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Allow 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 Ireland Doc John brought the highest standards of care and compassion to the most unfortunate at their hour of greatest need. I took this young man as my pupil teaching him the role of motorcycle doctor and quickly realised this exceptional doctor was truly special. In truth the pupil quickly became the master and I had the privilege of 15 years of working alongside him as his wingman.

Where 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.

Trish 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 of positive end expiratory pressure (PEEP), how deep to intubate, when to clamp the cord and the use of ultrasound. When babies arrive early their lungs can be full of meconium or fluid. Due to this, Trish recommends using PEEP – without which there is distal airway collapse and fluid accumulation. Aeration of the lungs is vital. To this end, how deep should intubation be aimed? The depth may not be overly important. This is because regional lung aeration triggers widespread, global increase in pulmonary blood flow. There is litt

Deirdre 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 acquired haematological disorders in critically ill patients. Platelets make up a tiny percentage of blood – just 0.01%. However, they have a crucial role to play. A low platelet count can be due to reduced production or increased destruction. Disseminated Intravascular Coagulation (DIC) is a clinical and laboratory diagnosis that affects about 1% of hospitalised patients. At the most severe end it is associated with bleeding and/or thrombotic complications. Disorders such as thrombotic thrombocytopenia purpura (TTP) and oth

Mervyn 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 predict death, separately from clinical presentation. Therefore, we can predict when critically ill patients are destined to die. So, does this mean that we are just prolonging the life of those destined to die in critical care? Perhaps. Mervyn discusses this being the possible reason for many failed ICU studies. Concurrently, the only progress in critical care in the past 20 years may be due only to less iatrogenic harm. Furthermore, he explains his experiments with rats demonstrating the use of cardiovascular parameters, c

Jim 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 characterised the beneficial physiological effects of adrenaline during cardiac arrest and closed-chest cardiopulmonary resuscitation (CC-CPR). Adrenaline administered during CC-CPR results in peripheral arterial vasoconstriction that raises the aortic pressure. Particularly during the relaxation phase of CC-CPR. This increase in aortic pressure results in an increased aortic to right atrial pressure gradient that drives blood flow to the myocardium during CC-CPR. This pressure gradient is known as the coronary perfusion pressure (CP

Congenital 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 deeper dive into hyperplastic left heart syndrome, the known cardiac patients (and what to do with them) and the paediatric cardiology wonder-drug: Prostaglandin infusion.

Working 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 emotional response to a patient and their parents from your professional assessment. I hope that by hightlighting mistakes I have encountered along the way that others will learn from them.

John 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 clear. For example, aircraft and crew safety cannot be compromised regardless of the clinical situation on scene. Other choices are far more complex. These require rapid and accurate cognitive appraisal of a dynamic and often incomplete information set. Moreover, interventions performed on scene, involve a balance of the patient’s immediate requirements against time and risk. During a mission, each decision to do something leads to how and where it should be done. This often results in a trade off between principle and preference.

A 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.

Sara 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 begins. The first thing to consider is a Code OB – a maternal cardiac arrest code. This will bring neonatal doctors, obstetricians, specialist nurses, airway specialists and all the specific equipment required to the department. A Code OB can be a life saver – if you do not have this, Sara implores you to implement it. Next, you must consider which room will be used for the resuscitation. The room should have two beds and lots of space. As you are organising this, mental preparation should begin. The uncommon and serious n

David 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, decompression, trans-thoracic impedance. Two points David would like you to take away: 1) Blood flows from high to low pressure even when the heart stops beating and 2) Blood doesn’t flow through the heart during systole. David talks about the two big theories of cardiopulmonary resuscitation. The first is the heart squeeze theory – that being chest compressions will pump blood out of the heart and around the body. This is as opposed to the thoracic pump theory which states blood flows due to a pressure gradient and by changin

The 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.

Pierre 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 and inflicting feelings of insecurity in the population. Terrorism is not blind. Terrorist attacks involve organised strategy that is much more complex than any natural or technological disaster. To oppose an aggressive strategy a static plan is not enough. Pierre highlights the need for a counter strategy, comprehensive and adaptable enough to counteract this and deal with a multitude of scenarios. This begins with effective leadership, combining the expertise of the Police, Rescue and Emergency. Prior preparation will all

Ciaran 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 modelling. Training for rare procedures can be very costly using the traditional simulation methods. However, training for such procedures shouldn't be avoided. Therefore, creating low cost, high fidelity SIM equipment is key.  Furthermore, Ciaran explains how 3D scanners can be attached to iPads to take accurate facial contours of a person. Ciaran demonstrates how to make a mould of a person’s neck and then 3D print it. This mould is re-usable and cost effective. Ciaran discusses the benefits of 3D printing and how it is

Diana 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 by the doctor that everything was fine without conducting any tests. Diana, therefore, feels that both she and the system failed her father. Doctors today are overwhelmed with the volume of patients who are older and have more complex conditions, morbidities and mortalities. Many feel that technology is the solution to the problem. However, the amount of money spent in health IT does not reflect the value of the product. This happens because the design of the technology does not match the user experience. Therefore the role o

Resa 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 element of creativity. Moreover, Resa explores the idea of reciprocal illumination – the process of exchange and education between clinician and patient. It is the dialogue that occurs between the two and allows for different and deep thinking.  Evidently, what underpins these thoughts is the idea of creativity. Resa asks you to consider how you are creative with your hands. It may be gardening, knitting, playing a musical instrument, writing, or even washing the dishes. Working with your hands is the gateway to creativity. Wor

'"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 care - tactical and motorcycle pit crew with a panel discussion debrief following. Demonstration and discussion of the medical response to these incidents.

Haney 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 technology may be the way of the future in medicine. Through the utilisation of technology which already exists, patients such as Jim can stay in their communities and have more holistic outcomes. There are three areas Haney discusses. Telemedicine Defined as medical information exchanged though electronic telecommunications to improve a patient’s outcomes. Traditionally telemedicine is big, bulky, and complicated. This brings with it resistance to use. However, with the advent of lighter and faster computers, telemedicine bec