Coda Change

Creativity in: non fiction  Let's face it, your real life is too strange for fiction. And why go looking for the stories, when they come right to you? During this session, we'll explore the tension between telling them, and taking them, how to keep their beauty, or their hilarity, without betraying confidence. Bring your best story, and your worst, and we'll find their true heart. One of the most common questions that gets asked by fellow clinicians, is what it takes to be a writer. Well, if you're an ER doctor, medic, or nurse, you've already checked the "weirdo" box. Pivotal. You can also add a position at the interface between the personal and the general as the right one for perspective. Everyone wants to know what you've seen, what happened next, and what matters most. The real answer, though, I stole from Annie Dillard: "Do you like sentences?" I mean, really REALLY like them? Enough to spend even more time alone, in dark basements, puzzling over whether to remove a "that" or keep it? Well, then you might have what it takes. I'll tell you how I got started, the mistakes I've made, and what principles have stayed alive for me, through two books. We'll talk about how to structure both your writing day, an argument, the joy when you turn in your finished work, years in the making, and the delight to receive it back, a few days later with the the advice: "you can do better". For more head to: codachange.org/podcasts

FOAMed (Free Open Access Medical Education) is an important tool that so many of us are passionate about. The ability for medical education to reach countries around the world is powerful and is driving us towards a healthier future. In this episode of PIP, Alexandra Presler encourages us to lean into the FOAMed community. Everyone can utilise FOAMed, regardless of your position, so talk to everyone, branch out and help make the community bigger. For more head to: codachange.org/podcasts

Emily Granger takes us through the original cardiothoracic conundrum: what to do about chest injuries and rib fractures? New approaches to the management of severe chest trauma and rib fractures are re-shaping our practice. Tune in to discover how. For more head to: codachange.org/podcasts  

Andrew Dixon takes us through five Common Trauma Radiology Misses and Misinterpretations. For more head to: codachange.org/podcasts

Jim Manning tells us why the time is now for Selective Aortic Arch Perfusion in improving cardiac arrest outcomes. For more head to: codachange.org/podcasts

Does adrenaline require resuscitation or is adrenaline good for resuscitation? Gavin Perkins takes us through the research and findings. For more head to: codachange.org/podcasts

Previously at SMACC, Steve talked about NonSTEMI that needed the cath lab immediately and showed many ECGs which represented acute coronary occlusion (Myocardial Infarctions) but present on the ECG as very subtle findings (http://hqmeded-ecg.blogspot.com/search?q=subtle), particularly as subtle ST segment elevation that does not meet “STEMI” criteria and is diagnosed as NonSTEMI. Now, he builds on that idea and challenges the whole idea of a dichotomy between STEMI and NonSTEMI. These are NOT distinct pathologies, but rather exist on a continuum of intracoronary thrombus. Nevertheless, this false dichotomy is rarely recognised by emergency physicians or cardiologists, and patients suffer because of it. There are obvious STEMI, which always need the cath lab emergently, and for which time is myocardium. On the other hand, there are patients whose symptoms are resolved, ECG is non-diagnostic, shows no active ischemia nor subtle ST elevation, but whose troponin is positive and their resolved chest pain is due to an MI with an open artery and no ongoing myocardial cell death. These are NonSTEMI that can be treated with antiplatelet and antithrombotic therapy and get their angiogram the next day. And then there are the patients who have subtle ST elevation representing acute coronary occlusion, or who have active symptoms and/or persistent ECG ischemia. These patients do NOT have STEMI but do need the cath lab now. 25% of occlusions do NOT have diagnostic ST elevation and they do not get their angiogram until 24-36 hours later; their outcomes are worse: they have worse LV function, higher biomarkers, and higher mortality than NonSTEMI whose arteries are open at next-day cath. Steve advocates for an end to another dichotomy: activate the cath lab (Pathway A) or do NOT activate. Instead, he advocates what they, at Hennepin County Medical Center, call “Pathway B”: emergent consultation with cardiology, including a high quality emergency contrast echocardiogram to look for wall motion abnormality. Finally, he shows a variety of ECGs which represent subtle coronary occlusion or ongoing ischemia. For more head to: codachange.org/podcasts

Trauma care should be easy… shouldn’t it? So why doesn’t it feel easy? The clinical component is the easy bit, the challenge is the non-technical factors. Clare Richmond, Chris Hicks, Cliff Reid take us through a SMACCForce simulation debrief and discuss the human factors of trauma care. For more head to: codachange.org/podcasts

An asthmatic who is hemodynamic compromised, can be killed instantly. This distinguishes these asthmatics from the standard asthmatic and how these patients are treated will make a huge difference to the outcome. Haney Mallemat recounts a story of an asthmatic who minutes after he was intubated, became bradycardic, hypertensive and coded. Haney discusses how breath stacking is what kills the asthmatic patient and how we can best avoid this happening to ultimately save lives. For more head to: codachange.org/podcasts

Airway management needs to be proven, predictable and as simple as possible. Silence = death. It is hard to open yourself up and ask to be coached through something but it can be lifesaving. Laura Duggan explains how to survive Trauma RSI and come out the other side. For more head to: codachange.org/podcasts