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What is it that enables some physicians to step into a high pressure situation with poise, presence, and consistently perform to their capabilities? What else is there beyond technical knowledge and clinical skill that can be developed to help immunize the person that is a physician from some of the more human challenges that can present? In a field so ripe with immense performance pressures, demands, and expectations what are those people doing who seem to thrive amidst it all? In this session you will be introduced to a variety of strategies rooted in the principles of performance psychology, and their application in high-pressure performance environments such as medicine. Learn how the top performers I have observed through my extensive collaborations with physicians, and others in high-pressure fields (e.g. elite athletes, business leaders and military/tactical officers) have come to gain efficiencies in how they focus, stay perceptive, maintain equanimity, process their experiences, create and sustain an

Kevin Fong is an astrophysicist, astronaut and anaesthetist with an interest in medical error and safety. In this talk he focuses on lessons learnt from his time at NASA which can be applied to medical practice. Fong believes that key to safer practice is in the collection of accurate data. He outlines some aspects of the famous communications between Sully Sullenberger (pilot) and the Le Gardia air-traffic control tower as Sullenberger miraculously lands a commercial airline on New York's Hudson River - Fong's point is not in the words said or in the calmness of the communications, but that we can go back and analyse every word spoken because the data is collected so accurately.  He goes on to discuss some of the failures surrounding both the Space Shuttle Challenger and Columbia accident's. More importantly he stresses not so much the lessons learnt but the lessons forgotten and the need to ensure organisational memory. We only protect ourselves and our patients through technology and the systems of operati

  Is the care you deliver to critically ill patients in your ED the same as the care delivered in your ICU? And if not, why not?Consider the challenges facing the delivery of excellent care in the ED, and be inspired to make changes at your hospital to improve your system. Learn ten strategies for optimizing the care of critically ill patients in your ED. References:1. Learn more about ED-ICU’s at Scott Weingart’s excellent site http://www.emcrit.org2. Consider a resuscitation fellowship like this one: http://www.resuscitationinstitute.org/index.cfm/education/resuscitation-fellowship1/3. There are zillions of articles about the benefits of simulation and training, here is a link to just one, if you only want to dip your toe in the water: http://qualitysafety.bmj.com/content/19/Suppl_2/i34.full4. Audit and feedback around quality outcomes are a potential strategy. Read more about the pros and cons from the World Health Organization here: http://www.euro.who.int/en/data-and-evidence/evidence-informed-policy-m

When settings outside the hospital are taken into account (ED, primary care), the overall number must be considerably higher. While many factors contribute to diagnostic failure, a variety of sources suggest that physician’s thinking has a lot to do with it. Dual Process Theory describes how the brain makes decisions in one of two modes: through fast, unconscious, intuitive processes (System 1) or through slower, conscious, analytical processes (System 2). Mental short-cuts (heuristics) and biases are predominantly located in the intuitive mode where we spend most of our conscious time, and this is where the majority of decision failures occur. Thinking straight essentially means achieving a good balance between System 1 and System 2 decision making, and much of our cognitive effort needs to go into monitoring what our unconscious brains are doing in System 1. This is referred to by a variety of terms: metacognition, reflection, mindfulness, and others. They all involve cognitive de-coupling from System 1 and

The human circulation is a complex system that has evolved over millenia, primarily designed to promptly respond to conditions of stress - the fight and flight response. The traditional physiological approach focuses on the heart as a pump, adapting to changes in volume and metabolic states. These principles are underpinned by the Starling equation and incorporated into an adaptation of Ohm\'s law. These principles have been maladapted, punctuated by an increasing reliance on surrogate and derived variables that have little to do with teleological haemodyanamic responses.Insights into the central role of the autonomic nervous system are provided by Guytonian theory that in part explain the physiological fallacy germane to many clinical protocols and practices. These fallacies have been amplified by commercial studies directed at short-term physiological improvements that have little to do with patient-centred outcomes in the medium and longer term.Such effects have been demonstrated in recent high-quality R

The Force is strong with this one… Despite years of research and new technology, the adjusted mortality rate for traumatic brain injury remains near 25%. Currently, primary injury occurs before we can intervene, and all our pre-hospital, ED and ICU care is directed towards preventing remarkably complicated and poorly understood secondary injuries. TBI is a heterogenous group of diseases often treated homogenously. You too can master the ways of the Force, by reviewing the Top 10 items you need to know to care for your next patient with a severe traumatic brain injury. Topics covered will include the most up to date evidence, anticoagulation reversal, early aggressive care, and future directions. Become a master of this complicated disease process in your clinical practice.

Neurologically intact recovery after out-of-hospital cardiac arrest remains dismal. In the United States, an 8% meaningful recovery rate is hopeful at best. The introduction of extracorporeal membrane oxygenation (ECMO) during cardiopulmonary resuscitation (CPR) is not new but has been shown to provide upwards of 27-30% meaningful recovery, when applied to the appropriate patient population. In 2011 we began extracorporeal CPR (ECPR) in our emergency department - a suburban non-academic center in San Diego, California, USA; the results have been very promising. As a result, we also began refining all aspects of resuscitation. What specific things did we change about the way we do resuscitation?Proper preparation of the resuscitation suite: If we assume the patient will end up on ECMO, then early femoral vessel access is the priority. Traditional paramedic offloading was problematic for many reasons. To address that we:attempt transfer of the patient from medic gurney to hospital gurney in the ambulance bay, w

Reuben Strayer takes us through the myriad uses of Ketamine, and dispells some myths in the process. A Special K classic.

In Coping with Isolation - All alone on Kangaroo Island, Tim talks with brutal honsety about the reality of being a rural doctor.

Oli Flower brings lessons from cage fighting that are relevant to all health care professionals. Be open minded about this one!

Christine Bowles takes on the big issue of Sex in critical care. In 2015, why is sexual equality in the workplace even an issue and how can we address it?

Roger Harris shows us just how complex decisions about resuscitation can be and when stopping can be the right thing to do.

Chris Nickson challenges us to examine lessons that are 150 years old

ENT surgeon Georgie Harris takes you through a logical approach to managing the horrific scenario of a transcected airway

Guess or Gestalt? by Simon Carley. The secret to being a great Emergency Physician lies in Skill, Knowledge and Clinical Acumen!

Failure is a fundamental part of learning, and growing. Michelle teaches us about failing better and the benefits and freedom this brings.

Rob Orman drills down on what suicidal ideation really means and how you can tell if your patient really has it.

An all-star panel of world sepsis experts discuss the controversial areas. Expertly hosted by Scott Weingart and lubricated with on-stage alcohol.

Hemorrhage is the leading cause of preventable death following trauma. Deborah Stein talks REBOA - who, what and why...

Beating sepsis in Latin America is a serious challenge. Flavia Machado descibes the 5 major issues & how they're being tackled.