Coda Change

Andrew Healey takes us on an exploration of the early phases of donor management in ICU and Emergency Medicine in his heart felt SMACC Chicago talk Optimizing the Care of the Organ Donation Patient. Which focuses on the processes of managing donor patients and their families,  while they ride their ICU/ ED journey through to organ donor.    Healey summarises his talk into four main points:   1. Se...

Jeremy Cohen took us on an Adrenal Function journey at SMACC Chicago with his talk Raging Hormones in Critical Care. Cohen explores the natural roll of cortisol in the human body, various schools of thought and recent research in the areas of sepsis and cortisol resistance.

Trauma is Risky Business  Deborah Stein SMACC Chicago talk Trauma is Risky Business - delves into the risk patients and physicians undergo when treating or being treated for Trauma.  Stein's speaks of the Risk Benefit Determination that physicians make daily and how this is used to best answer on going questions such as; can a patient have?, how do we care for this patient? and how do we best make...

Walter Eppich engages us on the topic of Interprofessional Communication: Challenges and Opportunities.    Eppich describes communication as the engine of learning - providing it is coming from a psychologically 'safe' environment free from humiliation and punishment.   Eppich characterises a psychologically safe environment being; an environment where people can speak up with idea, questions and...

Summary by: Rosy Wang Lactate has been viewed as a byproduct of anaerobic metabolism and an indicator of tissue hypoperfusion since the 1900s. This theory is still widely believed. Paul busts the myths surrounding lactic acidosis, anaerobic metabolism, tissue hypoxia and the role of lactate in sepsis. Key take-away facts include: - The production of lactate actually consumes hydrogen ions. Lactic...

Summary By: Rosy wang You don't have to be Bear Grylls to stay alive in the wild. Remember the rule of three - you can live 3 minutes without air, 3 hours without shelter, 3 days without water and 3 weeks without food. The two biggest killers in the wild are cold and heat. Justin discusses the physiology of our body's responses to cold and heat and the pathophysiology of hypo- and hyperthermia. He...

Kath Maitland takes the perspective that we should be cautious with how we give IV fluids. She argues that the underlying physiological evidence supporting the benefits of giving fluids is not there. The findings of the FEAST study are clear. Kath describes how during FEAST, the administration of fluids made the children look better, and improved the recorded physiological parameters. However thes...

The Mystery of MODS Summary By: Oli Flowers Mervyn Singer entertains the SMACC crowd with tales of MODS (Multi Organ Dysfunction Syndrome). With videos of Raquel Welch, stories from the Battle of Trafalgar and lessons from evolution, he makes us think about the important physiology underlying critical illness. This lecture precedes the latest SIRS definition and really puts them into context and l...

Scott Weingart's lecture at SMACC-Chicago was on OODA loops and the supremacy of System I for resuscitation. Check more here

How to Diagnose Dying A patient's death maybe certain but the timing isn't. Ashley Shreves talk is on the difficult subject of dying, and how best to understand and help diagnose when the battle is lost.  Shreves discusses the correlating patterns present in the  functional decline in end of life patients, with particular reference to the type of disease a patient is suffering from. Shreves sugges...

Selective Aortic Arch Perfusion - Summary by: Jim Manning Selective Aortic Arch Perfusion (SAAP) is an endovascular-extracorporeal perfusion resuscitation technique designed specifically to treat cardiac arrest. SAAP involves the blind insertion of a large-lumen balloon occlusion catheter into the descending thoracic aortic arch via a femoral artery.  With the SAAP catheter balloon inflated in the...

Historical prospective provides a great appreciation and understanding of Prehospital Medicine. Stefan cleverly highlights the journey of a specialty from its roots on the battlefield to the present day, where prehospital medicine has not only begun to influence, but also dictate, in hospital medicine. A brief and fascinating look at "How far we've come”.

PHARM Physician, Per Bredmose, provides an in-depth look at Ketamine in the prehospital setting. Per discusses the uses, benefits and potential complications of Ketamine, providing tips and tricks from his wealth of experience.

Dr. Karel Habig of Sydney HEMS, leads a global panel in the discussion of the retrieval of patient with a difficult airway in a rural ED. Additional discussion surrounds the capabilities of HEMS services around the world. Participants include: Dr. Geoff Healy, Dr. Stephen Hearns, Dr. Craig Bates, Dr. Mike Abernethy, Dr. Minh Le Cong, Crystal Upshaw. 

Justin Bowra - The elephant in the living room Justin Bowra takes a break from ultrasound to broach the uncool but crucial subject of health care economics. Health care spending make up a large proportion of the budgets of OECD nations, and it is increasing in relation to GDP. This is an unsustainable situation and something has got to give. In part 1 of Justin’s talk, he asks the question, where...

Tom Bleck - Subarachnoid haemorrhage: what matters? Tom Bleck gives an overview of the pertinent facts regarding the complications and management of aneurysmal subarachnoid haemorrhage (SAH). The complications of aneurysmal SAH can be divided into immediate, early and late. The risk of re-bleeding is maximal on the first day, it is fatal in 75% of patients and the best management is to secure the...

Dr. Brian Burns of Sydney HEMS, facilitates a global discussion on blunt abdomino-pelvic trauma 30 minutes away from ED, leading this incredible panel of experts on a hypothetical trauma case. Participants include: Dr Gareth Grier, Dr Howie Mell, Dr Thomas Dolven, Derek Sifford, NREMT-P, Dr Clare Richmond.  

Veteran Airforce Pararescueman turned critical care paramedic, Mike Lauria discusses the

Rob MacSweeney and Paul Marik debate whether the assessment of fluid responsiveness in the resuscitation of patients with shock a waste of time? Both Marik and MacSweeney agree that many of the traditional methods of assessing patients volume status are flawed and of no value. Marik goes on to argue that the only clinically meaningful outcome that we should measure in response to a fluid challenge...

Pretty much everything I learned as a resident in terms of the sequencing of airway management in ED has changed over the past 15 years. No longer is there simply RSI or stick a laryngoscope in with nothing and use pure brute force to intubate a patient; we have a host of different options and pathways when approaching airway management in the emergency department.   This lecture discusses some of...

Daniel Kornhall's is an introduction to snow avalanche physiology and the realities of mountain rescue. Dying in an avalanche is an extremely rare cause of death but for us who live in mountain regions and who enjoy winter mountain sports it is a thing that needs to be dealt with. The overall mortality in avalanche incidents is roughly 20% but this increases to 50% in the buried victims, which is...

Two legends of medical education, doctors Johnathan Sherbino and Robert Cooney go head to head debating whether assessment is a barrier to learning. Sherbino argues that assessment is in fact a first essential step in the learning process.

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Making Teams Work - Chris Hicks In Chris Hicks talk Making Teams work, Hicks discusses the systematic failures in training ourselves and our trainees for chaotic situations. He challenges the assumptions that people learn over time by osmosis (by just watching) and debunks the idea that by watching physicians will become skilled at soft non-technical skills.   Hicks goes on to discuss what makes a...

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