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Catalina Sokoloff presents Milrinone for treatment of post-aneurysmal subarachnoid haemorrhage vasospasm (delayed cerebral ischaemia.) Catalina firsts explains the pathophysiology of delayed cerebral ischaemia. She makes the point that there is still much we do not know. Probable mechanisms at the microcirculation level include release of free radicals, lipid peroxidation, cortical depression spreading and microthrombi formation. The ideal treatment once delayed cerebral ischaemia is present is therefore unknown. Mechanical angioplasty seems to be favourable in some instances however has its shortcomings. As such it is often reserved as a rescue option. ‘Triple H’ therapy is intended to improve blood flow beyond constricted vessels; however, each component is flawed as Catalina explains. Intraarterial drugs have been tried however similarly, the evidence is lacking. This brings Catalina to Milrinone. This drug is a phosphodiesterase 3 inhibitor that has vasodilating and inotropic properties. Relevantly, the c

Communicating Science In A Pandemic (Pt. 2)   The power & presence that social media has in healthcare communication cannot be ignored. However, many are still reluctant to embrace its usefulness as a tool which can enhance education and patient connections.   IN PART 2 OF THIS PODCAST, DR JESSICA STOKES-PARISH CONTINUES TO DISSECT THE ROLE OF SOCIAL MEDIA IN SCIENCE COMMUNICATION, ALONGSIDE REGISTERED NURSES PENNY BLUNDEN (@sick.happens) & PATRICK MCMURRAY (@patmacrn).   The trio begin by addressing the negative tone that accompanies the topic of social media in the nursing community. Patrick explains how this perception should be abandoned and social media should instead be seen & used as an educational tool. Patrick integrates social media into his own role as a clinical educator and knows first-hand how effective it can be when used correctly.   The focus then turns to the importance on educating the educators. Patrick & Penny outline how medical educators must learn how to use social medi

In Part 2 of this podcast Hugh Montgomery, Liz Crowe, and Shelly Dev along with Peter Brindley continue their discussion on wellness, resilience, burn out and being a healthcare worker in the world now. IN THIS EPISODE THE TEAM DISCUSSES THE BROADER ORGANISATION STRUCTURE AND HOW THIS CONTRIBUTES TO (OR DETRACTS FROM) TEAMWORK AND HEALTHCARE WORKER WELLNESS AND SATISFACTION. Shelly delves into the topic of the organisations and whether they are supporting the clinicians on the ground in the best possible way. Senior leadership, in her opinion, has done a major disservice to healthcare workers in their support and leadership roles. The support needed on the ground transcends yoga classes and healthy cooking recipes. Organisational support needs to acknowledge the needs and desires of healthcare staff, namely, to deliver excellent care and have good days at work in the context of a healthy life. Liz suggests that although the organisational leadership is important for the overall wellbeing of the workforce, the

This episode discusses the effect of the pandemic on healthcare professionals at an individual level, and how this has broad reaching ramifications at a team and industry level across different country contexts.   IN THIS PODCAST PETER BRINDLEY IS JOINED BY HUGH MONTGOMERY, LIZ CROWE, AND SHELLY DEV TO DISCUSS WELLNESS, RESILIENCE, BURN OUT AND BEING A HEALTHCARE WORKER IN THE WORLD NOW. THIS EPISODE EXPLORES JOB SECURITY, PUBLIC RECOGNITION, AND THE EFFECT OF THE PANDEMIC AT A PERSONAL LEVEL FOR DOCTORS AND NURSES.   In the context of the pandemic, the good comes with the bad – as Liz explains. Throughout the pandemic we have seen health care professionals experience trying work conditions the world over. However, it is one of the few industries that did not experience staff layoffs and work reduction. On the other hand, all healthcare systems in the world are imperfect. Throwing a pandemic into the mix produced even more challenges. It was therefore unlikely that the mental health and satisfaction from work

Communicating scientific information as a health professional is far more than just posting healthcare tips online. What can & can’t be posted? Who do we really listen to? And who is allowed to say what? DR JESSICA STOKES-PARISH CHATS WITH REGISTERED NURSES & SOCIAL MEDIA PERSONALITIES PENNY BLUNDEN (@sick.happens) & PARTICK MCMURRAY (@patmacrn) ABOUT THE BARRIERS FACING HEALTH PROFESSIONALS WHEN COMMUNICATING WITH THEIR AUDIENCES ONLINE.   Picking up where Professor Tim Caulfield’s “Great Rejection” misinformation podcast left off, Dr Jessica Stokes-Parish unpacks the challenge of communicating accurate information via social media as a health professional, specifically nurses. Penny Blunden and Patrick McMurray both have successful, widely-followed social media accounts which they use to provide useful insights into healthcare to mass audiences. Jessica states how in recent years, including during Covid, she saw a rise in scientific misinformation across social networks. Whilst there was a stron

Nazih Assaad provides his expertise on the treatment of subarachoid haemorrhage. Treatment for aneurysmal subarachnoid haemorrhage (SAH) is an area that has had extensive research but not a great deal of success. Promising animal studies have not turned out as hoped in clinical trials and many questions remain unanswered. Nazih guides the listener through his approach on how to address the complicated presentation of SAH. Firstly, subarachnoid haemorrhages can be graded clinically and radiologically. Clinical grades provide useful prognostic information, with poorer grades less likely to do as well as more favourable grades, despite best medical and intervention management. Nazih mentions the Fisher Scale which is useful for predicting vasospasm and how he integrates both into practise. Nazih will guide you through the four elements in the management of established SAH. Moreover, these are the four areas he believes every clinician working in this space should consider with every patient presenting with a SAH

Whilst US medicine has always had issues, the pandemic sent the practice of medicine into a state of disarray. DR JUSTIN HENSLEY DISCUSSES THE STATE OF US MEDICINE THROUGHOUT THE PANDEMIC. THE POWER OF INSURANCE COMPANIES AND DESPERATE WORKING CONDITIONS IN US HOSPITALS. In this talk, Justin outlines the "idealistic" view he had of emergency care before working in the ED. However, he was not prepared for the “joyless” nature of a medical system which seemed to place profits above patients.  Through a detailed account of what it’s like to work in the US healthcare system, Justin shares his belief that US medicine is “purely, 100% a business”. He dives into the unavoidable financial struggles that patients must endure with private insurance companies for even the most basic care. Justin states that, at times, it felt as though he was just “generating a bill for the patient”. Venturing further into the issue of insurance companies, Justin takes us through his own experience of delivering healthcare to rural Amer

In part 2 of The Great Rejection, Peter Brindley and Tim Caulfield return to continue their discussion of misinformation in the world of health science. This episode examines how to teach the public to think critically, how to deal with uncertainty as a clinician and how to better understand the pros and cons of transparency. How do we teach science in an ever-expanding world of knowledge and information? Tim suggests going back to first principles and reinforcing to the public that science is a process. Secondly, Tim highlights how basic educational tools can make a big difference when teaching the public to cut through the noise. Moreover, creating engaging content with accurate messaging can help turn the tide on misinformation in the public realm. This brings Tim and Peter to the idea of uncertainty and how it sits with the public. The research suggests that the public wants the scientific community to be honest about uncertainty. Reassuringly, the same research tells us that by being honest, an instituti

Please note this episode was recorded in November 2018 as part of Brain, a CICM Neuro Special Interest Group meeting click here for more info. Oli Flower gives us a preview into the future of traumatic brain injury (TBI) management. It is late in the 21st century and a man suffers a TBI. Oli describes the on scene immediate management of this patient. Drones and closed-circuit cameras combine to provide the closest ever trauma centre, taking tissue samples and patient images. Not only that, but the samples have been analysed and referenced against a huge database, providing the awaiting critical care clinicians with an individualised and effective treatment plan for each patient. But, this future depends on information. To develop the technology that Oli envisages, we need to collect more information in the right way. Ultimately, the future of TBI management requires the development of tools to apply masses of information to the patient in a meaningful way. One such was to achieve this, is by using biobanks.

Peter Brindley and Timothy Caulfield answer the big questions around how science and health are represented in the public sphere. What is science? When do we accept it and when do we reject it? The representation of science and medical information on social media has erupted in recent times – in large part thanks to the Covid-19 pandemic. Along the way, misinformation has come to the forefront. Why do people believe misinformation, where does it come from and what damage is it doing? These questions are not new, however in the modern world (pre- and post-Covid) they are in the public conversation more than ever. Tim believes that the spread of misinformation is one of the greatest challenges of today – sparking an ‘Infodemic’. The ideological nature of misinformation has also grown in recent times. Whilst Tim contends that it has always been there, it has become more dominant with the ever-growing popularity of social media. Social media is not going anywhere. As such, we must learn to live with it, and emplo

Reuben Strayer and Duncan Grossman discuss all things airway. Specifically, how the introduction of many airway technologies at once–some of them revolutionary, some not–have confused our airway strategy. So how can we incorporate the best of these technologies into contemporary airway management? They begin with a big question – what equipment should you choose? There are many options, including direct or video laryngoscopy as well as multiple versions of the laryngoscope blade itself. As Reuben explains, all these terms can be confusing and are often imprecise. Direct laryngoscopy clears a line of sight between one’s eyes and the glottis to visual it. This is unlike video laryngoscopy which uses a camera to visual the glottis. The next distinction is the type of blade – standard geometry versus hyperangulated blades. The differences between - and the varying uses of – standard geometry blades and hyperangulated blades are discussed. This discussion will clear up confusion about the nomenclature for all clin

Please note this episode was recorded in November 2018 as part of Brain, a CICM Neuro Special Interest Group meeting click here  Terry O’Brien presents the evidence and recommendations around the use of continuous EEG. EEG is an old technology, first introduced clinically in the 1920s. As we move deeper into the 21st century, Terry argues that this technology should be brought to the forefront in ICUs around the world.  EEG works in a simple manner. Electrodes are placed on the scalp, measuring the potential difference between two points, and displaying the trends over time. EEG has a high resolution, providing information that no other investigative modality can provide. How does this apply to intensive care? Continuous EEG (much like continuous ECG or oxygen saturation monitors), Terry insists, has a place in the monitoring of critically ill patients. It exists as the best way to diagnose a seizure and can provide information regarding treatment effect. Moreover, EEG gives real time information about depth

Alex Rowell, Fahad Ashraf, Greg Selkirk & Luke Torre continue their discussion stroke management. In this talk they tackle imaging and treatment of stroke, including mechanical thrombectomy. Imaging is an enormous part of the process of stroke management. It is critical for diagnosis and stratifying patient treatments. The first imaging modality to order is a non-contrast CT head. As Greg explains, not everyone with neurological symptoms has an ischemic stroke. Other diagnoses to consider include Todd’s paresis and intracranial haemorrhage. The CT will also inform the clinician how much established infarct is present and give an indication of where the clot is. Moreover, carotid angiogram should be used to assess the intracranial vessels. It also allows one to plan the fastest way to remove a clot, should it be present. Transradial and transfemoral thrombectomy are two options. The imaging provides the clinician with valuable information about the most efficient and fastest way of reaching the clot for re

In this podcast, Alex Rowell, Fahad Ashraf, Greg Selkirk & Luke Torre review stroke management in 2022. Stroke management has changed dramatically in the last 10 years. In 2015, we proved the efficacy of mechanical thrombectomy. In 2018, we established evidence for mechanical thrombectomy beyond 6 hours in patients with favourable imaging. Moreover, there has been extensive research into dual anti-platelet therapy to prevent recurring stroke in minor stroke patients. From a technical point of view, there has been an explosion of the number of suction catheters and stent retrievers on the market. This has made mechanical thrombectomy safer & has allowed us to chase distal clots. So in 2022, it is not just that we are doing thrombectomy, but… we are doing it better. And as a result, we are improving patient outcomes. Next, Fahad & Greg discuss what the patient journey looks like in 2022 from being out in the community, to receiving treatment. They discuss how we have streamlined the process - includ

In the Emergency Management of Chronic Pain podcast, Duncan Grossman and Reuben Strayer discuss how and why patients with chronic pain present to the ED. Managing patients with chronic pain is challenging and often it feels like these patients present to the ED during every shift. But… is it as common as it feels? Statistics suggest that 20% of American adults suffer from chronic pain. Why? Well, opioids are both the disease and the cure. Opioids are effective for managing acute pain. However, when they are used for (even) more than a couple of days they can start to cause pain. Therefore, we have to understand the spectrum of opioid benefit vs harm. Reuben and Duncan discuss a framework that accounts for the relationship between chronic pain and opioid use. Noting that each patient presents a unique challenge. Take for example, the patient who is on daily, low dose opioids but is otherwise unaffected by their pain medication. Or, the patient who has chronic pain but doesn’t take opioids. We need to be carefu

In this podcast, Roger Harris sits down for a second time with South African Emergency Physician, Victoria Stephen (Tori). Tori delves deeper into her first hand experience of the frightening political unrest and violence which erupted during the third wave of Covid-19 in Johannesburg in mid-2021. Managing Covid cases and gunshot wounds simultaneously was incredibly challenging both professionally and personally. In the midst of the violence, Victoria made the courageous decision to leave the safety of her home after curfew and to drive through the riots to get to the hospital. Tori was not rostered on at the hospital that night, but she felt an overwhelming need to help her junior staff manage the chaos that was unfolding. It was a critical and intensely dangerous time in South Africa. Reflecting on this experience, Tori emphasises the importance of a strong foundation of healthcare worker wellbeing. She identifies the need first to look after ourselves before we can look after others. Tori speaks candidly a

Trauma Resuscitation and the Covid-19 Pandemic in South Africa In this podcast, Roger Harris interviews Victoria Stephen about her experience as an emergency physician in a regional South African hospital. Sadly, trauma resuscitation is a big part of working in Emergency Medicine in South Africa.  Blunt force assaults and stab wounds are regular presentations. However, July 2021 was unlike anything Doctor Victoria Stephen had ever experienced. In July, South Africa was deep into its' third wave of Covid-19 infections. Vaccination rates were low and there was a huge burden of Covid patients in the Emergency Department. The ICU was completely overwhelmed, making this by far the worst of the pandemic that they had seen to date. To compound this, piped oxygen levels were running desperately low. The hospital relied on daily oxygen deliveries to keep Covid patients alive. Moreover, to add to the challenge, political unrest broke out and quickly escalated to riots with extreme violence across South Africa. At the t

Tune in to a cross over episode with Simulcast, as Jesse Spurr and Victoria Brazil discuss Safety-II, Drugs and Design Sprints in Intensive Care. In this episode, Vic and Jesse catch up to talk through a human centred design project aimed at improving medication safety in the Intensive Care Unit. Vic and Jesse discuss real world applications of Safety-II approaches, the core philosophy and practices of psychological safety and the importance of clinician led approaches to risk in practice. The episode closes with drawing parallels between this work and the skills and practices of simulation. Safety-II, Drugs and Design Sprints in Intensive Care For more like this head to our podcast page #CodaPodcast Or, head to Simulcast to hear more from Vic, Jesse & the team.

Irma Bilgrami, Alissa Starritt and Paula Lyons believe that the pandemic has narrowed the great divide between ICU and ward care. Covid has put incredible pressure on healthcare systems around the world. This has forced hospitals into overdrive, whereby staff have been redeployed and models of care have changed. Evidently, the pandemic has challenged the strict guidelines which we use to direct patient care and define critical illness. Wards are managing patients with much higher acuity, sparking the danger of normalising the abnormal. How do we navigate these murky waters? Irma, Alissa and Paula take a deep dive into these challenging issues. Irma asks, how are the wards going? How are the staff going? And importantly, what lessons can we take away for the future? Additionally, they address the health and wellbeing of staff in our hospitals after a challenging two years. Evidently, healthcare professionals and nurses have found themselves with increased workloads, providing clinical support, emotional suppor

In this cross over chat between Medical Mums and Coda, Dr Chris Bowles & A/Prof Nada Hamad discuss gender equity – What is it and why does it matter? Chris and Nada take a deep dive into gender equity in medicine, the impact of the pandemic and the possible solutions. First, they discuss the difference between gender equity and equality. Equality is the act of treating everyone the same. Whereas equity, focuses on levelling the playing field so that there is more representation and participation. This includes asking questions such as why inequity exists? And why aren’t women progressing? Evidently, women experience gender inequity at different times of their career. It may be after they’ve had children, or it may be when they want to step up and take on leadership roles. What is most obvious however, is that the impact of gender inequity in medicine extends far past the individual. Gender inequity impacts how we look after female patients, what kinds of questions we ask in research and how we perform and