Smacc

Neuro ICU - ICH: To operate or not

Neuro ICU: TBI: The elderly: decrying nihilism

Neuro ICU: TBI: Using MRI as a prognostic tool by Virginia Newcombe

Neuro ICU: TBI: When would I decompress? by Mark Wilson

Neuro ICU: TBI: Still more questions than answers by Simon Finfer

SMACCForce: E-CPR - Panel by Brian Burns, Paul Gowens, Lional Lamhaut, Steve Bernard, Nikki Stamp, Alice Hutin

SMACCForce: Rant - Scene Safety is Bullshit by Christina Heron

SMACCForce: Two Minute Remote Rant Everest by Sanjeeb Bhandari

All healthcare professionals should have a strong sense of situational awareness. Particularly in uncertain and unpredictable prehospital environments, situational awareness is an important skill to master. As we know, things can go south in an instant. So, what is situational awareness? Isn’t it just about paying attention? According to Mike Lauria, it is about much more than that. Situational awareness is a complex, cognitive process which involves perceiving the environment, comprehending the situation and taking steps to avoid error. If you look at every major disaster in history, a loss of situational awareness is one of the top causative factors. In the prehospital space, we need to develop ways in which we can teach our colleagues and trainees about how to be acutely aware of their external environment and what is happening around them. Mike suggests that there should be someone focused on local situational awareness and global situational awareness. Local awareness involves focusing 100% on the critic

SMACCForce: LIVE EMS Nation Podcast - "Feeding the Flame" by Faizan Arshad, Raed Arafat, Lamhaut and Anne Creaton

Acts of violence against paramedics is disgraceful but not doing anything about it is much worse. From DAS SMACC, Craig Wylie speaks to us about violence against paramedics in South Africa. In the four years leading up to this talk in 2017, there were 250 attacks against paramedics. In a neighbourhood where there can be up to 100 gunshots in three hours, this almost shouldn’t be surprising. Craig tells a story where he was called out to an emergency where his colleagues were under attack. His first thought? Why didn’t they get a police escort? But in a low to middle income country, it is rarely that straightforward. Where there is a high crime rate and may only be two police vehicles on duty, it isn’t always as easy as waiting for a police escort. Additionally, if paramedics had to rely on police attending their emergencies, is this just introducing another barrier to care? Craig asks three simple questions: 1. Has our management failed our staff members? 2. Have we done enough that the paramedics that we emp

Communication is something that we all do every day. Communication in healthcare however, isn’t the same as communicating in other areas of our lives. The nature of what we talk about is difficult, particularly when we are delivering bad news. This is amplified even further when communicating with children in medicine. How do we make their experience as enjoyable as possible, whilst communicating effectively with their families? One such way is to acknowledge the role of culture in communication. Culture underpins the way in which we give and receive information in all circumstances. It informs the way we think about things and in many cases, our reactions. We could provide two families with exactly the same diagnosis and information but they could respond in completely different ways. Families will react to information within the cultural framework for which they operate. We may perceive a sprained ankle as a minor injury, however for one family it could mean an inability to participate in sports which is a

From DAS SMACC, Charles Larson and Andrew Beck discuss intubating sick kids - small holes, big problems. When intubating a critically ill child we fear that they are going to arrest on induction and we consider the skill required to intubate in difficult circumstances. The most important thing to remember is that we will never be so good that we won’t make mistakes. The greatest critical care physicians are those that have good skills but that are also able to identify what might go wrong. Understanding the risks and having a plan for when something goes wrong is crucial. Managing critically ill children is a difficult task. We must understand their physiology, have a plan for induction and have a plan for if things go wrong. Importantly, we need to consider that it takes several minutes for drugs to kick in for children. What matters more than what drug you give is how you give it. Children don’t follow recipes so nor should you. Furthermore, some golden rules in managing airways in children: 1. Simulation a

SMACCForce: Silver Care - Panel by Conor Deasy, Gregor Prosen, Mark Wilson, Raed Arafat, Cheryl Cameron

Matt Morgan describes critical care physiology through history. Matt’s story begins in Copenhagen, 1952, when an 11-year-old girl in developed acute and severe polio. The last iron lung had been used. So, a young anaesthetist, Bjørn Ibsen, organised a tracheostomy and positive pressure ventilation (PPV) and changed the world. From that point we have discovered and understood the physiology of traumatic brain injury, mechanics of PPV, HFOV, APRV and echo to name a few. However, Matt contends that this story was not the beginning of our understanding of physiology. Matt will take you back through time to show how giraffes, dogs, fish and even frogs can teach us about physiology. Giraffes can tell us about the delivery of CPP. They utilise massive mean arterial pressures and a complex system of venous valves. The MAP is achieved through massive left ventricular hypertrophy – a completely normal finding in giraffes. High frequency oscillatory ventilation was first used in the 1970s… however, dogs have been doing

Join Timo de Raad as he discusses the complexities of CPR in paediatric congenital cardiac disease. Timo introduces the listener to Emma, a 4-year-old cheerful and playful girl. Emma was born with hypoplastic left heart syndrome – a condition where the left side of the heart is poorly formed. As a result, the heart cannot support adequate circulation around the body. 5 out of 10 000 live births in the Netherlands have this congenital heart defect. Timo was there for Emma’s birth, and he was there for Emma’s death. Treatment of hypoplastic left heart syndrome is a palliative three stage repair. The first procedure is the Norwood – within the first two weeks. Subsequently the Glenn procedure is undertaken, and finally the Fontan. In this procedure the pulmonary artery and aorta are combined to create one outflow tract from the heart. In essence, this creates one functional ventricle. As a result, there is a change in the cardiac physiology. This changes the dynamics when considering resuscitation in these patie

Camilla Strom discusses the outcomes for elderly patients in the intensive care. Camilla recognises a persistent “negative vibe” when people talk about elderly patients. This is inappropriate. We should acknowledge older patients for what they are! They are survival masters. This group of people have experience wars, famines, and recessions. They have seen many failures and successes in their long lives. They have overcome all in their path to be where they are today. Healthcare is facing an oncoming flood of older patients. In fact, this process is already happening across the world. The challenge is that these patients cost a lot of money to care for – especially in the ICU. In the general population, there is a 10% 1-year mortality rate for those 80 years and above. This jumps to 40% if they are admitted to hospital. If a patient older than 80 years is admitted to the ICU there is a 50-90% 1-year mortality rate. Therefore, the question is, should this population be admitted to ICU at all? Camilla argues th

Manu Malbrain presents the four phases of intravenous fluid therapy. He takes you through the big questions of fluids - What, when, why and how? To Manu, there are four Ds of fluid therapy: Drug, dose, duration, and de-escalation Drug Fluids are drugs. This means, like any drugs, consideration must be taken about the type, indication, contraindication, and adverse effects of fluids whenever prescribing them. The evidence suggests that we should stop using starches in sepsis, albumin in TBI and stop using more than 2L of saline in resuscitation. For maintenance – eliminate the use of unbalanced isotonic fluids, and do not forget to cover daily needs. The bottom line is starting to consider fluids as drugs. Dose As Paracelsus famously said “The dose makes the poison” This holds true when administering fluids. There are different doses for different patients dependent on the indication – whether using fluids for maintenance, resuscitation, or replacement. Duration When do you start and stop? You must weigh up th

When looking into someone’s abdomen, the first thing you'll notice is that it almost looks like there is nothing there. For Dr. Lauren Westafer, the gut looks like a black box. There's a lot of gas which makes it hard to see arteries and organs. In this podcast, Lauren discusses point of care Intestinal Ultrasound. To do an intestinal ultrasound, first, rub the curvilinear probe over the abdomen... That's it as far as technique is concerned! There is nothing  overly complicated for such a useful procedure. Why do we still need an ultrasound for small bowel obstructions when we already have other tools like patient history, a physical exam, and x-ray? Unfortunately, these tools are all unreliable for diagnosing small bowel obstructions. What's more, the training for gut ultrasound doesn't take much time. It takes around 10 minutes to do 5-10 scans. The scanning procedure itself takes less than five minutes to perform. For such a high-value procedure, it takes an incredibly low amount of effort and time!  When

Neil starts off by telling us a story about a plane that took off from JFK and flew to Portland. As they approached to land, they realised that they had a problem with the undercarriage. Instead of listening and taking advice from the flight engineer, who was on board and aware of the problem, the pilot chose to continue to fly the plane around in circles. This led to the plane eventually running out of fuel and a subsequent plane crash. Tragically, the plane crash killed multiple passengers on board, including the flight engineer. The moral of the story? Don’t be the captain who doesn’t listen and don’t be the flight engineer who didn’t speak up. Neil defines command gradient error as the actual or perceived difference in rank which inhibits communication, leads to a loss of the shared mental model and ultimately an undesirable event. We as healthcare professionals are doing much more to patients than we’ve ever done before. This sparks the need more than ever, to generate teams that are functional and colla