Smacc

SMACCForce: Neemo by Marc O Griofa

Join Celia Bradford as she discusses blood pressure control in intracranial haemorrhage in neuro critical care. Intracranial haemorrhage risk factors include hypertension. The question becomes, what do you do with hypertension in the management of intracranial haemorrhage? Does blood pressure being high cause the bleed to be more severe or does a severe bleed cause increased blood pressure? It is a classic chicken or egg scenario. Celia takes you through two prominent trials in the area and gives you valuable and practical tips on how to manage these patients. The INTERACT-1 trial looked at haematoma expansion in two groups randomised to blood pressures of

The information we consume leads us to believe that failure isn’t an option. Stories and movie depictions of characters who avoid the odds at all costs, tell us that failure is unacceptable and should be avoided. We expect elite performance and hyper competence. In medicine, where we are responsible for the lives of our patients, it is easy to understand why we set the bar high for ourselves and somewhat expect ourselves never to fail. The reality is however, that this is all a myth. Any complex system you can observe from around the world has experienced failure. In fact, the biggest lessons usually come from the biggest failures. In healthcare, we work in the ultimate complex system, where nobody is hyper competent and failure will always occur. It is inevitable. According to sociologist Diane Vaughan, wherever science, technology and risk to human life coincide, failure is inevitable. The answer is in finding ways to appropriately deal with failure and to overcome these challenges. So, given that failure i

Laszlo Hetzman discusses cost effective high fidelity simulation training for performance in pre-hospital and hospital critical care. One the great benefits of simulation training is the diversity of training it provides for all levels of experience. Based on his own hugely positive experiences of simulation, Laszlo was compelled to implement effective simulation in his country. The trouble was budget constraints. However, with a little bit of lateral thinking, Laszlo will show you that low budget does not necessarily mean low fidelity. Laszlo discusses the three areas of fidelity that are needed to have a successful simulation. These are equipment, environmental and psychological fidelity. Life like equipment, life like environment and a strong fiction contract. The later referring to the agreement that is held between all participants and trainers that the plastic mannikin they are working on is a real-life dying patient that they must help. Laszlo divulges seven tips and tricks he has developed to make tra

SMACCForce: Suspension Trauma - Discussion - Demo by Jason van der Velde & Karel Habig

A study showed that 15% of healthcare responders hesitated to start CPR because they thought that they would harm the patient. 21% didn’t want to start defibrillation because they thought that they were doing something bad. Hesitation means time. We are harming the patient by not starting sooner. A culture of excellence in resuscitation relies on an excellent system, not excellent individuals. As individuals, we could have all of the training in the world but the reality is that all parts of the system need to function or we will sink. Maaret Castren suggests that culture of excellence is a choice. We need to choose to be extraordinary and we need to commit to implementing systems that aspire for excellence. Maaret inspires us to think outside of the box and to think about what we can do to be better. When you look around the world it is evident that there isn’t one single system that has actually achieved excellence. We need to encourage our team not to settle. To avoid saying things like “this is the way th

Simulation, assessment and technology in medical education. This session brings together a panel of educators with a track record of innovation and design in medical education. Chris Nickson, Daniel Cabrera, Jenny Rudolph, Sandra Viggers, Simon Carley, Victoria Brazil, Walter Eppich & Jesse Spurr join to discuss the past, present and most importantly the future of how we will teach and learn critical care. They address some burning questions including, what does it mean to be an educator? Is simulation the answer to everything? What do we need from medical education to encourage healthcare professionals to thrive into the future? They explore the future changing role of the medical educator from one of information delivery and assessment to co-learner and developer. This is particularly challenging when asking senior healthcare professionals to unlearn processes and to be flexible and open to new ways of doing things. We are encouraged to consider the role of culture... how can we create a culture which e

SMACCForce: Top 10 PHARM Papers of the last year by Conor Deasy & MJ Slabbert

Panelist participation in the "Resuscitation for the Resuscitationist" panel session.

Jordan Bonomo delivers the run down on intracranial haemorrhage and anticoagulants in critical care. Jordan freely admits – this is not a simple topic. For the simple reason that intracranial haemorrhage (ICH) sucks – and that’s a problem. There are no treatments for it. Nothing seems to work. Add an anticoagulant and it is even worse. The mortality for an ICH is around 30-50%. With an anticoagulant onboard it goes up to 40-65%. So how do you manage an ICH in an anti-coagulated patient? The critical care starts in the Emergency Department. Roughly speaking 30% of intracerebral haemorrhages will increase in size by 30% in 3 hours. Time matters. In the Emergency Department there are three immediate actions that need to take place. 1) Control the blood pressure, 2) get the specific history and, 3) deliberately ascertain what medications the patient is taking. What to do about the anticoagulation? Jordan addresses three areas with his take on the best practice. The PATCH Trial compared standard care to transfusio

Daniel Cabrera wants you to play the game of anaphylaxis… a serious game! You are faced with a monster, with the name anaphylaxis. Daniel takes you through the resuscitation of refractory anaphylaxis. We do a terrible job managing anaphylaxis, missing 50% of the diagnoses, only giving epinephrine in 50% of the cases who need it. After the acute episode, only 40% of patient go home with an epinephrine auto-injector and only 20% get the appropriate follow up! 1-2% of the population will be affected by anaphylaxis, and 2% will die. Although this may not seem like a huge number, Daniel stresses the point - deaths from anaphylaxis are highly preventable Anaphylaxis is a sudden onset, rapid progressing multi-system organ failure due to the activation of mast cells. Anaphylactic vs anaphylactoid… it does not matter. What does matter is that it is becoming more common. Further, fatal anaphylaxis is very fast to progress highlighting the need to make the diagnosis and make it quickly. Although anaphylaxis kills throug

Brandon Foreman takes you through physiological targets for traumatic brain injury in neuro-critical care. Intensivist and emergency medicine physicians already use physiology targets. They understand the complexity of these targets and the pitfalls of overreliance on any one parameter. This is also true for the use of physiology after traumatic brain injuries (TBI). TBI has never been defined by its physiology. In fact, specific targets of physiology to drive successful outcomes have all failed in the research in this patient group. It is no doubt a complex area. Physiology after traumatic brain injury is not simply defined on the pressure and volume in the skull. There are a huge variety of variables, including blood pressure, autoregulation and flow coupled functioning. Even with all these parameters, there is no Level 1 or 2A evidence for physiologic thresholding in TBI patients. As such, Brandon takes you through his approach to using physiology to manage TBI patients in neuro-critical care. He guides yo

Numbers people, give me the NUMBERS! We need CONCRETE data points and percentages...! Go buy another machine to deliver the numbers and data points. We need it to be delivered by gadgets, gadgets that go ping and pong...more and more gadgets. Let’s plot it on graphs and write it into a protocol to then be memorised verbatim in training and dutifully regurgitated in medical exams. That makes us excellent clinicians right? Worthy of more numbers and a couple of extra letters behind our names. Medicine is obsessed with numbers! The glorified science of modern medicine. A fictitious safety net. We are often discouraged from relying on our brains to make decisions, especially in emergency situations. Criticism of human error and the human factors which lead to error are in abundance. What if I told you, your decision-making is far more complex than that? That, how I deal with an emergency also involve guts, prayers and yes, sometimes tricks. Does that make me reckless? A cowboy (girl) or a savant? Or am I just nu

Intubation is one of the most important procedures that we perform. There are many immediate and bedside methods of confirming tube placement. Ben Smith and Jacob Avila present how to confirm endotracheal tube placement with airway ultrasound. There has been a bad trauma come into the Emergency Department. The patient has suffered a head injury with an obvious laceration. They are agitated and being physically aggressive to staff. To make matters worse, they are in a neck collar, and have little to no jaw to speak of. Although you will need to protect the airway of this patient it is going to be difficult. What’s more, you have no access to video laryngoscopy. How will you confirm the placement of the endotracheal tube? Physical examination to confirm endotracheal tube placement has poor evidence behind it. End tidal C02 is similarly problematic. Ben and Jacob propose adding another tool to you armamentarium. Airway ultrasound. Airway ultrasound has sound evidence supporting it. It has sensitivity and specifi

A no-holds barred series of 6 provocative medical interrogations. We challenge the state of research, social media, pharmacology, social work, women in medicine, medicine in the developed work, and the health of healthcare workers. It should be novel, it may get heated, and it is not scripted. Sometimes to comfort the afflicted you also need to afflict the comfortable. This is why no prisoners will be taken, no topic is out of bounds, and no ego will be pampered. It may even offend: you have been warned.

Hardcore EM: EBM - Papers of the year by Justin Morgenstern  

SMACCForce: Bariatric Panel Discussion with Mark Forrest, Jason Van Der Velde, Phil Keating, Cameron O'Leary

Ashley Liebig passionately discusses medics in combat and post traumatic stress. Ashley got a tattoo recently. It was for a friend with whom she served in the army. Although this infantryman was tough, and cool, after a horrible injury he lost his leg and “gained a life full of trauma and scar tissue… and chronic pain and wounds” This left Ashley with grief, and anger. She slipped into an overwhelming sadness. Simple tasks and emails were piling up and she did not care. She was behind on her work. She was exhausted with the guilt. Work could wait. She needed to work through these feelings. This required her to be honest. Even if it made her feel vulnerable. She reached out to her colleagues to let them know what she was going through. In the medical world everyone paints the picture that they have their shit together. They paint the picture that they are on top of their game, always. The problem with this is that it makes it really hard to be honest when you need help. For Ashley, the moment came to reach out

Most people think it is easy to spot the paediatric emergency – and this usually holds true. However, this is not so in undiagnosed paediatric emergency cardiac disease, as Michele Domico explains. She delves into the practical points on recognising children over one month of age with life threatening cardiac disease. No child comes in and says, “I have chest pain” or in any way alerts the Emergency Department providers to include some type of paediatric heart disease in the differential diagnosis. This talk will review the most commonly missed cardiac “zebras”. Cardiac emergencies can masquerade as anything – fatigue, emesis, tachypnoea, septic shock, failure to thrive and abdominal pain could all point to a cardiac aetiology! Recognition is the key Recognition is the key Michele present five cases of paediatric cardiac emergencies to highlight the subtleties that can exist. Each case provides its own lesion and clinical pearl. A 7-year-old with abdominal pain and fatigue teaches us that a persistently tired

"Out for blood" by Bill Hinckley