, 2018•14 min
Sara Gray discusses the complex topic of prognostication post cardiac arrest in neuro intensive care. There is a short list of things that keep Sara up at night. She describes a specific cardiac arrest nightmare she has. She is looking after a patient post cardiac arrest. They remain in a coma after cooling. As they meet brain death criteria and they are an organ donor, they are transferred to the operating room. Whilst there, they regain spontaneous respirations. Although this is terrifying, th...
Dec 11, 2018•12 min
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...
Dec 09, 2018•14 min
Raed Arafat describes the amazing lessons he has learnt about functional systems for emergencies, mass casualties and disasters. SMURD (Mobile Emergency Service for Resuscitation and Extrication) is in Emergency Rescue Service in Romania. It was set up by Raed Arafat in 1990 to respond to a largely non-existent and broken system. By doing so, he created a pre-hospital care system that he could be proud of. SMURD has today transformed into an integrated, country wide, emergency response system pr...
Dec 04, 2018•22 min
Haney Mallemat states the case for ultrasound in cardiac arrest resuscitation. He tells the story of Stephen, a 43-year-old male who suffers a cardiac arrest. Unfortunately, whilst looking for reversible causes with a transthoracic echocardiogram (TTE), chest compressions stopped, and Stephen died. Enter the trans-(o)esophageal echocardiogram (TEE). A trans-esophageal echocardiogram is an amazing diagnostic tool. It works in exactly the same way as any other ultrasound – there is a transducer on...
Dec 03, 2018•11 min
Pik Mukherji will change your mind on assessing risk and benefit in resuscitation. There is a bent towards action in the Emergency Department. This is for a few reasons. We are risk adverse – we do not want to miss the acutely sick patient. We do not want to miss the patient that “falls of the cliff”. In fact, as Pik discusses, in emergency medicine and critical care, training is focused on looking for the sharks, even when the waters appear friendly and calm. This is highlighted acutely well by...
Nov 30, 2018•21 min
Brandon loves wavy lines. He will draw the curtain on the use of continuous EEG in neuro critical care. Brandon will first take you back to medical school with some neuroanatomy and physiology to underpin you understanding of the EEG. He then steps you through what an EEG is telling you. Bumps, lines, amplitudes and hertz are all demystified. With this knowledge, there is a lot you can do with continuous EEG. A few examples: EEG can be reflective of external stimulus – be it a shock, a sound, or...
Nov 28, 2018•16 min
Cliff Reid educates the audience on structured teaching of crisis resource management. Cliff works for Sydney HEMS in extreme conditions. The environment tries to kill them, and the patients try to die. He works in a big team, with a lot of the doctors never having worked in prehospital care. The team covers a huge area, completing many missions every year on both fixed wing and rotary wing platforms as well as road ambulances. Every case is scrutinised, both formally and informally. When things...
Nov 28, 2018•10 min
