Coda Change

TBI Management: Beyond the Resus Room by Andrew Chow In this podcast, Andrew Chow highlights the latest evidence for TBI. Andrew shares some clinical pearls for TBI management & highlights a future direction for the management of patients with a traumatic brain injury. Studies have shown that the demographic of TBI patients has shifted. We are now seeing an increase in the number of elderly patien...

From #CodaZero Live, Behny explains the importance of Echo and lists some of the ways in which Echo can help us during a cardiac arrest. It is more than we think!  Echo is a quick, easy and simple tool, making it invaluable in many situations including cardiac arrests.   It is a bedside test that is non invasive and painless for the patient. It is easily taught to any doctor or nurse and is perfor...

Updates in pain management by Gavin Pattullo Opioids are often a mainstay of therapy in trauma pain, though they are in turn the cause of much trauma. For every 4000 Australians prescribed an opioid there will be one death in the community as a result. In-patients similarly have greater risk of harm when their analgesia is opioid based. This presentation will focus on some of the valuable lessons...

In this podcast, Ken Sakurai provides an update on the recent RCTs for Vitamin C in Sepsis. The battle against sepsis continues, with Vitamin C the most recent weapon in our arsenal. Since Prof. Marik's 2017 trial on metabolic resuscitation, there has been renewed interest in the use of vitamin C. Ken reviews the rationale and pre-clinical evidence for Vitamin C use in treatments, as well as the m...

Oli covers the initial management of patients with traumatic cervical spinal cord injury. He covers the neurological assessment – how and why we do the ASIA or ISNCSCI Exam and why it matters. It's not always straight forward, but getting a motor and sensory level and determining if a patient has perianal sensation and voluntary anal contraction can be really helpful prognostically. The importance...

The importance of sex and gender in medical research. For many years it was widely assumed that the occurrence and outcome of disease was the same for women and men. Our understanding was that studies involving only men would be equally relevant for women. In the last two decades however, it has been shown that this assumption is highly prejudice and can have a detrimental impact on the health of...

Vascular Access Part 1: Reducing risk and increasing catheter longevity   The aim of having a structured decision matrix in the approach to vascular access is to reduce catheter-associated complications and to increase device longevity. There are over 15,000 central venous catheters placed in Australia annually. The actual insertion process for placing a central line only accounts for a small part...

From #CodaZero Live, Varun Harish provides an overview of the surgical management of burn injuries. He talks us through how surgeons make decisions regarding burn management, including the importance of early assessment and intervention. Burns evolve, what you see at the beginning is going to be very different in 24 hours and different again in three days. Importantly, the management and principle...

Global warming and the Jellyfish toxidrome. From #CodaZero Live, Alice Young provides a brief update on the presentation, complications and management of Irukandji syndrome; and why we all need to know about it. With ocean temperatures rising we are seeing an increasing number of Irukandji jellyfish and subsequent stings in waters further and further south. On average there are approximately 50-10...

Did you know that around a third of patients that present with a severe burn, also have a pre-existing mental health condition?   Furthermore, around 80% of patients report having had a major life event or severe stress prior to the burn.   Psychological management of patients with burns is complex and so important.    This talk will help you discover if all burns are traumatic, how and why a trau...

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...

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/podcast...

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...

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 do...

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 arti...

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 th...

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 emergenc...

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 ch...

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 info...

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/...

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...

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...

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, Teleh...

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 pe...

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: codac...