Coda Change

Ffion Davies gives her take on how to spot the sick child in the Emergency Department. Paediatric medicine is no doubt hard and can at times be scary. There is nothing worse, in Ffion's opinion, than sending a child home who later represents to the hospital in a worse condition, or even worse, later dies. So, how does one spot the sick child amongst the droves of children who will present with fev...

Alex Psirides discusses the problem with major hospitals and the systems that they use. Throughout he uses a case example to highlight how and why things go wrong. Moreover, he suggests potential strategies to reframe the way care is provided in the hospital system. As patients become more complex, the tribal systems we use to look after them remain stuck in the 18th Century. Back when the treatme...

Anthony Baca provides a focused talk on prehospital critical care response to the active shooter. Coming from the United States of America setting this is unfortunately not a rare occurrence. Anthony will discuss the real-world violence that exists, and what are the most important considerations for first responders in such situations. Anthony speaks about prehospital critical care team responses...

Scott Weingart discusses post-intubation sedation – a topic that tends to aggrieve him on a regular basis. Scott explains in simple terms why he is bemused at the lack of understanding surrounding intubated patients who become agitated or aggressive. How would you like a piece of plastic placed down your throat? The problem, as Scott explains, is that sedation does not blunt pain. Sedation without...

Katrin Hruska discusses the usefulness of biomarkers in Emergency Medicine. All biomarkers are awesome predictors of badness. Elevated hS-troponins after non-cardiac surgery or an acute exacerbation of COPD are associated with increased mortality. In seemingly healthy people, elevated D-dimer levels are associated with increased mortality. Similarly, NT-proBNP levels predict mortality in patients...

Chris Hicks delves in to how to optimise performance in a team environment in emergency medicine and critical care. When teams fail and fall apart, we are quick to analyse the performance. We pick it apart and see what went wrong, and why. Chris suggests that we should do the same thing for over-performing teams. We should analyse how and why they perform at optimum levels. In doing this, in reach...

Jo Anna Leuck discusses fatigue in critical care. Is there a specific time during our shift when we are too fatigued to safely practice? That was the question that led to Jo Anna's research project comparing the clinical performance of providers during the first hour of a day shift and the final hour of a string of night shifts. The providers were pulled out of their real-time clinical duties and...

Karin Amrein talks about the challenges for women working in the critical care world. Incredibly, despite female prevalence, Critical Care is considered a man's world. We've all heard the notion, "big boys with big toys." The false assumption is that men are more interested in the latest equipment and technology. However, Karin thinks that the "soft factors" like love, care and teamwork are what w...

Motorcycle Trauma Simulation and discussion

Ashley Liebig is a senior flight nurse and helicopter rescue specialist with STAR Flight. She talks with passion about her job, her vocation. Ashley divulges a deeply personal and deeply traumatic story from the SMACC stage. Pre-hospital medicine, emergency medicine and critical care are difficult jobs. There is a human toll to be paid when working in these areas. Ashley wonders if the stress, the...

Nikki Blackwell provides an insight into critical care in humanitarian emergencies. Through her experiences in hunger emergencies, epidemics, natural disasters and conflict zones, Nikki has gained a wealth of wisdom and lessons. She shares these from the SMACC stage. Nikki talks about some of the practical things she does when working in resource poor settings. It starts with hospital hygiene to r...

Kathryn Maitland describes the challenges faced with oxygen therapy as an emergency intervention in critical illness in African children. Where Kathryn works, in East Africa, there is no access to intensive care. Caring for critically ill children is all done in the Emergency Department. 70% of the global burden of disease and deaths from pneumonia occurs in Southeast Asia and Sub-Saharan Africa....

Francesca Rubulotta argues in favour of the ICU being no place for the elderly. She describes the ICU as a horrible monster, a very dangerous place. Furthermore, she suggests the ICU is on par with climbing a mountain in terms of risk and exposure to catastrophise. She continues to make the point that once a person reaches adulthood, the healthcare system is a one size fits all model. This extends...

Darren Braude and Karim Brohi debate over the utility of hard cervical collars. Darren argues that it is time to do away with hard cervical collars. He raises some assumptions. The first being that movement of the spine is bad. As he explains, movement is not the problem. Rather, energy deposition in the spine causes injury, not simply movement. With that being said, the problem is that the hard c...

PRO: Medicine is a complex craft. Acute medicine is more complex. Excellence is delivering effective acute care depends on recognising the broad base of basic sciences, clinical experience, and results of clinical trials. Central to all decisions has to be how these will benefit the patient – both in the short term as well and longer term so that survivors of acute illness are left with the best p...

Martin Smith and Mark Wilson debate whether neurocritical care improves outcomes in severe TBI. Martin argues in favour of neurocritical care. He concedes that longstanding and established practices are not as efficacious or innocuous as previously believed. Very few specific interventions have been shown to improve outcomes in large randomised controlled trials. With the possible exception of avo...

Anthony Holley and Marietjie 'MJ' Slabbert debate the value of prehospital doctors in trauma. Anthony argues that doctors in the prehospital setting add little value. He does so with the upmost respect for prehospital doctors and having worked in this setting himself. He makes the point that across the globe, the employment of doctors in the prehospital setting is a rarity. Working in this environ...

Resuscitation of the critically ill trauma patient involves a myriad of high-stakes, time-sensitive management decisions. The landscape is shifting rapidly: new evidence on hemostatic resuscitation and component therapy in hemorrhagic shock, peri-arrest point-of-care ultrasound, novel approaches to resuscitative thoracotomy and trauma RSI have at once clarified and muddied the waters. In this rapi...

Alex Psirides and Sara Gray debate over whether 'Do Not Resuscitate' (DNR) should be the default choice for all patients. Alex contends that application of 'CPR-for-all' is the ultimate evidence drift. A treatment that is completely appropriate for dropping dead whilst running a marathon has almost no place in acute healthcare facilities where chronic irreversible complex co-morbidities abound. 90...

In a 2 min rant about medical tribalism, Dr. van der Velde questions which medical specialty, if any, owns prehospital physician response. What is more important: skillset or specialty? Is there a role for tiers of physician response? Is there a future in a stand-alone specialty?

Marietjie (MJ) Slabbert describes the unseen enemy, fatigue in critical care medicine. MJ does 24 hour shifts every other day with just three to four hours of sleep. Though many would claim that this is more than enough, MJ thinks otherwise. Physicians are killing themselves while trying to save others because fatigue kills. MJ points out that sleep is one of the basic necessities in Maslow's hier...

James Tooley discusses the sheer terror that comes with the challenge of managing children in the pre-hospital environment. As James explains, although many clinicians may think that they do not need to (or may not want to) think about the paediatric population, it is something that every clinician would do well to mentally prepare for. James shows a video clip of a large-scale paediatric trauma a...

Flavia Machado and Paul Young present the top 10 ICU trials of the recent past SMACC style. Their list of trials includes a number that challenge dogma and establish interesting new lines of scientific enquiry. In addition, they also include all the recent clinical trials that should change your practice. If you want to know what's new in critical care then this is the talk for you.