Smacc

Bias by design in medicine with Tarlan Hedayati In the last episode of Carr's Clinic, David Carr chats to Tarlan Hedayati about bias in medicine. A patient comes into the emergency department and they are complaining of shortness of breath. Typical measurements are taken including heart rate, blood pressure, temperature, rest rate and O2 sat. Once the patient has been treated, they want to go home and we rely on vital signs and devices such as a pulse oximeter to determine if it is safe to do so. But... what if the pulse oximeter measurement is flawed, biased and could potentially harm your patient? Tragically the pulse oximeter has been proven to be inaccurate for non-white people. The consequences of this can be devastating and these devices need to be reviewed to acknowledge the bias in their design and correct the flaw in their products. What's even more concerning? Tarlan encourages us to consider what other sources of racial bias we might already have in clinical medicine that we haven't even considered

ECMO CPR ECMO in Cardiac arrest has increased exponentially in the past 10 years, on the back of, up until very recently, non-randomised, predominantly retrospective studies. What is the efficacy? Appropriate patient selection? Cost effectiveness and model of delivery of ECPR? Finally is ECMO really the intervention or just optimising the chain of survival? For more head to: codachange.org/podcasts

Burns Fluid Resuscitation. The first 24 hours for burns management is crucial.  The ability to deliver just the right amount of fluid in a patient with burns is the holy grail. From #CodaZero Claire Seiffert presents on Burns Fluid Resuscitation. Claire covers fluid overloaded with compartment syndrome, to underdone with an AKI and extension of burns. This short update will provide an overview of how to achieve the “just right” fluid balance and targets for resuscitation, ultimately enhancing patient outcomes. For more head to: codachange.org/podcasts 

Carr's Clinic is back but this time - with the man himself. David Carr walks us through a case which had him spooked (and for good reason). A 33 year old female comes into the Emergency Room with crushing chest pain. She has terrible pain radiating down her arm and it has only been 36 hours since she gave birth to her fifth kid. Her ECG showed a STEMI. But, 33 year old women who just gave birth don't have MI's. Do they? Turns out, she has SCAD - Spontaneous coronary artery dissection. SCAD represents 1 to 4% of all ACS angiograms. 30% of the time it presents as a STEMI and 70% of the time as a non-STEMI. The kicker? SCAD looks like STEMI. It has the same story, the same ECG, the same biomarker that is positive... it just depends on who is getting it. 91% of people with SCAD are less than the age of 25 and 85-94% are women. It also represents 43% of MIs in women under the age of 50. So how do we catch it? Think about the plus ones. ACS plus young woman with no risk factors. ACS plus pregnant or postpartum. ACS

What went wrong with publishing in COVID19.   Naomi Hammond walks us through the good, the bad and the ugly aspects of COVID19 publications.   The ability for researchers to rapidly design and conduct trials in the midst of a pandemic was valuable.   With that however, came an 'infodemic' where consumers struggled to keep up with the abundance of information.   In April 2020, there were 6,000 articles published in one month.   This caused concerns regarding the quality of publications, the increase in opinion articles and the number of articles which were retracted over the course of Covid.   Tune in to a fascinating talk about what went wrong with publishing in COVID19.   For more head to: codachange.org/podcasts

From #CodaZero Live, Phil Parry shares the impact a medical retrieval team can have on the treatment and outcome of patients suffering from major burns.   Over a two year period, the team were involved with 203 major burns in NSW.    Phil discusses the benefits of a medical retrieval response to prehospital patients suffering from major burns.   He explains what the response might look like and the treatment that they are capable of in the field that will set them down the correct treatment path.   Despite being a small team, what they can offer to a patient with major burns is significant. Senior medical decision making capability, advanced pain management, the ability for an anaesthetic and airway control, the list goes on.    First, they determine how much of the patient is burnt. Then, they commence treatment.    Tune into the podcast to hear firsthand, the impact this team has on the outcome of patients suffering from major burns.    For more head to: codachange.org/podcasts

Making a medical diagnosis with limited information is at the heart of emergency medicine. Emergency physicians often have to make decisions without all of the information.  Dr Anand Swaminathan shares a case where EMS rolled into emergency with a patient who was short of breath, hypotensive, tachycardic and hypoxic. She had syncopized at a rehabilitation centre and by the time she got to emergency, she was seriously unwell and unable to provide much information. Dr Swaminathan shares the steps he took in diagnosing a patient who was too sick to go for a CT scan. His first piece of advice? Ultrasound is key. Ideally, we all want to have diagnostic closure before prescribing medication which could be harmful, however this isn’t always possible if a patient is too sick. So how do we make the call without a definitive diagnosis? Think about the exclusions, weigh up all the options and do what is right for the patient. For more head to: codachange.org/podcasts

From #CodaZero Live, Khairil Musa presents on Sepsis in different contexts. Sepsis is the leading cause of death for people in low income countries.   Khairil shares his story of managing Covid-19 and Trauma in Yemen and Iraq whilst working with Doctors Without Borders in 2020. Khairil had never imagined his work with MSF would coincide with a global pandemic.   He shares his experience and the challenges of managing Covid-19 in places where resources are scarce.   To treat sepsis in different contexts, we must first start by learning and sharing knowledge.   For more head to: codachange.org/podcasts

How a Crisis Resource Management failure led to a full-blown medical emergency.   It is estimated that 70% of avoidable deaths in healthcare involve a breakdown of the principles of CRM. Crisis resource management, involves seven crucial steps: Know your environment Anticipate and plan Take a leadership role Communicate effectively Call for help early enough Allocate attention wisely, use all information Distribute workload, use all available resources Unfortunately, a failure in adhering to the 7 principles of CRM lead to serious complications for the birth of Tamara & Garry Hills’s son. We hear from Tamara and Garry as they explain the human and systemic factors that ultimately led to a full-blown medical emergency. A lack of situation awareness, combined with poor communication, unfortunately led to Christopher Hills suffering a severe brain injury. This likely occurred during the 17 minutes of terminal Bradycardia. Tamara, Garry and Christopher bravely share their story to inspire healthcare workers

From #CodaZero Live, David Carr chats with Sara Gray about treating recurrent ventricular tachycardia. A 50-year-old male arrives in the emergency room with chest pain. Upon examination, it is clear that he is experiencing recurrent episodes of V-tach. Defibrillation isn’t working, so what happens next? Treating recurrent ventricular tachycardia with Dr Sara Gray. For more head to: codachange.org/podcasts

From #SMACC2019 Vic Brazil, Eve Purdy, Jenny Rudolph, Chris Hicks, Simon Carley & Jenny Vaughan discuss learning and culture in healthcare. Simulation is a great learning tool but how do we organise simulation activities when we are resource and time poor? How do we translate learnings from Sim into the real world, when the stakes and stress levels are high? How do we encourage junior staff to be honest with their feedback? How do we set a culture that promotes an open learning environment? The fastest way to discourage feedback is to ask people to be honest but do nothing about it. Tune in to a discussion on learning and culture in healthcare from our stellar panel. For more head to: codachange.org/podcasts

From #SMACC2019 Phil Dobson shares some productivity tips for healthcare professionals. Society trends show that we are increasingly getting busier and busier. This is making our ability to prioritise harder, limiting our capacity to focus and resulting in an inability to switch off. High pressured, demanding jobs only makes this worse.  Phil suggests that we need to take a step away from busyness and towards effectiveness. To be less reactive and more self-directive. How? The first way to do this is by prioritising. We often prioritise based on what is urgent but by becoming more outcome oriented, we understand that not all tasks are equal and we avoid spending time on the wrong things. Think about your long term goals, yearly goals and quarterly goals. Are you spending time doing the things that will help you achieve those goals? Secondly, we need to manage our energy. Energy is a variable and it is a precious resource. It is not unlimited and we need to give our brain time to rest and recover. Utilise the

Sustainable healthcare: A move to Net Zero. If the health sector were a country, we would be the fifth-largest polluter in the world. It is crucial that we move towards a sustainable healthcare system, but what exactly does this mean? The NHS has led the way in modelling a Net Zero healthcare system. They have done this by considering all aspects of the industry, including energy, transport, Telehealth, equipment, devices and disease prevention. The reality is we live in a linear economy. Particularly in medicine - we buy things, we use them and we throw them out. The NHS has pledged to only use suppliers who match or exceed their expectations with Net Zero healthcare. You can’t address waste without addressing what you purchase. How can we shift into a circular economy? We need to invent ways to produce things that have a life expectancy beyond single-use. For example, Covid-19 has resulted in an unthinkable amount of waste from PPE, but innovative projects have seen how recycled face masks can be broken dow

In situ simulation for Trauma Team Training by Chris Hicks. Chris explains how managing difficult cases often doesn’t have anything to do with medical knowledge. The hard part is the practicality of getting things done in an interdisciplinary team environment. We strive for implicit coordination – where team members work so seamlessly together that they barely speak. This is the essence of high performing teams.  Chris talks us through the team based factors of trauma care and how to put this into action in your hospital.  For more head to: codachange.org/podcasts  

From think tank, to ‘do’ tank – making great ideas happen in healthcare.  From #SMACC2019 our expert panel sit down to discuss how to put thought into action. How do we prioritise physical and emotional recovery in such a highly demanding job? How do we propel innovation in critical care and medicine? How do we balance social media with creativity, nuance and deep thinking? For more head to: codachange.org/podcasts

In the previous podcast, the SMACCForce Simulation Team performed a Resuscitative Hysterotomy in a high-pressured situation. Now, we debrief. Sim is a powerful tool, it allows for healthcare professionals to practice rare medical procedures, to refine team work and to enhance collaboration. Importantly, it provides an opportunity for healthcare professionals to practice responding to challenging situations.  In this episode, the SMACCForce Simulation Team debrief on the learnings and opportunities from the Resuscitative Hysterotomy simulation. For more head to: codachange.org/podcasts

From #SMACC2019 the SIM team demonstrate a Resuscitative Hysterotomy on a pregnant, 36 year old female who was involved in a high speed motor vehicle accident. The catch? She is the surgical registrar and friends with members of the team. Watch or listen as the SIM team guide us through a Resuscitative Hysterotomy in a high-pressured situation. For more head to: codachange.org/podcasts

Liz Crowe interviews Justin Morgenstern about curiosity in medicine. Curiosity is the most important thing that Justin brings to medicine. Why? Because he believes that you can’t be a great clinician or educator without first being curious. The future of medicine is based on asking questions – what if? In the critical care environment, when you are under pressure, your brain will often resort to the first solution that comes to mind. Being curious helps us double check our decisions. What could I be missing? What else could I be doing? We often forget to ask about the person sitting in front of us.  One or two minutes of curiosity can change an entire management plan. Curiosity makes you a better practitioner. For more head to: codachange.org/podcasts

In the last 10 years, 50,000 articles have been printed about burnout. As healthcare workers, we are exposed to an enormous emotional toll.  We need a plan to look after our wellbeing and we need to start thinking about it now. Surround yourself with people you can trust and do things to boost your happiness. Most importantly, work with your team. If a team member needs to be covered, cover them. One day you may need covering too.   For more head to: codachange.org/podcasts

Surviving Massive Burns: Jamie Manning and the Royal North Shore Hospital team. In this panel discussion, we hear an incredible patient story from Jamie Manning and his wife, Karen Manning. In March 2014, Jamie was involved in a horrific car accident which resulted in catastrophic injuries and extreme burns to 40% of his body. Jamie and Karen reflect on their journey to recovery and their experience with the hospital system. They are joined on the panel by a number of the healthcare professionals who were involved with Jamie's recovery.  In this discussion, the team reflect on learnings for the future, such as the importance of continuity of care. Tune in to an unmissable podcast from #SMACC2019.  For more head to: codachange.org/podcasts