Smacc

Rueben 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 and disruptive and need to be sedated. You can do a history and exam and be fairly confident that there is no dangerous underlying condition. There is no threat to themselves or others. They can be managed by observation in an unmonitored bed. So, you can sacrifice speed of sedation to ensure safety. Simple and well worn, tried and tested methods of mixed medical sedation are fine in this situation. And Reuben stresses this… it is fine. To be better than fine, consider a single agent - droperidol. Droperidol is the most effe

Dr 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 perception of their performance can impact their chances of improvement. She suggests scientific methods to reduce this gap in perception. Resuscitation quality improvement (RQI) is a machine-based assessment method to improve the quality of chest compressions that helps doctors and nurses assess and improve their chest compression skills. An example is a person trying to intubate a patient while wearing a camera. This highlights how different his perception is of what he is doing. According to Vic, an important tool to improveme

This is a fresh ICH discussion covering controversies in 2015: blood pressure control, reversal of anticoagulation, and prognosis.

Tom 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.  

A 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.

SMACC Chicago Beat the Bug Q&A session with Kath Maitland, Mark Crislip, Flavia Machado and Chris Nickson.

SMACC Chicago Q & A session on Funky Physiology with Mybourgh, Saxona, Hensley and Perner.

Heart, Brazil and Gatward discuss The Future of Continued Medical Education in this SMACC Chicago Q&A Panel Review. 

Warwick 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 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 wounds but may draw the ire of surgeons because they cause an exothermic reaction that burns surrounding tissue. Howie emphasises that not all bleeding have to be stopped - if it’s not pouring out, it can wait. He teaches us to quantify blood loss in the field - three 335 mL cans of soda worth is when to start worrying. The talk ends with an interesting mini Q&A session as trauma surgeons and paediatricians also weigh into the debate.

Airway 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 vocal cords/cricothyroid membrane’), incrementalisation and consensus of method. Rich also briefly discusses the future of airway management - nasal oxygenation and the need to move past the surgical airway as a failed airway.

Andy 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.

In 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 institution, and the director of research and global health programs As we work though a series of clinical cases and events at the hospital we consider performance – highs and lows, including the dark side of high performance/ ambition. We teeter over boundaries and ethics in pursuit of high performance. We consider the impact of diversity in our staff profile. When it all goes wrong we discuss resilience, and dealing with human fallibility - mental health, substance abuse, physical illness, and aging. What does it all mean for

Simon 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 suggests as individuals we are not particularly good at rating ourselves, while inexperienced people tend to rate themselves more highly then experienced people,  calling this illusory superiority cognitive bias. Carley asked the question since you can’t have awesome without average, how do we measure ourselves?. He then talks us through the following tools and processes to establish better self learning and teaching processes; Reflection Diaries - revisit it (clinically and physically), follow up. Peer reviews: 1:1 feedbac

Cliff 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 one chosen path. Have an appreciation of what other specialities can add and what you can learn from them. Leave your ego at the door. Have a balance of confidence and competence. When something goes wrong you have to change something: Be it either yourself, your colleagues or the system. Follow up on your hypothesis: You won’t know if you got it right or wrong and will not gain or learn from the experience. Preserve comfort and dignity for your patients: 'No one knows how much you know, until they know how much you care' -

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’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. Work out barriers and overcome them 6. Deal with the ‘Whats in it for me?’WIFM

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 case studies. Juurlink speaks of the dreadful literature that is available on the thousands of drug interaction per year, stating that most information comes from case reports and volunteer studies, and suggests that majority of these interaction are avoidable. Juurlink then goes on to discuss the findings of 4 case studies involving the following Drug-Drug Interactions and their effects on the patients. SMX/TMP + sulfonylureas Macrolides + digoxin APAP + warfarin SMX/TMP + ACEI/ARB Juurlink provides us with a short list of

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 it was depicted that, what patients truely wanted was simple human intervention; reassurance, friendliness, explanation, basic care. These responses were then coded into 5 different themes to depict how patients believe their suffering should be addressed; 1. Emotional distress 2. Physical symptoms - including pain (but not restricted to) 3. Information - Included reassurance and explanation 4. Care - Basic care 5. Closure - patients want to put this horrible episode behind them Body notes that patients are telling us that t

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 donation.   2. Preserve the opportunity for donation - understand that this is often the last decisions a family will have to make about a loved one and they may need time.    3. Never Say No -  never say no to an organ donation, ask the specialist. The only people who can decide if a person is not ideal for organ donation are those people who intimately know the recipient.  Healey sights some interesting stats that are worth thinking about such as;   1 out of every 4 people who are on the heart transplant list in Canada die. While, th