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
Decompressive Craniectomy for Middle Cerebral Artery Infarction: Can we just STOP now?
September 29, 2016 21:00 - 10 minutes - 15 MBAn eight minute summary of the evidence and clinical considerations regarding decompressive craniectomy, discussion of some controversies, and presentation of a decision matrix to use when considering surgery in your patient with malignant middle cerebral artery infarction.
Decompressive Craniectomy in Middle Cerebral Artery Infarction
September 29, 2016 21:00 - 10 minutes - 15 MBAndrew Chow gives a rapid breakdown of malignant cerebral artery (MCA) infarction and the utility of decompressive craniectomy. An MCA infarction is an ischaemic stroke, affecting the total or subtotal area of the MCA. It involves the basal ganglia (at least partially) and may involve the adjacent territories. The incidence is 10-20 per 100 000 and there is a high mortality rate of up to 80%. Early clinical symptoms of MCA infarction are contralateral hemiparesis, gaze deviation and hemisens...
Lead Poisoning in developing countries
September 27, 2016 21:00 - 23 minutes - 32.9 MBNatalie Thrutle educates on the critical issue of lead poisoning in developing countries. Critical care means different things to different people. In the context of lead poisoning, you may or may not think of developing countries such as Nigeria. The response to the Zamfara state, lead poisoning outbreak, in Northern Nigeria, is unprecedented and requires a nuanced interpretation of ‘critical care’. In 2010, 400 children died from lead encephalopathy in the largest lead poisoning outbreak ...
Lead Poisoning In Nigeria
September 27, 2016 21:00 - 23 minutes - 32.9 MBIn 2010, 400 children died from lead encephalopathy in the largest lead poisoning outbreak ever recorded, affecting more than 5000 children in Zamfara state, Northern Nigeria. The outbreak is ongoing. The source is dust from artisanal gold mining, a major economic boon to a remote and rural population much in need. The response to the Zamfara outbreak is unprecedented and requires a nuanced interpretation of 'critical care'. Key life-saving activities include multi-level advocacy to addr...
Fighting Ebola in Guinea
September 26, 2016 21:00 - 27 minutes - 37.9 MBThe medical non-governmental organisation ALIMA (Alliance for International Medical Action) in collaboration with the Guinean Ministry of Health opened and ran the Ebola treatment centre (ETC), in Nzerekore, Guinea during the recent outbreak of Ebola virus disease in West Africa. This paper will describe the issues faced in treatment of the evolving phases of the illness and the aero-medical evacuation of health workers with suspected Ebola virus disease. The difficulties of participating in...
Emergency Response & the Ebola Outbreak
September 26, 2016 21:00 - 27 minutes - 37.9 MBNikki Blackwell tells her story of the emergency response to the Ebola outbreak in Nzerekore, Guinea. She chronicles the enormous challenges of providing care to some of the most vulnerable people in the world, in one of the most under resourced and challenging environments. The Ebola virus was first isolated in 1976. Between then and 2013 there were twenty outbreaks of Ebola. However, the outbreaks, although vicious, were relatively small and in isolated areas. This outbreak was by far th...
Stress Metabolism Adaptation & Critical Illness: Mervyn Singer
September 25, 2016 21:00 - 27 minutes - 38.1 MBIn this podcast, Mervyn Singer talks about the link between stress and multiple organ failure. Often, the organs involved in multi-organ failure show no signs of structural damage or cell damage that would indicate these organs might be under stress. Stress might cause functional damage rather than structural damage. Stress is a normal coping mechanism which helps to deal with the various stressors we encounter. These mechanisms include changes in behaviour, as well as autonomic and hormonal...
Should we De-stress the Distressed?
September 25, 2016 21:00 - 27 minutes - 38.1 MBThere is a rich literature showing excess stress - psychological, pharmacological or physiological - results in similar physical and cognitive manifestations. Critical illness is the perfect example of this manifestation of decompensated stress ("allostatic overload"). Failed organs frequently look normal histologically yet are functionally inactive, despite many varied insults/stressors triggering the failure. These organs regain their functionality prior to patient recovery suggesting, in...
Paediatric traumatic cardiac arrest
September 22, 2016 21:00 - 11 minutes - 16.4 MBJon McCormack gives you what you need to know in the case of paediatric blunt traumatic cardiac arrest. This is a rare but deadly occurrence. Data shows that the population incidence for paediatric blunt traumatic arrest is 1 in 100 000. Of these, most are male, and most are involved in vehicle traffic accidents, along with falls and non-accidental injuries. The median age is 7 years old. The injuries are severe, and the survival numbers make for grim reading… around 1%. So, the numbers are ...
First, do no oxygen
September 20, 2016 21:00 - 21 minutes - 29.7 MBOut-of-hospital cardiac arrest (OHCA) is common and carries a high mortality rate. In Victoria, Australia approximately 50% of patients with an initial cardiac rhythm of VF achieve a return of spontaneous circulation (ROSC) and 30% overall survive to hospital discharge. Currently, OHCA patients who have achieved ROSC but who remain unconscious routinely receive 100% oxygen for several hours in the ambulance, ED, cardiac catheterisation laboratory until admission to ICU. However, there is no...
Cardiac Arrest and Oxygen: Stephen Bernard
September 20, 2016 21:00 - 21 minutes - 29.7 MBStephen Bernard shares his thoughts and the current evidence for using oxygen for cardiac arrest patients. Oxygen is ubiquitous in society! You can buy it in bottles and there are even oxygen cafes. This is especially true in hospitals where oxygen is used frequently and often without much thought. Oxygen is a natural substance. So surely, a short time on 100% oxygen can’t be harmful, right? Stephen wants to challenge that idea. In this talk he presents the data on why oxygen might be harmfu...
Oxygen, Resuscitation & Clinical Outcomes in Critical Care
September 19, 2016 21:00 - 23 minutes - 32.9 MBJohn Myburgh speaks passionately about the use of oxygen in resuscitation, and clinical outcomes in critical care. For the 30 years, clinical understanding of haemodynamic resuscitation has been based on physiological paradigms that focus on convective oxygen delivery. Most of these emphasise the role of cardiac output, haemoglobin and recommend interventions using synthetic agents such as dobutamine, synthetic colloids and blood transfusions. However, markedly influenced by industry, these ...
Does oxygen delivery matter?
September 19, 2016 21:00 - 23 minutes - 32.9 MBFor the 30 years, clinical understanding of haemodynamic resuscitation has been based on physiological paradigms that focus on convective oxygen delivery. Most of these emphasise the role of cardiac output, haemoglobin and recommend interventions using synthetic agents such as dobutamine, synthetic colloids and blood transfusions. Markedly influenced by industry, these interventions and strategies hijacked critical thinking creating a belief in the utiliity of attaining short-term physiolog...
Meditation Performance and Critical Care: Scott Weingart
September 19, 2016 01:00 - 21 minutes - 21.1 MBScott Weingart discusses the scientific aspects of meditation. He believes meditation is to the mind what exercise is to the body. There are two types of meditation: focussed attention meditation or vipassana, and contemplative meditation. Generally, people exist in a default mode network. This happens when we are not focussed on anything in particular and thoughts occur in our brain without us being aware of it. Spending a few minutes every day aware of what thoughts are occurring in our br...
Kettlebells for the Brain
September 19, 2016 01:00 - 21 minutes - 21.1 MBScott Weingart's opening talk at SMACCdub was on meditation: vipassana and stoic negative contemplation. Visit Scott's personal Blog EMCrit http://emcrit.org/wee/vipassana-meditation/
Remote Ischaemic Conditioning and Critical Care
September 18, 2016 21:00 - 25 minutes - 34.6 MBPaul Young discusses remote ischaemic preconditioning and along he delves into the pitfalls of clinical research. 2016 was the 30th anniversary of ischaemic preconditioning. Remote ischaemic preconditioning is the magical offspring of ischaemic preconditioning and refers to the phenomenon whereby brief periods of ischaemia in one organ can protect other organs from subsequent prolonged ischaemic insults. Ischaemic preconditioning rose to prominence after a seminal paper in 1986 that demonstr...
The magic of remote ischaemic preconditioning
September 18, 2016 21:00 - 25 minutes - 34.6 MB2016 is the 30th anniversary of ischaemic preconditioning. Remote ischaemic preconditioning is the magical offspring of ischaemic preconditioning and refers to the phenomenon whereby brief periods of ischaemia in one organ can protect other organs from subsequent prolonged ischaemic insults. In theory, remote ischaemic preconditioning can be induced by temporarily interrupting the blood supply to an extremity using a blood pressure cuff. In experimental models this technique is effective...
How to do Prehospital Research
September 15, 2016 21:00 - 11 minutes - 15.5 MBCombining academic activity with pre- and in-hospital clinical practice is hard work. So why should you do it? Are you a strong believer that care should be evidence-based and that this principle also pertains to pre-hospital practice? Do you believe that the nature of the pre-hospital environment does not allow automatic extrapolation of in-hospital evidence to the field? Do you believe in the relevance of critically appraisal of practice to identify areas of improvement, areas of harm, and...
Evidence Based Medicine in Prehospital Resuscitation
September 15, 2016 21:00 - 11 minutes - 15.5 MBMarius Rehn examines the difficulties and importance of evidence based medicine in prehospital resuscitation. Notably, combining academic activity with pre- and in-hospital clinical practice is hard work. Being an academic in a flight suit can be quite lonely. Marius wants this to change and is passionate about increasing the quantity and quality of prehospital research. Prehospital research that examines patient pathophysiology should dictate care – as it does in the hospital environment. H...
Thin-Slicing in the ED
September 13, 2016 21:00 - 22 minutes - 31.3 MBAll diseases exist on a spectrum. Although the pathophysiology and relative illness of patients on the spectrum are different, we often apply the concepts of management of one of the spectrum to the other end. This can be extremely deleterious to our patients. For example, we cannot treat CHF exacerbations, acute pulmonary edema and cardiogenic shock with the same approach (i.e. no role for loop diuretics early in APE). Thin-slicing disease into a spectrum allows us to tailor our management ...
Precision Emergency Medicine & Outcomes by Anand Swaminathan
September 13, 2016 21:00 - 22 minutes - 31.3 MBAnand Swaminathan brings precision emergency medicine and outcomes in critical care into the light. He will convince you to start calling diseases for what they are and as a result start offering the proper treatments and care. All disease exists on a spectrum. You can’t treat one end of the spectrum the same way you treat the other end. This talk is inspired by a case of Anand’s. An older man presented to the ED with acute onset shortness of breath and crackles. He was treated with Lasi...
Geriatric EM: Our new USP?
September 12, 2016 21:00 - 26 minutes - 35.9 MBThis talk will outline the current state of play in terms of the 'silver tsunami' of elderly patients attending our EDs. What the evidence is for managing them effectively within the ED, and how we could manage them better. It will focus on the effective and efficient delivery of services for the elderly within the ED, the need for training and specialist skills and research to deliver improved care.
Geriatric Emergency Medicine
September 12, 2016 21:00 - 26 minutes - 35.9 MBSue Mason gives you her take on Geriatric Emergency Medicine. Sue’s bread and butter is managing the elderly in the Emergency Department. It is not a sexy topic and there are few gizmos and gadgets. Nevertheless, it is very important. How big is the problem? Patients over 65 years represent about a quarter of the patients that attend Sue’s Emergency Department. However, most of these patients arrive by ambulance and the vast majority of visits in this age group are deemed necessary. This cul...
1984 Dystopian Literature and Emergency Medicine
September 11, 2016 21:00 - 19 minutes - 26.5 MBThe key to dystopian literature is the backstory. These brutal, terrifying worlds are grim forecasts of the future, spawned from the choices and actions of the present. In critical care medicine we make rafts of decisions everyday - not all of them ideal. This talk looks at a projection into the future, both fictional and real, based on those small decisions, actions, and processes.
An alternate future for Emergency Medicine: Michelle Johnston
September 11, 2016 21:00 - 19 minutes - 26.5 MBDr Michelle Johnston talks about dystopian futures and the relevance of emergency medicine in forming such futures. Literature can provide insights into the two types of future we can expect: an optimistic, technologically advanced future as showcased in the movie “Blade Runner” or a dystopian future as envisioned by George Orwell in the novel “1984”. She discusses how different authors have written along similar dystopian themes with government controlling all aspects of human life. Some ...
Rural Trauma Resuscitation and Prevention
September 09, 2016 05:00 - 24 minutes - 24.2 MBMike Abernethy runs you through the pitfalls and challenges of rural trauma resuscitation and prevention. The farm is a dangerous workplace. Accidents have an unusually high morbidity and mortality not only for the worker, but also his/her family members. The reasons are multi-factorial but are the result of a complex interaction of environment, equipment and human factors. The vast majority of agricultural deaths involve tractors. No other industry uses 70-year-old machinery operated by wor...
When PHARM meets the Farm: Rescue, Resuscitation & Retrieval in the Agrarian Environment
September 09, 2016 05:00 - 24 minutes - 24.2 MBThe farm is a dangerous workplace. Accidents have an unusually high morbidity and mortality not only for the worker but also his/her family members. The reasons are multi-factorial but are the result of a complex interaction of environment, equipment, and human factors. Tractors are involved in the vast majority of agricultural deaths. No other industry uses 70-year-old machinery operated by workers whose age ranges from 10 to 90. How can we prevent such incidents? Today’s presentation is...
The future of Emergency Medicine: Simon Carley
September 06, 2016 21:00 - 23 minutes - 31.9 MBDr Simon Carley discusses the future of emergency medicine. Simon begins by talking about how things have changed in emergency medicine since he started his career in the 1990s. He wants to shed some light on where we are going with emergency medicine, what is happening to us and what is shaping us. He believes that predictions about the future, as shown in movies like Back to the Future, might not always come true but they certainly provide clues as to what is possible. According to Simon, ...
Emergency Medicine: The big issues
September 06, 2016 21:00 - 23 minutes - 31.9 MBIn the busy world of emergency medicine it's easy to focus on the here and now, there is always something that demands immediate attention. What of the future? How will demographics, workforce, technology, finance and politics affect the practice of emergency medicine? This talk explores these issues and charts a future that will be very different to today.
First Among Equals: A Tribute to Dr John Hinds
September 05, 2016 03:30 - 30 minutes - 31.5 MBJohn Hinds' tragic death has affected many people all over the world. In the inaugural John Hinds Plenary session at SMACCDUB, John's partner Janet and his mentor Fred MacSorley celebrate John's life in a fitting tribute to the man that has become a legend.
A Tribute to Dr John Hinds
September 05, 2016 03:30 - 30 minutes - 31.5 MBA Tribute to Dr John Hinds, Dr Janet Acheson speaks about her life with Dr John Hinds and how unexpected his death was. John Hinds was known as the pioneer of pre-hospital trauma, a master educator and powerful orator. He was “son” to his mother Josephine, “John boy” to his father Dermot and “John” to his friends and family. John Hinds inherited his meticulousness from his mother and sense of adventure from his father. Janet speaks about different lectures given by John Hinds during whic...
Disruption, danger, and droperidol: emergency management of the agitated patient - Reuben Strayer
September 03, 2016 11:00 - 28 minutes - 38.6 MBAgitation poses a direct threat to the safety of both patient and staff, as well as being an important manifestation of dangerous conditions that require rapid identification and treatment. Management of agitation consists primarily of physical and chemical restraint, and the details of how restraint is carried out–usually based more on tradition than considered plans or thoughtful protocols–directly determine case outcome. In this talk, we’ll discuss the initial approach to agitation, focu...
Dunning Kruger, Imposter Syndrome & Quality Improvement
September 03, 2016 11:00 - 26 minutes - 35.9 MBDr Victoria Brazil discusses the Dunning-Kruger Effect, Imposter Syndrome and quality improvement. Vic starts the podcast reminiscing about her initial days as a resuscitationist. She talks about the two psychological phenomena noticed in people working in pre-hospital care. The Dunning-Kruger effect, where people tend to think they are better at a job than they are, and imposter syndrome, where people tend to think they are worse than they are at doing a particular job. People's perc...
Emergency management of agitation: Reuben Strayer
September 03, 2016 11:00 - 28 minutes - 38.6 MBRueben Strayer provides a masterclass in droperidol for emergency management of agitation. He discusses sedation in three patient groups. Agitated but cooperative If the patient is agitated but cooperative there is no concern for a dangerous condition. They respond well to some company and a sandwich. Drug therapy in this group is relatively straightforward. Disruptive without danger You can converse and engage with this group; however, they are not responsive to suggestion. They are loud an...
Palliative Care and Critical Illness - Ashley Shreves
September 03, 2016 11:00 - 27 minutes - 38.3 MBDr Ashley Shreves discuses palliative care and critical illness. She begins by talking about a case she feels she mishandled during the initial days of her career. How she was unprepared to handle an end-of-life case efficiently. She goes on to enumerate the multiple specific challenges, a knowledge of which would have helped her handle the case more competently. First - One must identify the dying trajectory i.e., use the background information to check the viability of the patient. ...
So, You think you're a Resuscitationist? - Victoria Brazil
September 03, 2016 11:00 - 26 minutes - 35.9 MBLets explore dogma and myths about the knowledge and skills of 'resuscitationists', and the way we think we maintain and improve our skills. BLS and trauma team leadership will come under the spotlight - we often don't do what we think we do. Resuscitationists are exceptional people - but not necessarily in the way we think we are. And finally - some thoughts on what we'll leave behind as resuscitationists... with a tribute to John Hinds
Why we need palliative care everywhere - Ashley Shreves
September 03, 2016 11:00 - 27 minutes - 38.3 MBAs our population ages, the complexity of patients seeking care in the emergency department will increase dramatically. Chronic and terminal diseases will be ever-present but increasingly in patients also negotiating challenges like functional and cognitive decline. While their needs are different, in many hospitals, it is business as usual. A highly skilled and well-intentioned staff stands ready to deploy a limitless supply of diagnostic and therapeutic options designed to help patients l...
Controversies in the Acute Management of ICH
August 05, 2016 04:57 - 21 minutes - 20.4 MBThis is a fresh ICH discussion covering controversies in 2015: blood pressure control, reversal of anticoagulation, and prognosis.
Controversies in the acute management of status epilepticus
August 01, 2016 22:00 - 27 minutes - 44.7 MBTom Bleck has been in the top echelons of neurocritical care for decades. As a highly active member of the CCM-L internet group, he was pioneering internet based crit care discussions before Twitter was ever conceived. Considered by many to be the leading world expert on status epilepticus, he brings insights from research and extensive experience you will hear from no one else. A rare treat.
Subarachnoid Haemorrhage Case Discussion from SMACCBRAIN Chicago
July 30, 2016 01:33 - 42 minutes - 37.4 MBA panel of neurocritical care fanatics discuss the nuances of managing aneurysmal subarachnoid haemorrhage (SAH) from pre-hospital through ED to ICU. This is a fascinating insight into international practice variations and the justification for these. It's very unusual to have such a panel of experts all in the same room speaking so frankly. This was recorded live at the SMACCBRAIN workshop in Chicago 2015.
Q&A: Beat the Bugs
June 23, 2016 18:00 - 10 minutes - 8.7 MBSMACC Chicago Beat the Bug Q&A session with Kath Maitland, Mark Crislip, Flavia Machado and Chris Nickson.
SMACC Chicago Q & A session Funky Physiology
June 21, 2016 19:00 - 30 minutes - 23.3 MBSMACC Chicago Q & A session on Funky Physiology with Mybourgh, Saxona, Hensley and Perner.
Panel discussion: The Future of Continued Medical Education
June 21, 2016 05:00 - 28 minutes - 24 MBHeart, Brazil and Gatward discuss The Future of Continued Medical Education in this SMACC Chicago Q&A Panel Review.
All Paeds Trauma Should be Managed in a Paediatric Trauma Centre - Warwick Teague vs Andy Sloas
June 09, 2016 22:00 - 30 minutes - 26.1 MBWarwick Teague and Andy Sloas argue similar cases in their #SMACCChicago Cage match 'All Paeds Trauma Should be Managed in a Paediatric Trauma Centre’. An interesting insight into Paeds trauma centres in Australia and America. Teague and Sloas offer valuable idea’s on timely and affective treatment of paediatric trauma patients.
Howie Mell - How to Stop Bleeding Without a Hospital
June 07, 2016 18:30 - 30 minutes - 25.9 MBHowie shows us the tools in his toolkit: Tourniquets save lives and do not cause limb ischaemia. The aorta is clamped for many hours in cardiac surgery. Data from the battlefield showed that in >800 cases where tourniquets were applied, there were 3 adverse outcomes (loss of sensation in the distal fingertips). Haemorrhage control (Israeli) bandages are tourniquets with a haemostatic agent that can be applied to a bleeding wound QuickClot (haemostatic powder) can be used for abdominal w...
Rich Levitan - Extreme Airways
June 07, 2016 05:00 - 23 minutes - 21.3 MBAirway management induces stress and fear in the heart of many Critical Care practitioners. In a high pressure situation, it’s easy to falter on the see-saw of demand vs. ability. Rich argues that in difficult airway management, we are hindered by: complex algorithms, anecdotal expertise and the negative perception of the task as ‘undoable’ and the downplaying of our abilities. In crisis, we need simple! Rich discusses the need to redefine the priorities of the airway (away from ‘find the ...
Controversies in Acute Management of Subarachnoid Haemorrhage
June 03, 2016 20:30 - 1 hour - 58.4 MBAndy Naidech gives a fascinating and powerful short talk on controversies in management of aneurysmal subarachnoid haemorrhage, followed by discussion from the panel of experts and questions from the crowd. This was recorded at the neuro workshop for SMACC Chicago and was a very popular session.
HEAL THYSELF AND STAY SAFE
June 03, 2016 02:46 - 1 hour - 77 MBIn this hypothetical panel discussion, our protagonists have just started work at the Utopia Trauma Centre – a state of the art facility that is world renowned for its excellence in trauma care, research and teaching … Our panel includes a social worker in intensive care, a senior intensivist and director of training for ICU, an emergency physician and director of ‘physician leadership development’, a trauma surgeon, an ICU and flight nurse, a consultant high performance coach for the inst...
Simon Carley - Are You as Good as You Think?
May 31, 2016 20:00 - 30 minutes - 27.7 MBSimon Carley has us asking ourselves some confronting questions about our abilities in his SMACC Chicago talk ‘Are You as Good as You Think?’. Carley has us delve into our confidence, competencies and whats makes for a good self learning environment. Initially Carley asks how good we think we are at driving? He then sites studies of Australian and European driver responses stating that 93% of Aussies and 69% europeans rate themselves as above average drivers. In using the example Carley s...
Cliff Reid - Advice to a Young Resuscitationist: It is Up to Us to Save the World
May 31, 2016 04:38 - 30 minutes - 27.2 MBCliff Reid unites our passion of Critical Care in his SMACC Chicago talk Advice to Young Resuscitationist - It’s up to us to Save the World. Talking us through his advice to his former younger self, Reid sights mistakes, case examples, and essentially provides us with invaluable tips to nudge us along to Resus Mastery. Reid offers the following advice to his former, younger self; Your career and speciality is a journey and you chose your destination: Don’t be defied by the expectations of...