Coda Change
1,179 episodes - English - Latest episode: 16 days ago - ★★★★★ - 77 ratingsCoda Conference: Clinical Knowledge, Advocacy and Community.
Melbourne: 11-14 Sept 2022
codachange.org
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Episodes
Lessons from the Battlefield - Kate Prior
November 17, 2016 20:00 - 12 minutes - 17 MB"Unexpected survivors" are those patients who, according to their injury severity score, should die of their injuries but they survive against the odds.. The years of conflict in Afghanistan saw increasing numbers of these grievously injured patients surviving to live a fulfilling life. How was this achieved? This talk will cover rewriting the ABCDE of ATLS, the delivery of self and buddy first aid, the use of novel haemostatics and tourniquets, rapid delivery of specialist pre-hospital eme...
The problems with peer reviewed research: Richard Smith
November 15, 2016 20:00 - 30 minutes - 42.5 MBPeer review is at the heart of science. Yet, as Richard Smith explains in this talk, there are many problems with peer reviewed research. As Richard argues, peer review is not an evidence-based process, but rather a faith-based process. Is it time for something different? Peer review has two main functions: 1) Quality assurance and 2) Improving what is published. However, with that in mind, there is no evidence of effectiveness of peer review, and lots of evidence of its ineffectiveness. Thi...
The Perils of Peer Review - Richard Smith
November 15, 2016 20:00 - 30 minutes - 42.5 MBPeer review is central to science and yet was not scientifically examined until the 1980s. Studies of peer review show that it is slow, expensive, something of a lottery, anti-innovatory, ineffective at detecting errors or fraud, prone to bias, and easily abused. So we have lots of evidence of its failings but no convincing evidence of its effectiveness. "If it was a drug it would never get onto the market." Attempts have been made to improve peer review, but these have not proved successfu...
Finding Fraudsters - John Carlisle
November 14, 2016 20:00 - 14 minutes - 20.1 MBThe exposure of fabricated numbers in published papers by eagle-eyed readers has been due to sporadic serendipity. I am going to describe a semi-automated method that you can take away with you to do some sleuthing. I am going to describe what I found when I analysed over 4500 papers.
The Uncertainty of Medical Evidence in Critical Care: Jeff Drazen
November 13, 2016 20:00 - 31 minutes - 43.8 MBJeff Drazen delivers a powerful message on the use of medical evidence in critical care. Medicine is powered by knowledge, but how do we know what is true and what is not? How do we deal with uncertainty in a setting where outcomes are not closely related to known variables? For example, although there are a few people who have survived jumping or falling from an airplane at high altitude, it is a rare event. Thus, a test to determine how to prevent death from such a disaster would only take...
The Rise of Medical Evidence - Jeffrey M. Drazen
November 13, 2016 20:00 - 31 minutes - 14.6 MBMedicine is powered by knowledge, but how do we know what is true and what is not? How do we deal with uncertainty in a setting where outcomes are not closely related to known variables? For example, although there are a few people who have survived jumping or falling from an airplane at high altitude (http://zidbits.com/2010/12/can-you-survive-a-freefall-without-a-parachute/), it is a rare event. Thus, a test to determine how to prevent death from such a disaster would only take a small nu...
The Rise of Medical Evidence - Jeffrey M. Drazen
November 13, 2016 20:00 - 31 minutes - 14.6 MBMedicine is powered by knowledge, but how do we know what is true and what is not? How do we deal with uncertainty in a setting where outcomes are not closely related to known variables? For example, although there are a few people who have survived jumping or falling from an airplane at high altitude (http://zidbits.com/2010/12/can-you-survive-a-freefall-without-a-parachute/), it is a rare event. Thus, a test to determine how to prevent death from such a disaster would only take a small nu...
Prehospital Diagnosis and Treatment of Sepsis
November 10, 2016 20:00 - 11 minutes - 16.5 MBMichael Perlmutter guides you through the prehospital diagnosis and treatment of sepsis. Sepsis is a difficult diagnosis to make. Even in the hospital, where a plethora of tests are available to assist the clinician. The diagnosis remains a challenging one, due to the very nature of sepsis. A shadowy shape-shifter notorious for its ability to hide in plain sight. For now, even in-hospital, there is no test with perfect sensitivity or specificity for sepsis. This is especially true in...
Sepsis—The Dark Knight: Prehospital Diagnosis and Treatment - Michael Perlmutter
November 10, 2016 20:00 - 11 minutes - 16.5 MBSepsis is a difficult diagnosis to make, even in the hospital, where a plethora of tests are available to assist the clinician. However, the diagnosis remains a challenging one, due to the very nature of sepsis: a shadowy shape-shifter notorious for its ability to hide in plain sight, eluding early diagnosis and treatment. For now, even in-hospital, there is no test with perfect sensitivity or specificity for sepsis. This is especially true in the prehospital environment, where we must rely...
The role of the endothelium as a mediator of critical illness - Danny McAuley
November 08, 2016 01:00 - 25 minutes - 34.9 MBEndothelium was once thought to be an inert organ. However, it plays an important role in multiple functions. These include coagulation, inflammation and determination of vascular permeability. He then gives a brief overview of the endothelial arrangement, function of the glycocalyx layer and how an injury causing a loss of the protective layer results in holes in the endothelium. The inflammatory cells enter via these holes and causes oedema in the affected organs leading to multiple path...
Life From Death: Our role in organ donation and death by neurological criteria - Bill Knight
November 06, 2016 20:00 - 31 minutes - 43.7 MBBill Knight gives a superb 20 minute talk with the North American perspective on Organ Donation, brain death and management of the brain dead donor prior to organ donation. Bill is an neuro intensivist, pre-hospital and emergency physician from Cincinnati so he has a great global perspective.
Death by Neurological Criteria and Organ Donation: Bill Knight
November 06, 2016 20:00 - 31 minutes - 43.7 MBBill Knight explains the concept of death by neurological criteria and the complexities surrounding organ donation in such situations. Bill discusses the process of dying, the definition of death, how to approach the neurologically dead patient and how to consider organ donation. Death is a complex topic. Due to advancements in medical technology and processes, the definition of death is a challenging one. Bill talks at length about the definition of death by the neurological criteri...
Greg Kelly - Oh, Baby!
November 05, 2016 01:00 - 20 minutes - 28.6 MBGreg Kelly focuses on transferable skills from adult practice applicable to the collapsed neonate, taking us first through a systematic approach to the common underlying causes and the physiology behind them. He outlines a comprehensive approach to the clapped out baby even when the underlying cause isn't immediately clear and reassures us that there are plenty of simple interventions we can undertake.
What I learned from Dr John Hinds - Fred McSorley
November 03, 2016 20:00 - 11 minutes - 15.7 MBAllow me to introduce to you this extraordinarily talented doctor. John Hinds became involved in our motorcycle racing medical team as a medical student and progressed to inspirational teacher and natural leader. He had a burning passion for improving the care of the injured and on qualification it was evident he was destined for greatness within the world of critical care. In his role as Delta 7 for the Northern Ireland Ambulance Service and as a travelling doctor at motorcycle races in Ir...
Warwick Teague - Gut Feelings
October 28, 2016 18:30 - 37 minutes - 51.7 MBWhere does the abdominal assessment occur when you manage a paediatric trauma patient? Warwick Teague challenges us to stop just leaving it to the paediatric surgeon as he talks us through his approach to the abdomen in a paediatric trauma, including the key aspects of assessment and treatment - so simple, he says, even a surgeon can do it.
Neonatal Intensive Care: Trish Woods
October 27, 2016 20:00 - 10 minutes - 14.3 MBTrish Woods guides you through some clinical pearls in the intensive care management of neonates. The complex physiology of the transitioning required in the journey from foetal life to neonatal presents many challenges and scary moments. Trish helps you to navigate these challenges and to unlock the key to providing quality neonatal intensive care. Many things can go wrong in the neonatal period as babies transition to life in the real world. Trish highlights her thoughts on the use o...
Sick Neonates are Simple!
October 27, 2016 20:00 - 10 minutes - 14.3 MBNeonates are a nightmare.. until you appreciate the physiological transitioning required in the journey from fetal to neonatal state in the big outside world. Learn to understand the challenges faced by not-quite-ready-yet premature babies to those with critical physiology gone wrong and unlock the key to providing quality neonatal intensive care. Take the fear out of caring for newborns and in performing emergency care procedures. Don’t fly blind, use your tuned in clinical awareness and t...
Critical Care Haematology
October 25, 2016 20:00 - 23 minutes - 32.1 MBDeirdre talks ‘bad blood’ – the complex world of critical care haematology. Critically ill patients frequently have activation of inflammatory and clotting pathways. These are likely adaptive responses in the human. When they run riot, or the fine balance between pro- and anti-inflammatory states is shifted, there can be significant morbidity and mortality. Deirdre presents three patients to highlight these issues and what you can do about it. This acronym-busting talk will focus on some ac...
Bad Blood - Deirdre Murphy
October 25, 2016 20:00 - 23 minutes - 32.1 MBCritically ill patients frequently have activation of inflammatory and clotting pathways. These are likely adaptive responses in the human. When they run riot or the fine balance between pro- and anti-inflammatory states is shifted however there can be significant morbidity and mortality. This acronym-busting talk will focus on some acquired haematological disorders in critically ill patients. Disseminated Intravascular Coagulation (DIC) is a clinical and laboratory diagnosis that affects ...
Is survival predetermined in the critically ill - Mervyn Singer
October 24, 2016 20:00 - 20 minutes - 28.6 MBMultiple biomarkers - physiological, biochemical, biological - can prognosticate early in critical illness, even in the ED. This implies the die is already cast (literally as well as figuratively) so we are simply prolonging death is those predetermined to die. We thus need to adopt a completely different strategy for such patients. This also applies to trial design, especially where survival is the endpoint.
Biomarkers in Critical Care: Mervyn Singer
October 24, 2016 20:00 - 20 minutes - 28.6 MBMervyn Singer discusses the use of biomarkers in critical care. Multiple biomarkers - physiological, biochemical, biological - can prognosticate early in critical illness, even in the ED. These biomarkers are numerous - lipids, progesterone, troponin, thyroid stimulating hormone, inflammatory cytokines, mitochondrial dysfunction… so on and so forth! Prognostication can happen as early as the Emergency Department. Studies from the States have found high levels of inflammatory cytokines can pr...
Adrenaline in Cardiac Arrest: Jim Manning
October 23, 2016 20:00 - 29 minutes - 41.1 MBJim Manning presents the how and why of adrenaline in cardiac arrest. The use of adrenaline in cardiac arrest resuscitation has been popular since the 1960s. Laboratory studies and anecdotal experience showed improved rates of return of spontaneous circulation (ROSC) with the use of adrenaline at small dosages. This led to the widespread adoption of adrenaline administration during cardiac arrest into every resuscitation guideline for decades to come. Extensive laboratory studies characteris...
Rethinking Adrenaline in Cardiac Arrest - James E. Manning, MD
October 23, 2016 20:00 - 29 minutes - 41.1 MBThe use of adrenaline in cardiac arrest resuscitation has been advocated since the 1960s. Laboratory studies and anecdotal experience showed improved rates of return of spontaneous circulation (ROSC) with the use of adrenaline at a dosage of approximately 0.01 mg/kg. This led to the widespread adoption of adrenaline administration during cardiac arrest into every resuscitation guideline for decades to come. Extensive laboratory studies characterized the beneficial physiological effects of a...
Nick Pigott - Young at Heart
October 22, 2016 01:00 - 25 minutes - 34.9 MBCongenital heart disease isn't just diagnosed in the antenatal period and during post-natal examination. Nick Pigott takes us through the three main presentations of congenital heart disease (shock, cyanosis and heart failure) and reassures us that treating these patients is simpler than we think, urging us to consider cardiac disease in the sick newborn. He covers duct-dependent lesions, structural obstructive lesions, immediate resuscitation, the usefulness of physical examination, a deepe...
Prehospital trade-offs
October 20, 2016 20:00 - 11 minutes - 15.6 MBEvery Pre Hospital and Retrieval Medicine (PHARM) mission involves a series of complex decisions, which must be rapidly made in a fluid and often pressured environment. Excellent PHARM clinicians are invariably expert decision makers, and the ability to identify, accept and manage trade offs is a key skill in prehospital and retrieval medicine. Some of these trade offs are obvious, and the best options are clear – for example aircraft and crew safety cannot be compromised regardless of t...
Communication with kids and families - how NOT to do it!
October 20, 2016 20:00 - 7 minutes - 10.5 MBWorking in a Paediatric Emergency Department that has 52,000 attendances per year, means that at this point I have fallen into almost every possible pitfall associated with communicating with children and their parents, whether it be the seriously ill or the efficient disposition of the worried well and everything in between. The art of appearing to take all the time in the world whilst managing large volumes of patients can be challenging at times. It can be difficult to separate your emot...
Trade-offs in Prehospital Critical Care: John Glasheen
October 20, 2016 20:00 - 11 minutes - 15.6 MBJohn Glasheen discusses the importance and challenges of trade-offs in prehospital critical care. Every Pre Hospital and Retrieval Medicine (PHARM) mission involves a series of complex decisions. These are made rapidly in a high-pressure environment. Excellent PHARM clinicians are invariably expert decision makers. The ability to identify, accept and manage trade-offs is a key skill in prehospital and retrieval medicine. Some of these trade-offs are obvious, and the best options are cl...
Making ECPR Happen - Jason Rox McClure
October 18, 2016 20:00 - 20 minutes - 27.9 MBA demonstration in the ECMO-CPR process and then going back to basics, to understand the need for such a process and how to design and develop it from scratch using simulation to cut lead time and highlight and remove issues prior to rolling out on the patients. Making E-CPR both possible and safer.
Resuscitative Hysterotomy: Sara Gray
October 17, 2016 20:00 - 22 minutes - 31.1 MBSara Gray presents an incredible case highlighting the importance of resuscitative hysterotomy. The story is full of drama, moments that went well and moments that went poorly. It demonstrates the key points when considering this emergency lifesaving procedure. The case is a woman who is eight months pregnant and has an out of hospital cardiac arrest. The call comes in advising of an imminent arrival. This is where the preparation for a perinatal resuscitation and resuscitative hysterotomy ...
Resuscitative Hysterotomy 101 - Sara Gray
October 17, 2016 20:00 - 22 minutes - 31.1 MBThis session will review the latest evidence for resuscitative hysterotomy (aka perimortem cesearean section), in light of the latest ACLS guidelines. Is there really evidence for the 4 minute rule? How fast do we need to do this? Terrified of this risky procedure? Come learn some practical tips for getting through this as effectively as possible. No time for the whole podcast? Check out these quick links and references: • http://emupdates.com/2013/10/22/perimortem-cesarean-section-in-the-...
How Resuscitation Works - David Halliwell
October 16, 2016 20:00 - 28 minutes - 39.3 MBThis talk uses a case study approach to discuss why resuscitation practitioners should focus upon technical accuracy when resuscitating, focussing on all of the facets of a resuscitation, compression, decompression, trans-thoracic impedance. It suggests that many of the smallest of subtleties can have a dramatic effect on patient survival. We focus on the physiological effects of Manual Chest Compression and use historical reference to underpin modern techniques.
Science of Cardiopulmonary Resuscitation
October 16, 2016 20:00 - 28 minutes - 39.3 MBDavid Halliwell presents the science of cardiopulmonary resuscitation. Resuscitation means lots of things to different people – compression, CPR, mouth to mouth, ventilation, return to normal and reanimation all come to mind. But how and why does resuscitation really work – let David explain. This talk uses a case study approach to discuss why resuscitation practitioners should focus upon technical accuracy when resuscitating, focussing on all the facets of a resuscitation, compression, deco...
Natalie May - You Snooze, You Lose
October 15, 2016 01:00 - 17 minutes - 24 MBThe child with the reduced conscious level presents a unique challenge to the Emergency provider - how can we recognise normal sleepiness versus pathology? Natalie May reminds us that, even if it's after bedtime, we have to take the time to wake children up fully as part of our routine assessment. She then explores the common pathologies - 5MF! - we need to consider in children with a reduced conscious level and how we can figure out which one is in front of us.
Prehospital and Critical Care Responses to Terrorist Attacks
October 13, 2016 20:00 - 13 minutes - 18 MBPierre Carli expands on the prehospital and critical care responses to terrorist attacks. For retrieval medicine specialists and prehospital care providers, terrorist attacks are a new and unique threat. As Pierre impresses on you, terrorist attacks are not accidents. They are a targeted human activity whose purpose is to kill, injure, and inflict the maximum amount of human casualty as possible. They do this with the intention of disrupting society, spreading feelings of fear and panic ...
A world of new threats
October 13, 2016 20:00 - 13 minutes - 18 MBFor retrieval medicine specialists and pre hospital care providers, terrorist attack is one the new threat! Terrorist attack is not an accident: It is a human activity whose purpose is to kill, injure, the maximum casualties to disrupt society, to spread the feeling of fear of panic and insecurity in the population. Terrorism is not blind, it is an organized strategy, much more complex than any natural or technological disaster. To oppose an aggressive strategy a static plan is not enough, ...
3D printing of high fidelity simulation equipment
October 11, 2016 20:00 - 26 minutes - 36.1 MBCiaran McKenna discusses 3D printing of high fidelity simulation equipment. Simulation training is useful, but it is often a costly exercise. However, according to Ciaran McKenna, it doesn't have to be. Ciaran shares his experience of using 3D printing to create simulation equipment. According to Ciaran, anyone with basic computer skills is capable of making their own 3D solutions for simulation training. For example, he demonstrates how to design and print a basic mackintosh blade using 3D...
Stop Complaining, Start Making... 3D print your own Sim Stuff - Ciaran McKenna
October 11, 2016 20:00 - 26 minutes - 36.1 MBDiscover how 3D scanning and printing can be used to develop low cost but high fidelity simulation training equipment. An introduction to free, open access Design software and affordable Compact 3D scanners. Cut out the middle men and save your department $$$ by making your own training manikins. Surgical airway trainer, central line insertion phantom, even an ultra-low cost video laryngoscope can easily be created without learning how to use complex 3D software packages.
Chief Medical Informatics Officer - I could do that! - Diana Badcock
October 10, 2016 20:00 - 25 minutes - 34.9 MBIt’s natural that as doctors we fear failure. In Health, never has so much been asked by so many of so few. Every day feels like a battle zone. Engage a Chief Medical Informatics Officer (CMIO) to introduce technology. That will save us. Established with structure, status and enough support to create and translate innovative models of change in the mindsets of clinicians and healthcare politicians alike, this role could work. However reality is so different. So lets understand failing early...
Medical Informatics improving healthcare outcomes
October 10, 2016 20:00 - 25 minutes - 34.9 MBDiana Badcock begins the talk by discussing her decision to take up the role of Chief Medical Informatics Officer (CMIO). Diana was optimistic about taking this job. However, she left the job after a year. Though she failed in the job, Diana thinks she learnt a lot about failing with fortitude. Diana next talks about the death of her father who was very healthy throughout his life. Three months before his death, he went for a check-up as he was not feeling well. However, he was reassured...
Ultrasound Improves Resuscitation Outcomes: Resa Lewiss
October 09, 2016 20:00 - 21 minutes - 30.2 MBResa Lewiss tells you how ultrasound improves resuscitation outcomes in critical care. Ultrasound helps you make more accurate diagnoses. It allows you to perform procedures with fewer complications, and ultrasound enables you to be more time and cost efficient. However, there may be more to ultrasound - Resa enlightens you. The ultrasound allows the clinician to interact with their patients. Further, Ultrasound enables patients to be integrated into their own care and it allows for an ele...
How Ultrasound Makes You Better - Resa E. Lewiss
October 09, 2016 20:00 - 21 minutes - 30.2 MBIn the evaluation of an emergency and critical care patient, the provider accounts for the chief complaint, the relevant history and the physical examination. With the evolution of Point-of-Care Ultrasound protocols and algorithms, such as the RUSH protocol or the BLUE protocol, the provider now can organize differential diagnoses and treatment options by integrating point-of-care ultrasound interpretations. However, these are not absolutes. These are probabilities. Although we are followin...
Lisa McQueen - Blood: Sweat & Tears
October 08, 2016 01:00 - 24 minutes - 33.3 MB'"Think of the danger while things are going smoothly." Chicago's own Lisa McQueen picks apart the challenges of identifying those children who genuinely need sepsis resucitation in the "pre-shock phase" and explores the pathophysiology and treatment of shock in children.
Two simulations for prehospital medical response
October 06, 2016 20:00 - 31 minutes - 43.1 MBTwo simulations for prehospital care - tactical and motorcycle pit crew with a panel discussion debrief following. Demonstration and discussion of the medical response to these incidents.
Get Your Tech On - Haney Mallemat
October 04, 2016 20:00 - 26 minutes - 35.9 MBTechnology (tech) makes our lives in many ways, yet that same technology is lacking from healthcare. Many of the things that are used in our daily lives can be applied to providing better healthcare to our patients and bring specialized care to any corner of the planet. This talk will discuss some of the ways such technology is being used and ideas for care in the future.
Technology improving healthcare: Haney Mallemat
October 04, 2016 20:00 - 26 minutes - 35.9 MBHaney Mallemat informs you how technology is improving healthcare. Haney’s talk is grounded in a patient experience. Jim is a gentleman from a small farm in a rural area of United States. His farm is everything to him and his wife and daughter. When Jim got seriously sick, he had to have an extended stay in a major tertiary hospital. As a result, he and his family lost their farm, which was their world. Could Jim have been treated locally with the utilisation of technology? Haney thinks tech...
Healthcare Inequality, Ethics & Developing Countries
October 03, 2016 20:00 - 25 minutes - 35.1 MBFlavia Machado gives you the ins and outs of a day in the life of an ICU doctor working in Brazil. She addresses healthcare inequality, ethics, and the challenges she faces in a developing country. By sharing a blow-by-blow account of a day at work, Flavia demonstrates the challenges and inequality that exists. And whilst poverty is shocking, Flavia believes inequality is worse. Flavia’s day begins in the morning with a ward round. Critical bed shortages mean that the clinicians have to make...
All in a Day’s Work in Brazil - Flavia Machado
October 03, 2016 20:00 - 25 minutes - 35.1 MBAs many other emerging countries, Brazil has two completely different healthcare systems, a private system restricted to those who are insured and a public system free-of-charge available for everyone. As anywhere, there are lots of boring things in our daily routine. Some of them will piss you off regardless if you are working for a very nice private ICU or for an overcrowded public one. Deal with the assistant physicians, with our own colleagues and other healthcare professionals is not e...
Fiji Critical Care Jenga
October 03, 2016 08:00 - 26 minutes - 35.8 MBProviding a service to the critically ill depends on a number of essential building blocks: Trained staff, diagnostics, equipment, drugs, guidelines and processes. Compromise one element and maintaining quality of care becomes precarious. Jenga is a game of physical and mental skill. Using real cases see how removing one block at a time may see even the seasoned clinician struggle to perform well. Welcome to Fiji Critical Care Jenga.
Healthcare Capacity Building in Fiji
October 03, 2016 08:00 - 26 minutes - 35.8 MBDr Anne Creaton talks about the healthcare capacity building in Fiji. Fiji was struck by Cyclone Winston in 2016. It caused widespread devastation and the impact will be felt for a long time in the future. The most important thing that Fiji has taught her is faith, patience and persistence. Anne begins by talking about the three Rs that are essential in trainees who want to work in Fiji or similar situations. The three Rs being: Realistic, Resilient and Resourceful. Emotional intelligence is...
Fran Lockie & Phil Hyde - Small is Beautiful: Airway & Breathing
October 01, 2016 02:00 - 54 minutes - 74.6 MBThe paediatric airway terrifies many of us: at the smaccMINI paediatric critical care workshop, Fran Lockie explores some real-life examples of airway challenges and considerations. He takes us through the concept of the "airway bundle" and how teamworking and communication is key to improving paediatric airway care, emphasising the concepts we can borrow from adult practice to offload some of our cognitive burden and outlining the key components of first-class post-intubation care, with pit...