Coda Change
1,179 episodes - English - Latest episode: 16 days ago - ★★★★★ - 77 ratingsCoda Conference: Clinical Knowledge, Advocacy and Community.
Melbourne: 11-14 Sept 2022
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Episodes
Prehospital Critical Care Response to the Active Shooter
March 05, 2017 20:00 - 12 minutes - 17.7 MBAnthony Baca provides a focused talk on prehospital critical care response to the active shooter. Coming from the United States of America setting this is unfortunately not a rare occurrence. Anthony will discuss the real-world violence that exists, and what are the most important considerations for first responders in such situations. Anthony speaks about prehospital critical care team responses to mass shootings. He explores how emotional and physiological barriers run amok making th...
Post-Intubation Sedation - Scott Weingart
March 03, 2017 20:00 - 27 minutes - 37.7 MBScott Weingart discusses Post-Intubation Sedation.
Post-Intubation Sedation: Scott Weingart
March 03, 2017 20:00 - 27 minutes - 37.7 MBScott Weingart discusses post-intubation sedation – a topic that tends to aggrieve him on a regular basis. Scott explains in simple terms why he is bemused at the lack of understanding surrounding intubated patients who become agitated or aggressive. How would you like a piece of plastic placed down your throat? The problem, as Scott explains, is that sedation does not blunt pain. Sedation without analgesia leads to delirium. In simple terms delirium leads to poor outcomes and death....
Biomarkers in Emergency Medicine: Katrin Hruska
February 28, 2017 20:00 - 26 minutes - 24.6 MBKatrin Hruska discusses the usefulness of biomarkers in Emergency Medicine. All biomarkers are awesome predictors of badness. Elevated hS-troponins after non-cardiac surgery or an acute exacerbation of COPD are associated with increased mortality. In seemingly healthy people, elevated D-dimer levels are associated with increased mortality. Similarly, NT-proBNP levels predict mortality in patients with end-stage renal disease. A biomarker, in its broadest sense, is defined as “a charact...
Biomarkers in the ED - useful or useless - Katrin Hruska
February 28, 2017 20:00 - 26 minutes - 24.6 MBAll biomarkers are awesome predictors of badness. Elevated hS-troponins after non-cardiac surgery or an acute exacerbation of COPD are associated with increased mortality. In seemingly healthy people elevated D-dimer levels are associated with increased mortality, just like NT-proBNP levels predict mortality in patients with end-stage renal disease. A biomarker, in its broadest sense, is defined as ” a characteristic that is objectively measured and evaluated as an indicator of normal bi...
High Performance Teams in Critical Care
February 26, 2017 20:00 - 28 minutes - 25.8 MBChris Hicks delves in to how to optimise performance in a team environment in emergency medicine and critical care. When teams fail and fall apart, we are quick to analyse the performance. We pick it apart and see what went wrong, and why. Chris suggests that we should do the same thing for over-performing teams. We should analyse how and why they perform at optimum levels. In doing this, in reaching a higher understanding of elite performance, we can harness the techniques used, simulate an...
Into the Deep: Developing The Resuscitative Collective Unconscious - Christopher Hicks
February 26, 2017 20:00 - 28 minutes - 25.8 MBThe vocabulary of elite teams is changing. Understanding the roots of grit, resilience and poise under pressure requires a deep dive into the challenging, sometimes ugly world of our emotions, fear, anxiety and expectations. This is the good news: the science of human performance has evolved as well, and offers insight on how to train for a focused and enlightened team mindset. Emotional regulation, environmental manipulation, stress inoculation, mental preparation -- these are the concepts...
Learning from excellence in critical care
February 22, 2017 20:00 - 23 minutes - 21.6 MBAdrian Plunkett describes how to learn from excellence in critical care. Learning from excellence is an initiative which began at Birmingham Children’s Hospital. Firstly, Adrian shares an anecdote regarding how the initiative begun. He sent a letter to the CEO of a hospital appreciating one of the doctors who treated him for cancer. The doctor unfortunately never received it. This caused Adrian to ask - is appreciation and gratitude undervalued? Evidently, noticing excellence will lead to ...
Learning from Excellence - Adrian Plunkett
February 22, 2017 20:00 - 23 minutes - 21.6 MBOur attempts to improve safety and quality in healthcare have tended to focus on learning from error. Intuitively, this seems like a good idea: if we make a mistake, we would like to learn why it happened and how to stop it happening again. But errors only occur in a minority of clinical encounters, so our focus is quite narrow. We may be missing learning opportunities from the episodes when things have gone very well. Furthermore, by focussing entirely on learning from adverse events, we r...
Does the Early Bird Catch the Worm?: How to be truly "awake" during a shift - Jo Anna Leuck
February 21, 2017 20:00 - 23 minutes - 21.4 MBIs there a specific time during our shift when we are too fatigued to safety practice? That was the question that led to a research project comparing the clinical performance of providers during the first hour of a day shift and the final hour of a string of night shifts. These providers were pulled out of their real-time clinical duties and video-taped while performing simulated critical care cases. The hypothesis was that the day shift providers would out-perform the night shift, but the ...
Fatigue in Critical Care: Jo Anna Leuck
February 21, 2017 20:00 - 23 minutes - 21.4 MBJo Anna Leuck discusses fatigue in critical care. Is there a specific time during our shift when we are too fatigued to safely practice? That was the question that led to Jo Anna’s research project comparing the clinical performance of providers during the first hour of a day shift and the final hour of a string of night shifts. The providers were pulled out of their real-time clinical duties and video-taped while performing simulated critical care cases. The hypothesis was that the ...
The Challenges for Women in Critical Care
February 20, 2017 20:00 - 24 minutes - 34.2 MBKarin Amrein talks about the challenges for women working in the critical care world. Incredibly, despite female prevalence, Critical Care is considered a man’s world. We've all heard the notion, “big boys with big toys.” The false assumption is that men are more interested in the latest equipment and technology. However, Karin thinks that the “soft factors” like love, care and teamwork are what will make the biggest difference in the future. Moreover, women are judged by their appeara...
Critical Care: No place for a woman? - Karin Amrein
February 20, 2017 20:00 - 24 minutes - 34.2 MBAh, but you don't look like a professor! A recent statement from a (female) patient says it all, doesn't it? Since the first women were admitted to medical schools – quite a while ago in most countries, the participation of women in clinical and academic medicine has increased steadily. Overall, women represent the majority of health care workers and also medical students in most countries of the world today. SMACC audience is almost 50% female. However, only few women make it to the to...
Motorcycle Simulation - Brent May
February 16, 2017 20:00 - 36 minutes - 82.9 MBMotorcycle Trauma Simulation and discussion
Dealing with Chronic Stress in Critical Care
February 14, 2017 20:00 - 26 minutes - 36.6 MBAshley Liebig is a senior flight nurse and helicopter rescue specialist with STAR Flight. She talks with passion about her job, her vocation. Ashley divulges a deeply personal and deeply traumatic story from the SMACC stage. Pre-hospital medicine, emergency medicine and critical care are difficult jobs. There is a human toll to be paid when working in these areas. Ashley wonders if the stress, the emotion and the trauma torments all listeners. She believes it does not matter. Because...
The Golden Fleece, Golden Hour & Golden Rule - Ashley Voss-Liebig
February 14, 2017 20:00 - 26 minutes - 36.6 MBTime tested rules and myths explored in a real life adventure, meant to honor and display the courage, commitment and sacrifice made by emergency medicine and critical care professionals around the globe. In a painfully honest reflection, Ashley crushes stigma and leaves us acutely aware of how our words and actions affect our colleagues and those that we love.
Critical Care in Humanitarian Emergencies: Nikki Blackwell
February 13, 2017 20:00 - 27 minutes - 24.9 MBNikki Blackwell provides an insight into critical care in humanitarian emergencies. Through her experiences in hunger emergencies, epidemics, natural disasters and conflict zones, Nikki has gained a wealth of wisdom and lessons. She shares these from the SMACC stage. Nikki talks about some of the practical things she does when working in resource poor settings. It starts with hospital hygiene to reduce nosocomial infections, and often entails Nikki working alongside the cleaners due to...
Critical Care in Difficult Contexts - Nikki Blackwell
February 13, 2017 20:00 - 27 minutes - 24.9 MBWhat paradigms should take precedence during a humanitarian emergency when the needs may overwhelm the resources, particularly in the early phase ? Is it possible to resolve the tension between quality and quantity in a resource constrained situation ? How has a changing geopolitical climate affected humanitarian medical action ? Is there a rôle for a critical care specialist at all, when medical resources are simple and finite ? What are the particular challenges of living and working ...
Emergency Interventions in African Children: What Next? - Kathryn Maitland
February 12, 2017 20:00 - 27 minutes - 25 MBIn Africa up to a quarter of children will visit a health facility in their final illness; many dying on the day of admission. Targeted emergency care may be a very cost-effective means of reducing child mortality, but has not been afforded a high enough priority. Moreover, the most basic treatments provided in the emergency room have never been subjected to evaluation in clinical trials, including in resource-rich settings. The controlled FEAST trial of fluids resuscitation demonstrated th...
Emergency Interventions: The use of Oxygen
February 12, 2017 20:00 - 27 minutes - 25 MBKathryn Maitland describes the challenges faced with oxygen therapy as an emergency intervention in critical illness in African children. Where Kathryn works, in East Africa, there is no access to intensive care. Caring for critically ill children is all done in the Emergency Department. 70% of the global burden of disease and deaths from pneumonia occurs in Southeast Asia and Sub-Saharan Africa. The WHO has published guidelines as to what classifies as pneumonia, severe pneumonia, and v...
Debate: The ICU is no place for the elderly
February 11, 2017 20:00 - 25 minutes - 35.1 MBFrancesca Rubulotta argues in favour of the ICU being no place for the elderly. She describes the ICU as a horrible monster, a very dangerous place. Furthermore, she suggests the ICU is on par with climbing a mountain in terms of risk and exposure to catastrophise. She continues to make the point that once a person reaches adulthood, the healthcare system is a one size fits all model. This extends to the type of treatment required – whether it be for an acute or chronic condition. Wh...
"The ICU is no place for the Elderly - Francesca Rubulotta & Karin Amrein
February 11, 2017 20:00 - 25 minutes - 35.1 MBFrancesca Rubulotta and Karin Amrein both came out swinging in this debate that universally gets people going! The crowd was 50:50 split to start with - where will you stand by the end of this podcast?
Debate: It Is Time To Throw Away The Hard Cervical Collar
February 09, 2017 20:00 - 24 minutes - 33.4 MBDarren Braude and Karim Brohi debate over the utility of hard cervical collars. Darren argues that it is time to do away with hard cervical collars. He raises some assumptions. The first being that movement of the spine is bad. As he explains, movement is not the problem. Rather, energy deposition in the spine causes injury, not simply movement. With that being said, the problem is that the hard collar does not prevent movement! Surely, the benefits of the hard collar outweigh the ri...
It is time to throw away the hard cervical collar - Darren Braude & Karim Brohi
February 09, 2017 20:00 - 24 minutes - 33.4 MBDarren Braude and Karim Brohi battle it out in the #SMACCDub Cage Match 'It is time to throw away the hard cervical collar'.
RCTs are the Basis of Good Clinical Practice - John Myburgh & Peter Brindley
February 08, 2017 13:14 - 26 minutes - 36.3 MBPRO: Medicine is a complex craft. Acute medicine is more complex. Excellence is delivering effective acute care depends on recognising the broad base of basic sciences, clinical experience, and results of clinical trials. Central to all decisions has to be how these will benefit the patient – both in the short term as well and longer term so that survivors of acute illness are left with the best possible outcome for that patient, their caregivers and the community at large. This is a dau...
Neurocritical care and traumatic brain injury - Martin Smith & Mark Wilson
February 07, 2017 20:00 - 23 minutes - 21.2 MBMartin -PRO- : The management of severe traumatic brain injury (TBI) has undergone extensive revision following evidence that longstanding and established practices are not as efficacious or innocuous as previously believed. Very few specific interventions have been shown to improve outcome in large randomized controlled trials and, with the possible exception of avoidance of hypotension and hypoxaemia, most are based on observational studies or analysis of physiology and pathophysiology....
Debate: Neurocritical Care Improves Outcomes in Severe TBI
February 07, 2017 20:00 - 23 minutes - 21.2 MBMartin Smith and Mark Wilson debate whether neurocritical care improves outcomes in severe TBI. Martin argues in favour of neurocritical care. He concedes that longstanding and established practices are not as efficacious or innocuous as previously believed. Very few specific interventions have been shown to improve outcomes in large randomised controlled trials. With the possible exception of avoidance of hypotension and hypoxaemia, most are based on analysis of physiology and pathoph...
Debate: Prehospital Doctors add little value in Trauma
February 06, 2017 20:00 - 21 minutes - 19.3 MBAnthony Holley and Marietjie ‘MJ’ Slabbert debate the value of prehospital doctors in trauma. Anthony argues that doctors in the prehospital setting add little value. He does so with the upmost respect for prehospital doctors and having worked in this setting himself. He makes the point that across the globe, the employment of doctors in the prehospital setting is a rarity. Working in this environment is diverse and every situation encountered requires a different skillset. This presen...
Prehospital doctors debate - Anthony Holley & MJ Slabbert
February 06, 2017 20:00 - 21 minutes - 19.3 MBEver wondered if prehospital doctors add LITTLE or LOTS of value in trauma? Ever wondered if an Amazonian Warrior Girl can take on a Kangaroo Aussie Military Man? If you are looking for level-1 evidence on either of these topics, you are in the wrong room! But stick around, it will sure be entertaining & enlightening. Show me anyone who doesn't like a full-contact bare knuckle debate. Bring it on!
The Sick and the Dead: Evidence-Based Trauma Resuscitation in 2016 - Andrew Petrosoniak and Chris Hicks
February 04, 2017 20:00 - 30 minutes - 42.3 MBResuscitation of the critically ill trauma patient involves a myriad of high-stakes, time-sensitive management decisions. The landscape is shifting rapidly: new evidence on hemostatic resuscitation and component therapy in hemorrhagic shock, peri-arrest point-of-care ultrasound, novel approaches to resuscitative thoracotomy and trauma RSI have at once clarified and muddied the waters. In this rapid-fire, case-based session, Petro and Hicks will debate some of the recent and potentially prac...
DNR Should Be The Default - Alex Psirides & Sara Gray
February 04, 2017 01:00 - 27 minutes - 37.3 MBAlex -PRO- : The application of ‘CPR-for-all’ is the ultimate evidence drift. A treatment that is completely appropriate for dropping dead whilst running a marathon has almost no place in acute healthcare facilities where chronic irreversible complex co-morbidities abound. 90% of doctors would not choose CPR for themselves, yet 100% are trained in how to administer it to patients. Defaulting to ‘CPR-for-all’ removes a patients’ ability to provide informed consent for assault whilst they d...
Debate: ‘Do Not Resuscitate’ Should Be The Default
February 04, 2017 01:00 - 27 minutes - 37.3 MBAlex Psirides and Sara Gray debate over whether ‘Do Not Resuscitate’ (DNR) should be the default choice for all patients. Alex contends that application of ‘CPR-for-all’ is the ultimate evidence drift. A treatment that is completely appropriate for dropping dead whilst running a marathon has almost no place in acute healthcare facilities where chronic irreversible complex co-morbidities abound. 90% of doctors would not choose CPR for themselves, yet 100% are trained in how to administer it t...
SMACC Force Rant: Is it the Skillset or Background that Count? - Dr. Jason van der Velde
February 01, 2017 20:00 - 4 minutes - 9.82 MBIn a 2 min rant about medical tribalism, Dr. van der Velde questions which medical specialty, if any, owns prehospital physician response. What is more important: skillset or specialty? Is there a role for tiers of physician response? Is there a future in a stand-alone specialty?
Fatigue, the enemy unseen - Dr. Marietjie (MJ) Slabbert
January 26, 2017 20:00 - 12 minutes - 29.4 MBCritical care practice in and out of hospital is a demanding field of medicine. It attracts a certain type of personality - the warrior: Those who want to do more, be more, work harder, evolve, innovate, be there for the big jobs, the complicated challenges. In a life that is becoming 24/7 and technology that can provide interventions and care in the this field of medicine that was only dreamt off a few years ago has become a reality, but also led to incredible high demands on our time, ene...
Fatigue in Critical Care: Marietjie "MJ" Slabbert
January 26, 2017 20:00 - 12 minutes - 29.4 MBMarietjie (MJ) Slabbert describes the unseen enemy, fatigue in critical care medicine. MJ does 24 hour shifts every other day with just three to four hours of sleep. Though many would claim that this is more than enough, MJ thinks otherwise. Physicians are killing themselves while trying to save others because fatigue kills. MJ points out that sleep is one of the basic necessities in Maslow's hierarchy of needs. Fatigue often affects the go getters or type A personalities. Among doct...
Challenges in pre-hospital management of children
January 25, 2017 20:00 - 12 minutes - 29.3 MBJames Tooley discusses the sheer terror that comes with the challenge of managing children in the pre-hospital environment. As James explains, although many clinicians may think that they do not need to (or may not want to) think about the paediatric population, it is something that every clinician would do well to mentally prepare for. James shows a video clip of a large-scale paediatric trauma and challenges you to consider being dispatched to the scene. How do you prepare for that? ...
The challenges in the prehospital management of sick kids - James Tooley
January 25, 2017 20:00 - 12 minutes - 29.3 MBFight, Flight and (more commonly) Freeze are common reactions when faced with the critically ill child. In this talk i will discuss recognising these states and developing techniques to prevent and recover from them
ICU year in review - Paul Young & Flavia Machado
January 23, 2017 20:00 - 28 minutes - 26 MBFlavia Machado and Paul Young present the top 10 ICU trials of the recent past SMACC style. Their list of trials includes a number that challenge dogma and establish interesting new lines of scientific enquiry. In addition, they also include all the recent clinical trials that should change your practice. If you want to know what’s new in critical care then this is the talk for you.
Submassive PE should be Thrombolysed
January 22, 2017 20:00 - 23 minutes - 32.1 MBAnand 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...
Submassive PE should be thrombolysed - Anand Swaminathan & Iain Beardsell
January 22, 2017 20:00 - 23 minutes - 32.1 MBAnand Swaminathan - PRO - PE is a spectrum of disease and patients on different parts of the spectrum should be treated differently. Subsegmental PE may need no treatment at all whereas massive PE is unlikely to improve without lytics. Between these ends of the spectrum lies the submassive PE - hemodynamically stable but with signs of RV strain portending worse long-term functional outcomes for patients and possible early deterioration. These patients should all be considered for systemi...
"Standards in HEMS. What standards?" - Dr. Ryan Wubben
January 20, 2017 20:00 - 11 minutes - 26.8 MBThe 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 decidedly different path in recent years compared to those in other countries. The wide spread use of single engine, VFR only aircraft, owned and operated by for profit companies is a uniquely American phenomena; at odds with most other countries who have developed HEMS programs around the world. This has result...
The Standards in Helicopter EMS (HEMS)
January 20, 2017 20:00 - 11 minutes - 26.8 MBRyan 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 ...
What's It Like to be a Young Person with Critical Illness? - Natalie May & Roisin McNamara
January 19, 2017 20:00 - 17 minutes - 39.8 MBWhat if they things that healthcare practitioners think are important aren't the same things that patients think are important? Natalie May & Roisin McNamara talk to a patient - a young person who attended the Emergency Department with impending airway obstruction necessitating emergent intubation and intensive care admission - about her experiences of the Emergency Department and ICU, what was good about the care she experienced and what we as clinicians can do or think about differently t...
A Young Person's Experience of Critical Illness
January 19, 2017 20:00 - 17 minutes - 39.8 MBNatalie 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 sal...
POCUS is a Problem - Maxime Valois & Chris Fox
January 18, 2017 20:00 - 25 minutes - 35.5 MBPRO Point-of-care ultrasound (POCUS) is gaining widespread acceptance in the various medical sub-specialties and is progressively being integrated in pre-graduate medical curriculums around the world. 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. As it is gaining widespread acceptance, the use of POCUS is currently shifting from the hands ...
Is Point of Care Ultrasound (POCUS) a problem?
January 18, 2017 20:00 - 25 minutes - 35.5 MBMaxime 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 i...
EM is a Failed Paradigm - Scott Weingart & Simon Carley
January 16, 2017 20:00 - 24 minutes - 33.8 MBSimon: I am presenting the opposing view to Scott Weingart who thinks that emergency medicine is a failed paradigm. He's wrong of course. For a starter, millions of people can't be wrong. Sure, it's not the same as when we started, but such dynamism and adaptation is something to be celebrated not vilified. Emergency Medicine will never die. It will forever adapt and survive.
Is Emergency Medicine a Failed Paradigm
January 16, 2017 20:00 - 24 minutes - 33.8 MBScott 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...
EM Year in Review - Ryan Radecki & Ashley Shreves
January 15, 2017 20:00 - 25 minutes - 35.2 MBAshley 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...
(How to stop) Bariatrics going Bad - Ben Shippey
January 09, 2017 20:00 - 27 minutes - 38.2 MBObesity surgery can induce strong responses in healthcare professionals. These biases must be overcome to allow efficient and safe services. The obese patient presents some challenges to the anaesthetist, some of which are underestimated, others overestimated. Building a team to deliver a new service presented significant obstacles which were overcome successfully to deliver complex surgery in high risk patients with a medical length of stay of 36 hours, and a minimal complication rate.