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    • Nov 23, 2021 LATEST EPISODE
    • weekly NEW EPISODES
    • 23m AVG DURATION
    • 846 EPISODES

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    Latest episodes from SMACC

    Safety-II, Drugs and Design Sprints in Intensive Care

    Play Episode Listen Later Nov 23, 2021 39:38

    Tune in to a cross over episode with Simulcast, as Jesse Spurr and Victoria Brazil discuss Safety-II, Drugs and Design Sprints in Intensive Care. In this episode, Vic and Jesse catch up to talk through a human centred design project aimed at improving medication safety in the Intensive Care Unit. Vic and Jesse discuss real world applications of Safety-II approaches, the core philosophy and practices of psychological safety and the importance of clinician led approaches to risk in practice. The episode closes with drawing parallels between this work and the skills and practices of simulation. Safety-II, Drugs and Design Sprints in Intensive Care For more like this head to our podcast page #CodaPodcast Or, head to Simulcast to hear more from Vic, Jesse & the team.

    How the pandemic narrowed the great divide between ICU and ward care

    Play Episode Listen Later Nov 10, 2021 18:43

    Irma Bilgrami, Alissa Starritt and Paula Lyons believe that the pandemic has narrowed the great divide between ICU and ward care. Covid has put incredible pressure on healthcare systems around the world. This has forced hospitals into overdrive, whereby staff have been redeployed and models of care have changed. Evidently, the pandemic has challenged the strict guidelines which we use to direct patient care and define critical illness. Wards are managing patients with much higher acuity, sparking the danger of normalising the abnormal. How do we navigate these murky waters? Irma, Alissa and Paula take a deep dive into these challenging issues. Irma asks, how are the wards going? How are the staff going? And importantly, what lessons can we take away for the future? Additionally, they address the health and wellbeing of staff in our hospitals after a challenging two years. Evidently, healthcare professionals and nurses have found themselves with increased workloads, providing clinical support, emotional support and teaching support all in one go. Irma, Alissa and Paula explain that there are lessons to be learnt from the pandemic. The pandemic has forced some of the existing hierarchical walls to come down and there is opportunity for us to critically think about how we can work differently in the future. Tune in to hear the full discussion: How the pandemic narrowed the great divide between ICU and ward care. Finally, for more like this head to our podcast page #CodaPodcast

    Gender Equity in Medicine – What is it & Why Does it Matter?

    Play Episode Listen Later Oct 26, 2021 44:34

    In this cross over chat between Medical Mums and Coda, Dr Chris Bowles & A/Prof Nada Hamad discuss gender equity – What is it and why does it matter? Chris and Nada take a deep dive into gender equity in medicine, the impact of the pandemic and the possible solutions. First, they discuss the difference between gender equity and equality. Equality is the act of treating everyone the same. Whereas equity, focuses on levelling the playing field so that there is more representation and participation. This includes asking questions such as why inequity exists? And why aren't women progressing? Evidently, women experience gender inequity at different times of their career. It may be after they've had children, or it may be when they want to step up and take on leadership roles. What is most obvious however, is that the impact of gender inequity in medicine extends far past the individual. Gender inequity impacts how we look after female patients, what kinds of questions we ask in research and how we perform and apply that research in the context of women's healthcare. Chris and Nada discuss what needs to happen to make the system more accommodating. This includes implicit bias training, intersectionality training and leadership training. Investment in leadership skills and training is crucial. We can have all of the right policies in place, however if leadership doesn't set the standard to encourage uptake, inequity will always exist. Join Emergency & Trauma physician, Dr Chris Bowles and Haematologist, Dr Nada Hamad, as they discuss gender inequity in medicine. They inspire us to identify and challenge the inequity that exists today. For more like this, head to our podcast page. #CodaPodcast

    Impella and modern mechanical support

    Play Episode Listen Later Oct 13, 2021 14:19

    From CodaZero Live, Steve Morgan talks to us about temporary mechanical circulatory support in cardiogenic shock. Steve gives an example of a patient with refractory cardiogenic shock, who hasn't responded to pharmacological support. So, how do we go about choosing between temporary circulatory support options? First, Steve acknowledges that critical care echocardiography is central. Additionally, he discusses the use of pulmonary artery catheters.  Finally, Steve hopes that future Randomised Control Trials might contribute to a better evidence base to guide the use of these supports in specific patients. Finally, for more, head to our podcast page #CodaPodcast 

    Brain injury outcomes and predictors

    Play Episode Listen Later Oct 6, 2021 9:28

    Brain injury outcomes and predictors by Kiran Lele Being able to prognosticate in the aftermath of a traumatic brain injury (TBI) is important as it assists with counselling patients and families. Moreover, it helps rationally allocate healthcare resources. However, due to the heterogenous nature of TBI and variable pre brain injury patient factors and post brain injury course, this has proven to be a difficult task. Large cohort studies have enabled improved accuracy in the prediction of 6 month mortality and unfavourable outcome. Furthermore, many of the factors that contribute to long-term outcome have also emerged. However, it is not yet possible to use them in prediction algorithms or mathematical models. There is emerging evidence that pre injury psychosocial and demographic factors may be of more relevance than injury severity. Moreover, that 'outcome' becomes increasingly subjective and complex as the post injury duration increases. We end with three brief vignettes which highlight the fraught nature of long term outcome prediction. For more head to, 

    COVID-19: A patient's experience

    Play Episode Listen Later Sep 29, 2021 14:39

    In this podcast, Celia Bradford talks to Bing Brotohusodo about a challenging time in his life. Early in 2020, Bing contracted COVID-19. This resulted in a two-month hospital stay and admission to the ICU. Celia was one of Bing's physicians and together, they reflect on Bing's time in hospital and his recovery. Bing was as a helpful patient. So much so, that he was able to prone himself! However, Celia recalls how challenging it was treating Covid in those early days. Staff were desperately trying to work out what Covid was and how best to treat it. The question of "are we doing the right thing?" was always in the back of people's minds. Furthermore, this was exacerbated by the confusion of multiple treatments being promoted in the media. There were countless opinions about how Covid should be treated. Information was flowing fast, making it challenging to discern what the best way forward was. Celia and Bing reflect on Bing's time in ICU and his post-COVID recovery. Tune in to a podcast from #CodaZero Live on a patient's perspective of COVID-19. For more head to 

    Vascular Access: RaCeVa, RaPeVa, Micropuncture, Tip position

    Play Episode Listen Later Sep 22, 2021 14:25

    In this second episode on vascular access, the team from the Australian Vascular Access Society (AVAS) discuss vessel assessment with RaCeVa and RaPeVa as well as the use of Micropuncture and establishing optimal catheter tip position.  Before puncturing a vessel for vascular access it is important to: Trace the anatomy of the vascular pathway for aberrancy Ensure that the vessel calibre is suitable for the chosen catheter Ensure no obstruction with thrombus or occlusion Moreover, it is vital that the catheter doesn't occupy more than one-third of the diameter of the vessel. This will significantly reduce venous blood flow and increase the risk of catheter-related thrombosis. For PICC line insertion the arm can be divided into three zones to select an optimal vessel puncture site. The brachial fossa region is a "Red - no Go" zone, the mid-arm is the "Green - Optimal" zone and the proximal third of the arm is a "Yellow - Axillary" zone. When inserting a line, the catheter tip should be at the cavoatrial junction approximately 3-5cm below the carina on a chest X-ray. The use of a navigation system like catheter tip ECG (intracavitary ECG) is extremely accurate. It is often still useful in patients in atrial fibrillation but more difficult for patients' with paced rhythms. For more like this, head to 

    Prehospital resuscitation of TBI

    Play Episode Listen Later Sep 15, 2021 10:09

    The prehospital management of patients with moderate and severe TBI can be complex.  In this podcast, Marty Nichols talks us through managing patients with TBI in a prehospital environment. This involves avoiding hypoxia and hypotension, ensuring a safe transportation and getting to the right treatment centre the first time.  Notably, due to the nature of the accident, patients with a severe head injury also often present with other injuries. Managing multiple injuries at the same time has implications for how TBI's are managed and treated in prehospital settings. First and foremost, clinician's should prioritise the prevention of hypoxia and hypotension when managing TBI patients. This includes effective airway management, however, airway management and the prevention of hypotension present some of the greatest challenges to clinicians.  Marty discusses the challenges in treating patients with TBI in prehospital environments. Furthermore, he discusses the processes in place which help to ensure that these patients have the best possible outcomes.  For more head to 

    Top 10 Critical Care Papers of 2020

    Play Episode Listen Later Sep 8, 2021 19:02

    In this podcast, Ed Litton summarises 10 clinical trials in 10 minutes. Ed invites you to choose, based on the title alone, whether the findings were consistent with, or contrary to, the study hypothesis. Ed discusses 10 non-covid clinical trials, all published in 2020. Notably, all of these were published in the New England Journal, JAMA or Lancet and had important findings. The following hypothesises are discussed: 10. Firstly, the impact of resident physician schedules and the affect on patient safety. 9. Early initiation of renal replacement therapy and whether this improved outcomes for Acute Kidney Injury. 8. Does the implementation of early ECMO improve outcomes for patients with refractory VF and out of hospital cardiac arrest? 7. Then, can a machine learning algorithm reduce hypotensive severity? 6. In mechanically ventilated patients, is an approach of non sedation superior to light sedation? 5. Moreover, in patients who are ready for decannulation, does timing based on the suctioning frequency improve outcomes? 4. Does administering high dose tranexamic acid in patients with upper or lower GI bleeds decrease mortality? 3. Next, does a decreased exposure to vasopressors improve outcomes in older critically ill patients? 2. Will starting Dexmedetomidine at the time of cardiac surgery reduce AF and delirium in patients? 1. Also, will being conservative with oxygen in patients with ARDS improve outcomes? Tune in to a talk by Ed Litton as he shares the top 10 papers of 2020 in 10 minutes. Finally, for more podcasts head to 

    The importance of communication in pain management

    Play Episode Listen Later Sep 1, 2021 12:45

    In this podcast, Claire discusses the role of clinician communication and its impact on acute pain management. Claire explains how pain management outcomes can be optimised by enhancing patient expectations of benefit via patient-provider communication. Firstly, what we say to patients matters. Secondly, how we say it also matters. Pain is a complex phenomenon and managing expectations of pain and people's experience of empathy is crucial. As healthcare professionals, we see multiple patients and are often run off our feet, but, as the studies clearly demonstrate… communication matters. And it matters a lot in pain management. This presentation shares research demonstrating the impact of clinician communication. Specifically, this includes how clinicians' talk about pain and pain management. Claire discusses the importance of patients' experience of pain, the effectiveness of pain management and patients' treatment outcomes. From CodaZero Live, tune in to a fascinating discussion on the importance of communication.  For more like this, head to 

    Advanced support of Acute Liver Injury

    Play Episode Listen Later Aug 24, 2021 15:50

    From CodaZero Live, Alex Rowell reviews the available advanced liver supports for patients with acute liver failure. Artificial supports for the liver are quite complex and difficult. This is largely due to the liver's complex function. Some of the advanced liver supports include CVVHDF, Molecular Adsorbent Recirculating System (MARS), Single Pass Albumin Dialysis (SPAD) and high volume plasma exchange. In this podcast, Alex takes us through the research and evidence for these supports and shares some guidance on when they should be used.  CVVHDF is familiar and effective but we need to remember to use it early with acute liver failure patients. Furthermore, Molecular Adsorbent Recirculating System (MARS) is widely studied but unfortunately not available in all places. Single Pass Albumin Dialysis (SPAD) is easily implemented. Although there is less evidence on SPAD, it is generally agreed to be an effective support. Unfortunately, there are no mortality benefits in any of these supports. They are however, useful tools in bridging to transplant. For more head to 

    Surgical considerations in the injured spine patient

    Play Episode Listen Later Aug 19, 2021 14:34

    In this podcast, Ruth provides a summary of surgical considerations when managing an injured spine patient. She covers imaging considerations, indications for surgery and challenges to delivering excellent surgical care.   Ruth shares a story of one of the most severely injured patients she has ever looked after. A 78 year old woman came into a trauma centre having been driven over by a 4WD... twice.   She had a fractured lower limb, significant chest trauma, a significantly deformed torso, she could not feel or move her legs (other than wiggle her toes slightly) and she had tyre marks on her torso...    When looking at her injuries, it was clear that she had a significant group of chest injuries. This is an important reminder that spine trauma happens in the context of multi trauma. This subsequently impacts every step of the care process including surgical planning and management.    The objective from the outset is to try and get patients like this to theatre as quickly as possible but there are surgical considerations to take in to account.    Tune in to an incredible story as Ruth shares that the key to success is simple things done well, done consistently and in a team environment.  For more head to 

    Update on delayed cerebral ischaemia

    Play Episode Listen Later Aug 17, 2021 17:57

    Chris provides a brief update on some of the postulated underlying mechanisms involved in subarachnoid haemorrhage associated brain injury. These mechanisms provide hints to future therapeutic targets that will hopefully expand our currently limited repertoire of options. Subarachnoid haemorrhage is a catastrophic type of stroke. Subarachnoid haemorrhage represents only 5% of the total stroke burden. Notably however, as it is most common in people aged 40-60 years, it has a disproportionate effect from a personal, social and economic perspective. Subarachnoid haemorrhage classically presents as a thunder clap headache and loss of consciousness. Unfortunately, it is associated with high morbidity and mortality rates. There is limited research in this area and there is significant opportunity to improve the way that we manage these cases.  The key is understanding the link between early brain injury and why we develop delayed cerebral ischemia. How can we stop this from happening? How can we better understand why good brains go bad? From #CodaZero Live, Christopher Andersen provides an update on delayed cerebral ischaemia. Join Chris as he looks for future treatment options through the mechanism of brain injury in subarachnoid haemorrhage. For more like this, head to our podcast page. #CodaPodcast 

    TBI Management: Beyond the Resus Room

    Play Episode Listen Later Aug 12, 2021 12:33

    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 patients with a TBI injury that need intensive care admission.  Andrew suggests that with this change in demographic, we need to consider different injury patterns and treatment protocols. Andrew provides a summary of the latest evidence impacting intensive care management of patients with TBI. He shares some clinical pearls and provides a brief run through of multi-modal advanced neuro monitoring. One thing is for sure and that is that our knowledge of TBI is still growing. The future of TBI management is evolving and Andrew predicts that it will be individualised, patient centric and involve multi-modal monitoring. For more like this, head to our podcast page. #CodaPodcast  

    Echo in Cardiac Arrest

    Play Episode Listen Later Aug 10, 2021 11:59

    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 performed in real time at the bedside. It can be used to guide and inform management and treatment, so why isn't everyone embracing Echo?   Behny challenges us to consider another bedside tool which compares to the effectiveness and usefulness of Echo.    Moreover, in the chaos of cardiac arrests, Echo can help to exclude some of the 4Hs & 4Ts. It can help to check the rhythm, check the quality of compressions and assess for post-resuscitation care. It is an invaluable tool in managing a patient suffering cardiac arrest.    Behny suggests that the focused 2D echo is our generations stethoscope. We need to open our minds and embrace the capabilities of Echo and challenge each other to learn how to effectively utilise this tool in times that matter.  Tune in to a fascinating podcast by Behny Samadi on the value of Echo in Cardiac Arrest.  For more like this, head to 

    Updates in pain management

    Play Episode Listen Later Aug 5, 2021 11:51

    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 learnt in pain management resulting from the opioid crisis. These include: Our need to differentiate clinically between pain and nociception. Pain - the affective unpleasant experience - is assessed by clinicians enquiring with the use of the words: coping, bothersomeness and troubling. While nociception is focussed on asking about physical feelings and sensations. Profound levels of nociception and the potential to lead to reports of significant pain, a major feature of trauma patients, requires firstly a focus on the two most effective anti-nociceptive strategies of neural blockade and NSAIDs/COX-2 inhibitors before introducing less effective strategies. Pain, the affective distressing unpleasant experience, when present with or without the use of anti-nociceptive strategies has historically been managed solely with biological strategies of opioids and adjuvant agents.  An increasing focus in clinical practice on non-pharmacological strategies to manage pain, including placebo enhancing communication strategies and message framing. Avoidance of over-reliance on pain scores. Clinicians are too often misled and poor decisions are made when the robustness of pain scores is over-relied upon. Pain scores can be useful provided there is clear understanding in both the enquirer and the patient of whether the question is relating to the level of nociception or pain being experienced. Ensuring optimal effectiveness of the opioid avoiding strategy of neural blockade. Four clinical assessment endpoints indicate effectiveness of neural blockade: presence of Dynamic pain relief, Analgesia, Sensory anaesthesia and Opioid sparing/elimination (DASO). For more head to:

    Vitamin C: fact or fiction?

    Play Episode Listen Later Aug 3, 2021 18:33

    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 most recent RCTs for Vitamin C in Sepsis. For more head to:

    Acute Spinal Cord Injury: What Matters

    Play Episode Listen Later Jul 29, 2021 11:34

    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 of avoiding hypoxia, including ways to manage an airway in this context are then discussed. Oli then talks blood pressure targets – still a controversial area, but aiming for a MAP > 85 mmHg may really help. Hypotension definitely doesn't help. Timing of surgery is another hot topic in acute SCI. Low quality evidence suggests surgery in

    The importance of sex and gender in medical research

    Play Episode Listen Later Jul 27, 2021 16:30

    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 women. It is, therefore, really important to incorporate a sex and gender research lens in medical research. First, Kelly makes the important distinction between sex and gender and how this can impact medical diagnosis, treatment and outcomes.  Then, she identifies how the incorporation of sex and gender into research has allowed for advancements across healthcare: Improved accuracy, avoiding misinterpretation, reduced unintentional bias and greater social equity to name a few. In this presentation, Kelly Thompson refers to case studies to examine the differences in the interpretation of health data when examining through a sex and gender research lens. The severity of disease, risk factors and treatment effectiveness are just a few of the reasons why this is so important. Kelly encourages researchers to ensure gender diversity in the research team and to explain how sex and gender are accounted for in research applications moving forward. For more head to:

    Vascular Access Part 1: Reducing risk and increasing catheter longevity

    Play Episode Listen Later Jul 23, 2021 20:16

    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 of the 'life span' of that line (approximately 1%), but the choices made at the time of insertion have a huge impact on the longevity of the device and the associated complications. In this introductory talk Evan Alexandrou outlines the top ten tips for reducing complications associated with vascular access devices: Always use ultrasound: Never do a blind puncture Ensure with the site chosen for the catheter that it exits the skin on a flat surface. Consider the Axillary vein in preference for the subclavian vein Use micro-puncture techniques Avoid using a scalpel if possible Avoid catheters being inserted all the way to the hub Use impregnated dressings when possible Use sutureless securing techniques Secure the dressing on a flat surface (refer rule 2) Ensure optimal positioning of the catheter tip by utilising ultrasound or intracavitary ECG We hope you enjoy part 1 of the Vascular Access series: Reducing risk and increasing catheter longevity by Evan Alexandrou.   For more head to:

    Surgical management of burn injuries

    Play Episode Listen Later Jul 22, 2021 13:21

    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 principles of intervention differ for minor burns compared to severe burns. For smaller burns, the golden rule is two weeks. If there is a good chance that the burn will heal in two weeks, intervention is avoided. If this is not the case, intervention in the way of a skin graft or other surgical procedure is usually the best option. Varun details how the management priorities shift for larger burns. Larger burns significantly increase the chances of infection, making it important to intervene earlier rather than later. Tune in to an interesting talk on the Surgical management of burn injuries by Varun Harish. For more head to:

    Global warming and the Jellyfish toxidrome

    Play Episode Listen Later Jul 20, 2021 14:17

    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 50-100 people stung every year in Australia. Reports show that people typically experience symptoms between five minutes and two hours post sting. Symptoms include systemic symptoms, severe pain, headaches, shortness of breath and often what is described as an impending sense of doom. Irukandji jellyfish have the potential to cause Irukandji syndrome - a life threatening envenomation syndrome that causes severe pain, heart failure and intracranial haemorrhage. As these jellyfish stings are becoming more and more common in southern regions of Australia, it is important that healthcare workers understand the characteristics of the sting and how to respond with treatment. Listen to the full episode "Global warming and the Jellyfish toxidrome" wherever you get your podcasts. For more head to:

    Psychological Management of Burns

    Play Episode Listen Later Jul 15, 2021 12:44

    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 trauma-related disorder may evolve and increase your understanding of how trauma responses can interfere with many aspects of physical and psychological recovery.   How do we give our patients some control back in situations where they have no control over what is happening to them?   How do we help our patients manage the rehabilitation process?   Crucially, how do we support our patients through their journey of acceptance and loss?   Tune in to a discussion by A/Prof Caryl Barnes on the Psychological Management of Burns.   For more head to:

    Bias by design in medicine with Tarlan Hedayati

    Play Episode Listen Later Jul 14, 2021 14:49

    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 or acknowledged yet? Tune in to a great discussion with David Carr and Tarlan Hedayati on bias by design in medicine. For more head to:


    Play Episode Listen Later Jul 12, 2021 24:18

    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:

    Burns Fluid Resuscitation with Claire Seiffert

    Play Episode Listen Later Jul 8, 2021 13:32

    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: 

    SCAD will also screw you up by David Carr

    Play Episode Listen Later Jul 7, 2021 15:37

    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 plus some significant stressor. SCAD is something we need to remember and we need to consider. For more head to:

    What went wrong with publishing in COVID19

    Play Episode Listen Later Jul 6, 2021 15:12

    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:

    Medical retrieval response to major burns

    Play Episode Listen Later Jul 1, 2021 13:02

    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:

    The challenge of making a medical diagnosis with limited information

    Play Episode Listen Later Jun 30, 2021 15:30

    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:

    Sepsis in different contexts

    Play Episode Listen Later Jun 29, 2021 19:15

    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:

    How a Crisis Resource Management failure led to a full-blown medical emergency

    Play Episode Listen Later Jun 25, 2021 8:29

    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 to embrace crisis resource management. For more head to:

    Treating recurrent ventricular tachycardia with Dr Sara Gray

    Play Episode Listen Later Jun 22, 2021 12:57

    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:

    Learning and culture in healthcare

    Play Episode Listen Later Jun 18, 2021 14:11

    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:

    Productivity tips for healthcare professionals

    Play Episode Listen Later Jun 17, 2021 16:07

    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 times during the day where your energy is at its peak to tackle challenging tasks. Finally, observe your attention. How distracted are you? Trends are showing that we are giving more and more things our partial attention. Become aware of your attention and how you choose to spend it. For more head to:

    Sustainable healthcare: A move to Net Zero

    Play Episode Listen Later Jun 16, 2021 18:57

    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 down and used to make new roads. The healthcare industry has two key priorities: first, we need to reduce our carbon footprint. Then, we need to prepare ourselves for the climate change that is locked in for decades to come. Whether this is managing heat waves or ensuring that our hospitals don't flood. So how can we achieve sustainable healthcare? Find a group of like-minded healthcare colleagues, go to your General Manager and make the case for clean energy in your hospital. Use your voice – healthcare professionals are the most trusted professional group in society, so speak up at every opportunity.   Start making steps right now Sustainable healthcare: A move to Net Zero is the way of the future. We just need to get there sooner rather than later. For more head to:

    In situ simulation for Trauma Team Training by Chris Hicks

    Play Episode Listen Later Jun 14, 2021 27:08

    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:  

    Making great ideas happen in healthcare

    Play Episode Listen Later Jun 11, 2021 13:48

    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:

    Resuscitative Hysterotomy - The Debrief

    Play Episode Listen Later Jun 10, 2021 15:33

    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:

    Resuscitative Hysterotomy by the SMACCForce Simulation Team

    Play Episode Listen Later Jun 9, 2021 13:51

    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:

    Curiosity in medicine

    Play Episode Listen Later Jun 8, 2021 5:37

    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:

    Burnout in healthcare

    Play Episode Listen Later Jun 2, 2021 17:31

    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:

    Surviving Massive Burns

    Play Episode Listen Later Jun 1, 2021 58:00

    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:

    Necessity is the mother of invention: POCUS pivots around the pandemic

    Play Episode Listen Later Jun 1, 2021 14:00

    A round table check in between Ireland, Australia and the United States. Hosted by Cian McDermott from Dublin, Trish Henwood (Philadelphia, US), Kylie Baker (Queensland, AU) and Rachel Liu (New Haven, US) share their local experiences on remote education, innovation, and ultrasound in the remote environment. Finding new ways to work, changing priorities, and pivoting fast and hard.

    POCUS and the “InfoDemic”

    Play Episode Listen Later Jun 1, 2021 25:19

    In the second part of the podcast focused on POCUS, Cian, Trish, Kylie and Rachel take a deep dive into the ultrasound process during the COVID-19 pandemic. How do we keep our equipment clean? Who do we turn to as a reliable and up-to-date source of information? Now, that the traditional literature is struggling to keep up with the times, and social learning networks aren’t always best evidence where is the knowledge. The “InfoDemic” has been experienced by all. What we do know is that strong POCUS infrastructure and collaboration underpins flexible opportunities for innovation. Jump into the comments section to join the discussion!

    Future of Battlefield Surgery

    Play Episode Listen Later May 31, 2021 18:50

    The Future of Battlefield Surgery. The traditional battlefield involved soldiers on both sides, fighting against each other. Today, the battlefield is quite different and this has impacted how we practice surgery. Why? First, the world is full, more than half of humanity lives in cities. Hospitals in developing countries are exhausted and under-resourced. Furthermore, the threats we face today are global - global warming, pollution, air pollution, terrorism and water supply. Modern-day weapons are so powerful that conventional warfare is almost obsolete - atomic weapons, cyber warfare.. the list goes on. Finally, diagnosis and surgical intervention relies on extensive technology and minimal invasiveness. This is unsuitable to battlefield situations and makes it incredibly challenging to provide care. MSF goes where no one else will go, but doing this kind of good is not getting any easier. For more head to:

    Pacific Island Playlist 5: Mental Health

    Play Episode Listen Later May 30, 2021 5:52

    Pacific Island Playlist 5: Mental Health. From #SMACC2019, the incredible Jess Morton speaks candidly about her own mental health journey. Jess knows first-hand how important it is that we give mental health the focus it deserves. Eliminating the stigma that surrounds mental health starts with us as healthcare professionals. We need to lead the way. Pacific Island Playlist song: Unwell by Matchbox Twenty For more head to:

    Pacific Island Playlist 5: Mental Health

    Play Episode Listen Later May 28, 2021 6:04

    From #SMACC2019, the incredible Jess Morton speaks candidly about her own mental health journey. Jess knows first-hand how important it is that we give mental health the focus it deserves. Eliminating the stigma that surrounds mental health starts with us as healthcare professionals. We need to lead the way. Pacific Island Playlist Song: Unwell by Matchbox Twenty  

    A patient- focussed model for inclusive healthcare

    Play Episode Listen Later May 27, 2021 69:22

    In this episode, we examine accessibility in healthcare and the limitations to accessing equitable care for all. We must understand both the limitations posed by a patient's disability and the predicted accessibility challenges they face. This requires asking questions about a patient's disability. Healthcare accessibility is not only the physical ability to reach care but also the ability to engage and connect holistically with that care. To truly design a more accessible healthcare system, we need to involve people with accessibility issues right from the start and design new systems, based on them. Tune in to the podcast or watch the video to better your understanding of what accessible healthcare really looks like.  For more head to:

    Redesigning healthcare systems to be more accessible

    Play Episode Listen Later May 25, 2021 22:24

    The Covid restrictions saw an increase in Telehealth services and a flow-on effect was that it provided a safe space for people with accessibility differences. To sustain this, planning must go into adapting existing clinical practices. We need triage tools to identify which consultations are suitable to provide virtual care before we can engage with patients and provide them with a choice. We need to better understand the problem before we can determine what service changes might appeal to people with accessibility differences. People with lived experience need to be involved right from the start in the planning process. Healthcare must be open to the knowledge of what it is actually like to live with a disability. Then we can design new systems that narrow the gap and make the process of getting a diagnosis and seeing a clinician faster. As healthcare professionals, we are all incredibly busy, but taking the time to listen is when patient-centred care shines. For more head to:

    What is accessible healthcare?

    Play Episode Listen Later May 23, 2021 12:18

    Healthcare should be equitable and accessible for everyone, but what exactly is equitable access to healthcare? Access is the ability to seek healthcare. The ability to physically connect and to pay for healthcare. Most importantly, access is the ability to engage with healthcare. Open and honest communication with patients is key. Empower people to make decisions about their own care, finding a way to communicate even if in a non-traditional way. The reality is, a lot of clinicians live and work with disabilities themselves, yet healthcare is void of a system that caters to everyone. It is really important as clinicians, to not just look at the numbers but to look at the patient as a whole. We need to come together and reinvent how we deliver healthcare – to suit everyone. For more head to:

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