Coda Change

Controversies in Traumatic Brain Injury

Simon Finfer has spent his career managing patients with traumatic brain injury nad has watched treatment fads come and go. He's also taken part in some of the best and biggest clinical trials in this area which give him a unique perspective on why we do what we do in managing this devastating but common condition. In the contraints of 15 minutes, he'll make you think and hopefully question your own practice!

Imogen Mitchell - Morphing the Recalcitrant Clinician

Imogen Mitchell’s SMACC Chicago talk 'Morphing the Recalcitrant Clinician’ talks us through the steps to engage the reluctant physician when implementing change. Imogen initally touches on the stages of physician engagement from aversion, to apathy, to engaged and then outlines the steps to morphing the reluctant physician. 1. Seek out a clinical champion 2. Establish a common purpose/vision 3. Standardise what is standardisable 4. Communication, communication, communication 5. Wor...

David Juurlink - Drug Interactions That Can Kill (and How to Avoid Them)

David Juurlink SMACC Chicago talk 'Drug Interactions That Can Kill (and How to Avoid Them)’ takes us on a journey of drug interactions, case studies, and avoidance strategies. Juurlink starts by educating us on the two different drug-drug interactions (DDI) - effects of one drug altered by the use of another . First of which is Pharmacokinetic where by one drug alters the level of another, the second Pharmacodynamic being no change in drug levels, and uses this as a basis for his following...

Rick Body - Is Compassion a Patient Right?

Rick Body’s SMACC Chicago talk 'Is compassion a Patients Right?' takes us on a journey of emotions in critical care. Starting with his rendition of john Lennons ‘Love’. Body, explains the origin of the word compassion - a move to act based on someone else suffering, a sharing of suffering with. Body, initially focuses on a study conducted within his hospital of 125 patients, who were interviewed when admitted to their emergency department and when they where discharged. From the study ...

Optimizing the Care of the Organ Donation Patient

Andrew Healey takes us on an exploration of the early phases of donor management in ICU and Emergency Medicine in his heart felt SMACC Chicago talk Optimizing the Care of the Organ Donation Patient. Which focuses on the processes of managing donor patients and their families,  while they ride their ICU/ ED journey through to organ donor.    Healey summarises his talk into four main points:   1. Set families up to make the right decisions -  be it with end of life care or organ donatio...

Jeremy Cohen - Raging Hormones and the Critically Ill

Jeremy Cohen took us on an Adrenal Function journey at SMACC Chicago with his talk Raging Hormones in Critical Care. Cohen explores the natural roll of cortisol in the human body, various schools of thought and recent research in the areas of sepsis and cortisol resistance.

Trauma is Risky Business - Deborah Stein

Trauma is Risky Business  Deborah Stein SMACC Chicago talk Trauma is Risky Business - delves into the risk patients and physicians undergo when treating or being treated for Trauma.  Stein’s speaks of the Risk Benefit Determination that physicians make daily and how this is used to best answer on going questions such as; can a patient have?, how do we care for this patient? and how do we best make all the these decisions?.  Stein’s suggests a thorough Risk Benefit Determination will in...

Walter Eppich - Interprofessional Communication: Challenges and Opportunities

Walter Eppich engages us on the topic of Interprofessional Communication: Challenges and Opportunities.    Eppich describes communication as the engine of learning - providing it is coming from a psychologically 'safe' environment free from humiliation and punishment.   Eppich characterises a psychologically safe environment being; an environment where people can speak up with idea, questions and mistakes without being fearful of being wrong and stresses when communication breaks dow...

Paul Marik - Understanding Lactate

Summary by: Rosy Wang Lactate has been viewed as a byproduct of anaerobic metabolism and an indicator of tissue hypoperfusion since the 1900s. This theory is still widely believed. Paul busts the myths surrounding lactic acidosis, anaerobic metabolism, tissue hypoxia and the role of lactate in sepsis. Key take-away facts include: - The production of lactate actually consumes hydrogen ions. Lactic acidosis is really lactic alkalosis. - Lactate is produced physiologically and is a precu...

Justin Hensley - Surviving in the Wild

Summary By: Rosy wang You don’t have to be Bear Grylls to stay alive in the wild. Remember the rule of three - you can live 3 minutes without air, 3 hours without shelter, 3 days without water and 3 weeks without food. The two biggest killers in the wild are cold and heat. Justin discusses the physiology of our body’s responses to cold and heat and the pathophysiology of hypo- and hyperthermia. He also talks about the simple of ways of preventing cold and heat injury, including staying d...

Kathryn Maitland vs Nick Pigott - Forget Physiology: Cautious Fluids Save Lives

Kath Maitland takes the perspective that we should be cautious with how we give IV fluids. She argues that the underlying physiological evidence supporting the benefits of giving fluids is not there. The findings of the FEAST study are clear. Kath describes how during FEAST, the administration of fluids made the children look better, and improved the recorded physiological parameters. However these surrogate outcomes did not translate to a mortality benefit - fluid boluses were associated wi...

The Mystery of MODS - Mervyn Singer

The Mystery of MODS Summary By: Oli Flowers Mervyn Singer entertains the SMACC crowd with tales of MODS (Multi Organ Dysfunction Syndrome). With videos of Raquel Welch, stories from the Battle of Trafalgar and lessons from evolution, he makes us think about the important physiology underlying critical illness. This lecture precedes the latest SIRS definition and really puts them into context and leads on to the promise of precision medicine.

The Resuscitationist Mindset: Bread Baking and OODA Loops - Scott Weingart

Scott Weingart's lecture at SMACC-Chicago was on OODA loops and the supremacy of System I for resuscitation. Check more here

Ashley Shreves - How to Diagnose Dying

How to Diagnose Dying A patient's death maybe certain but the timing isn’t. Ashley Shreves talk is on the difficult subject of dying, and how best to understand and help diagnose when the battle is lost.  Shreves discusses the correlating patterns present in the functional decline in end of life patients, with particular reference to the type of disease a patient is suffering from. Shreves suggests, that understanding these patterns is paramount to understanding the care and medical inter...

Jim Manning - Selective Aortic Arch Perfusion

Selective Aortic Arch Perfusion - Summary by: Jim Manning Selective Aortic Arch Perfusion (SAAP) is an endovascular-extracorporeal perfusion resuscitation technique designed specifically to treat cardiac arrest. SAAP involves the blind insertion of a large-lumen balloon occlusion catheter into the descending thoracic aortic arch via a femoral artery.  With the SAAP catheter balloon inflated in the thoracic aorta, the heart and brain are relatively isolated for resuscitative perfusion throu...

Prehospital Medicine: How far we've come

Historical prospective provides a great appreciation and understanding of Prehospital Medicine. Stefan cleverly highlights the journey of a specialty from its roots on the battlefield to the present day, where prehospital medicine has not only begun to influence, but also dictate, in hospital medicine. A brief and fascinating look at "How far we've come”.

Prehospital Ketamine – Is there anything it can’t do?

PHARM Physician, Per Bredmose, provides an in-depth look at Ketamine in the prehospital setting. Per discusses the uses, benefits and potential complications of Ketamine, providing tips and tricks from his wealth of experience.

“Hot Potato” - Retrieval of adult patient with airway complications in rural ED.

Dr. Karel Habig of Sydney HEMS, leads a global panel in the discussion of the retrieval of patient with a difficult airway in a rural ED. Additional discussion surrounds the capabilities of HEMS services around the world. Participants include: Dr. Geoff Healy, Dr. Stephen Hearns, Dr. Craig Bates, Dr. Mike Abernethy, Dr. Minh Le Cong, Crystal Upshaw. 

Justin Bowra - The Elephant In The Living Room

Justin Bowra - The elephant in the living room Justin Bowra takes a break from ultrasound to broach the uncool but crucial subject of health care economics. Health care spending make up a large proportion of the budgets of OECD nations, and it is increasing in relation to GDP. This is an unsustainable situation and something has got to give. In part 1 of Justin’s talk, he asks the question, where is the money going? The commonly asserted points of the aging population, better medical treat...

Tom Bleck - Subarachnoid Hemorrhage: What Matters?

Tom Bleck - Subarachnoid haemorrhage: what matters? Tom Bleck gives an overview of the pertinent facts regarding the complications and management of aneurysmal subarachnoid haemorrhage (SAH). The complications of aneurysmal SAH can be divided into immediate, early and late. The risk of re-bleeding is maximal on the first day, it is fatal in 75% of patients and the best management is to secure the aneurysm by coiling or clipping. Blood pressure control is utilised widely but parameters are ...

“There’s a Hole in My Bucket” The Exsanguinating Patient

Dr. Brian Burns of Sydney HEMS, facilitates a global discussion on blunt abdomino-pelvic trauma 30 minutes away from ED, leading this incredible panel of experts on a hypothetical trauma case. Participants include: Dr Gareth Grier, Dr Howie Mell, Dr Thomas Dolven, Derek Sifford, NREMT-P, Dr Clare Richmond.  

Prehospital CRM – Maximal Simultaneous Activity with Minimal Bandwith

Veteran Airforce Pararescueman turned critical care paramedic, Mike Lauria discusses the

Rob Mac Sweeney vs Paul Marik - Predicting Fluid Responsiveness is a Waste of Time

Rob MacSweeney and Paul Marik debate whether the assessment of fluid responsiveness in the resuscitation of patients with shock a waste of time? Both Marik and MacSweeney agree that many of the traditional methods of assessing patients volume status are flawed and of no value. Marik goes on to argue that the only clinically meaningful outcome that we should measure in response to a fluid challenge is Stoke Volume. In at least 50% of patients there is no improvement in stroke volume and furth...

Scott Weingart - Emergent Intubation Resequenced

Pretty much everything I learned as a resident in terms of the sequencing of airway management in ED has changed over the past 15 years. No longer is there simply RSI or stick a laryngoscope in with nothing and use pure brute force to intubate a patient; we have a host of different options and pathways when approaching airway management in the emergency department.   This lecture discusses some of these updated ways of getting from a sick patient requiring airway management to a tube bet...

Daniel Kornhall - AVALANCHE!

Daniel Kornhall's is an introduction to snow avalanche physiology and the realities of mountain rescue. Dying in an avalanche is an extremely rare cause of death but for us who live in mountain regions and who enjoy winter mountain sports it is a thing that needs to be dealt with. The overall mortality in avalanche incidents is roughly 20% but this increases to 50% in the buried victims, which is why my talk, and most avalanche medicine, focuses on the buried victims. Asphyxia causes the va...

Rob Cooney vs Jonathan Sherbino - Assessment is a Barrier to Learning

Two legends of medical education, doctors Johnathan Sherbino and Robert Cooney go head to head debating whether assessment is a barrier to learning. Sherbino argues that assessment is in fact a first essential step in the learning process.

Andrew Naidech - Intracerebral Hemorrhage: Down, Not Out

TBA

Chris Hicks - Making Teams Work

Making Teams Work - Chris Hicks In Chris Hicks talk Making Teams work, Hicks discusses the systematic failures in training ourselves and our trainees for chaotic situations. He challenges the assumptions that people learn over time by osmosis (by just watching) and debunks the idea that by watching physicians will become skilled at soft non-technical skills.   Hicks goes on to discuss what makes a high performing team - touching on;  Shared mental model of team and task.  Implicit co-or...

Mark Crislip - Adventures of a Pus Whisperer

TBA

Sarah Webb - Room Service Resus

Rapid response systems (RRSs) have become a routine part of the way patients are managed in general wards of acute care hospitals. They have been adopted by national health and safety organisations in North America, Canada, the United Kingdom and Australia and are increasingly being used in other parts of the world. Studies have almost universally shown significant reductions in outcome indicators such as mortality (up to one third) and cardiac arrest rates (up to 50%). However the validit...

John Myburgh vs Anthony Holley - ICP monitoring in TBI is so last season

Emerging Toxicology - Steve Aks

Poisons and novel agents are a moving target in the clinical arena. This talk begins with a historical look at decontamination and pitfalls that have been discovered along the way. The advent of intubation and critical care was a major boon in the improvement in mortality from poisoning. The Scandinavian Method is described and is an important lesion to this day. The rise of antidotes is mentioned.   Emerging drugs are highlighted in the context of where we have come from. The phenylethyla...

Is there a Doctor on the Plane - Joe Lex

Is There a Doctor on the Plane? Summary by: Joe Lex How Common Are In-Flight Emergencies? • Occur on one in every 600 flights • 44,000 of 2.75B airline passengers / year What Are Most Common Emergencies • Lightheadedness or fainting ~37% • Respiratory problems ~12% • Nausea or vomiting ~10% • Cardiac symptoms ~8% • Seizures ~6% • Other Emergencies • Laceration ~0.3% • Cardiac arrest ~0.3% • Ear pain ~0.4% • Obstetrical or gynecological symptoms ~0.5% • Headache ~1% Who Responds to the Ca...

Mike Winters - Don’t Forget A and B!

Don't Forget A & B! Over 500,000 patients per year suffer sudden cardiac arrest. Despite advances in our understanding and management of cardiac arrest, less than 15% of patients survive to hospital discharge with meaningful neurologic survival. In recent years, the focus of cardiac arrest resuscitation has been the delivery of high-quality chest compressions and early defibrillation for those with a shockable rhythm. As a result, airway interventions and ventilation now follow attempts to ...

Lisa McQueen - Pearl or Fecalith?

Lisa McQueen - Pearl or Fecalith? Summary by: Lisa McQueen I’ve long been a fan of David Newman’s “Pseudoaxioms,” those medical proclamations handed down from generation to generation despite growing evidence that they are false. In this talk, I turn a critical eye toward common pseudoaxioms in pediatrics. Does aspirin really cause Reye syndrome? Should you routinely use atropine in preparation for neonatal intubation? Join me in an exploration of these and other pseudoaxioms. I may even d...

Zack Shinar - How we do ED– ECMO

ECMO or extracorporeal membrane oxygenation has shown promise in the use of cardiac arrest patients. Zack Shinar and his crew from San Diego have lead the way in emergency physician initiated ECMO for patients in cardiac arrest. In this lecture he explains briefly how ECMO works, what their outcomes have been and where ECMO is moving. Initially 5 of their first 8 patients were neurologically intact survivors. Their first patient had over an hour of downtime when cardiac bypass was initiated...

Goodbye GCS! - Mark Wilson

Goodbye GCS! Summary by: Mark Wilson Consciousness comprises “wakefulness” (that’s the brain stem, opening your eyes component) and “content” (that’s the supratentorial, thinking, “someone’s home” component). You can have wakefulness without content (e.g. persistent vegetative state) but not content without wakefulness. Describing a “level” of consciousness, converting this multifaceted human brain ability into a linear scale was possibly the biggest neuroscience break through of the 20th...

Andy Sloas - Are we Masters of the Paediatric Airway?

One of the many things that we, as intensivists or emergency physicians, do better than anyone in the business is obtain the emergent airway. We are usually introduced to our patients on the worst days of their lives and even though we may sometimes wish for it, we do not have the option to reschedule our intubations. Smashed, bloody, distorted, edematous airways secondary to trauma, anaphylaxis, and GI bleeds are the commonality not the exception. We manage those airways routinely with nary...

Steve Mathieu - Too Sick for Surgery

This talk will cover what we should do for patients who are considered too sick to have emergency surgery. These patients provide major management challenges in Critical Care. Do we admit them to intensive care to optimise them prior to emergency surgery or should we get on with surgery and resuscitate them intraoperatively? Should the surgery, if undertaken, be limited to damgae control surgery or operative resuscitation, or should more definitive surgical procedures be undertaken. There o...

Simon Carley - Medical error: Are You as Good as You Think?

Error is almost inevitable in our clinical practice so we should be prepared to help and prepare those individuals involved for the benefit of them, our systems and our patients. Do you remember that patient you saw last night?': A phrase the strikes terror into the hearts of all physicians. The prospect of a patient coming to harm as a result of a mistake is terrifying but it can and does happen. The consequences for the patient and their family are often tragic but what of the clinicians w...

Malaria: Can clincial trials help? - Kathryn Maitland

In 2013, ~500,000 children in sub-Saharan Africa died as a direct result of Plasmodium falciparum malaria, accounting for 90% of global malaria mortality. The scale-up of control efforts has led to some reductions in malaria incidence in parts of Africa, but countries where transmission is high malaria continues to be a major public health problem. Early optimism that the most promising malaria vaccine candidate (RTS,S) would reduce the burden of malaria proved premature since following (3-d...

Peter Brindley - Resuscitation: What’s the Point

Resuscitation- what's the point. Cardiopulmonary resuscitation (CPR) is unique as the only medical intervention performed on anyone without explicit contrary documentation. Therefore, CPR need to be understood in terms of societal expectations, legal mandates and professional duties. We also need to understand not just the the likelihood of survival, but also the likelihood of disability and the cost (both literally and figuratively) to patients, healthcare workers, and to an already stretc...

Anders Perner - When to Pull the Transfusion Trigger?

The management of the septic patient in ICU is a recurrent topic for debate amongst intensivists. The decision of if and/or when to give blood transfusions is one of the key sources of contention. Dr Anders Perner is one of the most qualified people to weigh in on this debate. In this talk from SMACC Chicago, he delivers his stance on when to pull the transfusion trigger. Dr Anders Perner is an Intensive Care Specialist at Rigshospitalet and a professor in intensive care at Copenhagen Unive...

Phil Hyde - Paeds Sim: Not for Dummies

Simulation is one of the most important advances in healthcare education and skills training of our generation. We now have simulation mannequins that can blink, breath, or even give birth thus allowing us to practice scenarios and skills before we encounter them in real patients. However, these sim dummies are not real people and so it is all too easy to dehumanize the scenario. According to Dr Phil Hyde, Director of Children’s Major Trauma and Southampton Children’s Hospital, it is this la...

Chris Ho vs Joe Bellezzo - ECPR is a Step Too Far

Are you ready for this rumble in the urban jungle?? Chris Ho vs Joe Bellezzo in the no holds barred debate about whether ECMO CPR is a step too far? The next cage match from SMACC Chicago. Chris and Joe are the director and vice-director respectively, of Emergency Medicine at Sharp Memorial Hospital in San Diego, California. They are two of the leading experts in ECPR, with Joe being one of the key players behind EDECMO. On a day-to-day basis, they are friends and colleagues, working togeth...

Haney Mallemat - Shift Work: Thriving or Surviving?

Working night shifts is a part of medicine that we have come to accept. We work these shift because generations of people before us had done it. But could working night shifts have negative consequences? Night shifts have been shown to be detrimental to patient safety by increasing errors in medication administration and direct patient care. Working night shifts may negatively affect our health by increasing the risks of substance abuse, obesity, social relationships, and certain malignancie...

Patients are at risk! - Victoria Brazil

Patients are at risk – from the moment they begin their healthcare journey. They are at risk of bad outcomes (as defined by us) and of bad experience (as can only be defined by them) Patient safety experts like James Reason, and groups like the Institute for Healthcare Improvement (IHI) have prompted us to think about systems and complexity as sources of error – and supported strategies to remove predictable human fallibility as far as possible. This is important to make healthcare safer. V...

Innovating Medical Education -Larry Chu

In this talk from SMACC Chicago 2015, Larry Chu takes a step back from the clinical side of things to discuss Innovating Medical Education.  Dr Larry Chu is an Associate Professor of Anaesthesiology and the Executive Director of Stanford Medicine X.  Medicine X is an initiative from the Stanford AIM lab. It is a project aimed at promoting new ideas for the future of medicine, healthcare and education using emerging technologies. It focuses on empowering patients to participated in their own...

David Anderson - Breaking Bad (News)

What is the problem? Delivering bad news and having an end of life conversation are core skills for any practitioner who deals with critically ill patients. Current data show that while 22% of deaths in the USA now occur in ICU, 54% of families surveyed have a poor understanding of patient’s diagnosis, treatment plan and prognosis. Dr. Kate Granger found this out first hand while admitted to hospital in the UK and started the #hellomynameis campaign. What is the evidence? While families fee...

The Child in Pain - Greg Kelly

Pain in children is often under treated due to practitioners lacking the knowledge or confidence to be aggressive enough. This is partly due to the lack of structure presented in pain managment and it is frequently made to seem more complex than it is. Almost all acute pain in children can be dealt with by a simple stepwise regime using a small number of common, established and easy to use drugs. Likewise, procedural sedation can be safely and simply performed with simple regimes.