Coda Change

Anand Swaminathan and Iain Beardsell debate the use of thrombolytics in the treatment of submassive pulmonary embolism (PE). PE is a spectrum of disease. Patients should be treated differently depending on where they are on the spectrum. Subsegmental PE may need no treatment at all, whereas massive PE is unlikely to improve without thrombolytics. Anand argues for the use of thrombolytics. Evidentl...

Ryan Wubben discusses the standards in Helicopter HEMS. He asks the question, what standards? The development of Helicopter EMS (HEMS, or as the Federal Aviation Administration recently coined it: "Helicopter Air Ambulance" or "HAA") services in the United States has taken a different path in recent years compared to other countries. The widespread use of single engine, VFR only aircraft, owned an...

Natalie May & Roisin McNamara discuss a young person's experience of critical illness. They are joined by Ema, an 11-year-old girl who had a scary time when she was diagnosed with tracheitis. Experiencing critical illness is  scary for anyone. However, when you are a young person, this terrifying experience is amplified. Natalie and Roisin tell us what we as clinicians can do or think about differ...

Maxime Valois and John Christian Fox argue the role of POCUS in critical care. Maxime makes the case for POCUS being a problem. POCUS changes everything. It has helped physicians throughout the world to make easier, more accurate and faster diagnoses. It has contributed to enhance the diagnostic possibilities in resource-scarce environments However, as it gains more widespread acceptance, its use...

Scott presents the argument that whilst Emergency Physicians are amazing, as it stands, Emergency Medicine is failing. Scott presents the system as it should be. This involves stabilising the critically ill before admission to the ICU, seeing sick patients in appropriate time and seeing the less sick patients as you can. The issue as it stands, is when this system breaks down. He talks about the '...

There are nearly 100 billion stars in the Milky Way – and almost that many articles published every year. Luckily for you, we read them all – or, at least, the ones in the domain of EM (Emergency Medicine). Catch up with where the new literature is leading you, leading you astray, or just plain bonkers. Sit back and let us inspire you to take your own deep dive into all the great foundational scie...

Ben Shippey discusses the important anaesthetic considerations in bariatric surgery. Obesity surgery can induce a strong response in healthcare professionals. These biases must be overcome to facilitate efficient and safe services. Evidently, Bariatric surgery provides many challenges. To begin with, healthcare professionals can associate negative thoughts with obesity. Secondly, these patients pr...

John Carlisle asks the big question – what is the risk of surgery? It is a big question that holds implications for everyone involved in caring for patients. Like John, patients want to live a long and happy life. They would like to know whether the chances of living a long and happy life are enhanced by having surgery or not. They do not generally care whether they will be alive in 30 days or not...

Karim Brohi gives an insight into his mindset as a trauma surgeon, drawing on lessons from Zen philosophy. During this talk he discusses how we can develop the self confidence that helps us cope with stressful clinical situations. The word confidence is often talked about in a negative context, in terms of overconfidence or arrogance. Karim however uses this talk to highlight the importance of sel...

Haney Mallemat discusses the treatment for PEA cardiac arrest. Patients who present with pulseless electrical activity (PEA) arrest have a high mortality. The treatment of PEA requires finding and reversing the underlying cause; therefore a simple and rapid approach is required. Traditionally we were taught to use the H's and the T's, but this diagnostic tool is cumbersome and of questionable util...

John Greenwood takes a broad view on pulmonary hypertension and explores the heart-lung interactions that occur in this disease process. Pulmonary hypertension commonly occurs when managing a patient with an acute critical illness. Pulmonary hypertension has a devastating impact on cardiac function. Whilst we recognise the disease itself, we don't recognise the 'upstream' effects. John explains ho...

Michele Domico presents a talk on the pitfalls of common paediatric resuscitative manoeuvres in paediatric cardiac patients. Emergency and critical care physicians are all well accustomed to items such as oxygen, bolus adrenaline, intubation and cardioversion. However, as Michele explains, these 'go to' interventions may in fact be harmful for the paediatric cardiac patient presenting to the emerg...

Deirdre Murphy presents everything that can go wrong in cardiac surgery. Deirdre will impress on you that cardiac surgery is by no means a safe procedure! Murphy's Law stipulates everything that can go wrong, will go wrong. Subsequently, Finagle's corollary will tell us, it will be at the worst possible moment. In this talk Deirdre attempts to prove these theories in the world of cardiac surgery....

Peter Brindley explains how burnout affects us all. It affects the cost, quality of care, organisational culture, performance and patient outcomes. Burnout is fatigue, loss of ideals, purposelessness, presentism and the sense of being under-appreciated. It is not tiredness, exhaustion, boredom, mid-life crisis, depression, PTSD, perfectionism or narcissism. Moreover, burnout involves the 4 C's: cu...

Francesca Rubulotta talks about disproportionate care in ICU. Disproportionate care is disproportionate in relation to the expected prognosis. Moreover, this can lead to moral distress among clinicians who think they are offering inappropriate care. There is mounting research and evidence pointing to the existence of disproportionate care. Furthermore, stress and burnout cause increased miscommuni...

Karin Amrein highlights the importance of bone health in ICU. Karin asks – do fractures matter? If the presentation is a hip fracture for elderly patients, then the answer is obviously, yes! However, Karin will describe why this answer should be a resounding yes for all patients who are admitted to the ICU. Critical illness affects bone. It is not a stretch to conceptualise this. However, Karin wa...

Natalie May gives you the break down of paediatric trauma. Paediatric trauma is relatively rare but terrifying. However, there are many ways we can think about paediatric trauma to make these challenging situations easier to face. Children are inherently portable. This means that they often turn up at peripheral, non-paediatric centres that are not major trauma centres. This highlights the importa...

Confined Space Airway Management in Emergency and Critical Care by Ross Hofmeyr Ross Hofmeyr discusses the ins and outs of managing an airway in a confined space. He details the challenges, the potential solutions and his top tips when faced with an airway in a less than ideal setting. Ross defines confined space airway management as airway management in an environment where access to the patient,...

The Role of the Immediate Responder in Mass Casualty Trauma Christina Hernon describes a traumatic experience in gripping detail. In doing so, she shares her deeply personal insights into what it is to be an Immediate Responder. Christina suggests that the medical system must change to support these people. After a major formative experience at a life-threatening mass casualty incident, Christina...

Natalie May brings the lessons she has learnt from Sydney HEMS training and teaches you how to apply them to your practice. What can hospital specialties learn from teaching and training in prehospital and retrieval medicine? Natalie, a self-described medical education enthusiast, gives you her thoughts on the application of educational theory to the challenges of the prehospital environment. Evid...

Sara Gray tackles the controversial topic of disaster ethics in critical care. Most hospitals develop a disaster plan, but few jurisdictions develop a plan for triaging or rationing scarce resources when the existing supply is overwhelmed. Rather than leaving individual health care workers to make these decisions, we should work together as a community of experts to develop ethical, practical and...

Liz Crowe believes that love can revolutionise the way we approach critical care. She wants every doctor to become love ambassadors for their critical care community and share love like nothing is holding them back. Liz believes that work life balance does not exist because we spend most of our time at work. Therefore, it is essential to love and be passionate about the work we do. Liz compares th...

For Ross Fisher there are things that scare him. And he knows there are things that scare you too. Ross discusses the purpose and effect of fear in medicine and surgery. Whoever you are and whatever you do, there are things that you are afraid of. It is not stress, it's fear, it's real and it affects us. Ross wants you to know, it is okay to be afraid. Being afraid is recognising a threat and real...