Coda Change

Australia has established a global competitive advantage in agriculture. However innovation in the agriculture and food industries globally is changing and the entrance of new technologies, capital, and perspectives is putting pressure on existing systems and ways of thinking. Entrepreneurs especially are playing a critical role in this transformation. This presentation will provide insights into how Australia can build on a competitive advantage in agriculture to become a competitive global player in agrifood technologies and will give practical take-home principles for how we can all innovate to improve the world we live in. codachange.org/podcasts

Brandon will be giving high-impact, rapid-fire talks on assessing stroke symptoms, using EEG after acute brain injury, and advanced multimodality monitoring. For more head to: codachange.org/podcasts

Anne Creaton is interviewed by Peter Brindley. She talks about her experience in setting up Emergency Medicine Training in Fiji and give advice to those who may want to work in a similar setting. www.codachange.org/podcasts  

Sexual assault affects 1 in 3 women and 1 in 6 men during their lifetime worldwide. It is more common than most medical issues we are trained to look for, despite this being a patient population we are going to see by virtue of the "anyone, anytime" nature of an emergency and critical care. Generous estimates find than only 20% of survivors present for medical care and may not disclose this initially in their visit. Look for it during public holidays, large parties or concerts, college or university fresh week, particularly in young women. Other scene awareness clues that a sexual assault may have occurred include sedation that does not match the substances taken or clinical level seen, ripped or missing clothing, or being separated from their group. Documenting your suspicions and findings is key - as this chart is more likely to go to court, but not for 2 years. Direct quotations of what was said by the patient or EMS, body diagrams for what was found, and your clinical decision making are the essentials. Physical findings may be absent or minimal; this does not mean that no assault took place! The discussion that you had with the patient around further treatment and legal options needs to be recorded. Care of a sexually assaulted patient is complex and can have long-lasting detrimental psychological effects if not done well. Referral to a specialized care program to bridge the gap between medical and legal in a patient-centred trauma-informed manner is best. Treating survivors with belief, support and humanity as you assist them with making an informed decision as to the next steps in their care is vital as the first step in healing. www.codachange.org/podcasts

This first episode of Coda Cure has set the scene. The importance of clear definitions, treatment strategies, managing Antimicrobial Resistance, vaccination programs and dealing with the long term outcomes of sepsis were all identified. The Cure pillar remains in the early stages of identifying areas for our community to take meaningful action on global sepsis. codachange.org/podcasts

We apologise for the low quality audio, Dr Flavia Machado kindly delivered her talk in the middle of a hospital shift in São Paulo during the global pandemic.

Blanket standards applied in research design, particularly those applied traditionally in a "peace time" setting are worth being carefully examined for their relevance now in this pandemic "war time" setting so that we don't hog-tie ourselves with irrelevant and unhelpful regulations. At the same time, we don't want the 'wild wacky west'. Everyone is under pressure in research to move quickly, but we need to ensure that if we change standards we do so intelligently so that the choices we make for more pragmatic design are perfect. The pandemic has shown how as experts we are so narrow minded. It is sad how little we really listen to each other. On a large scale COVID-19 has really shown up that many of us in medicine have become super-specialised, and it is very hard for us to think across different domains and to think with any range. codachange.org/podcasts

While the timely use of Antibiotics for sepsis is well recognised, the rise of Antimicrobial Resistance (AMR) is a huge threat to global health. The current pandemic has highlighted our vulnerability to infection and we are now experiencing first hand the public health and economic cost of a pandemic. We know now what it really means to not have effective diagnostics, treatments and vaccines for an infectious pathogen. AMR accounts for 700,000 deaths annually. Antibiotic use is the key driver for AMR. Some use of antibiotics in COVID-19 infections is likely appropriate and some likely inappropriate, so this is where AMR comes in. Vaccines can help in AMR by reducing the carriage and transmission of AMR pathogens and by reducing the clinical symptoms of certain infections that can result in appropriate antibiotic use. Vaccines can specifically help reduce AMR within three categories: 1: Vaccines against common bacterial pathogens like Haemophilus Influenzae 2: Vaccines against specific AMR pathogens like Tuberculosis or Gonorrhea 3: Vaccines against viruses that ma result in symptoms then prompting the inappropriate use on antibiotics and this is where a COVID-19 vaccine comes in. codachange.org/podcasts

The global burden of Sepsis continues to challenge clinicians in its definition, diagnosis and treatment. The current Covid-19 pandemic seems to have almost taken our understanding of the Sepsis Syndrome back decades. What are the similarities between the current pandemic and sepsis? And what can we learn? We have never avoided healthy controversy and in this episode Simon Finfer puts the case that the multi-organ dysfunction and cytokine storm seen in critically ill Covid19 infected patients is analogous to the conventional Sepsis Syndrome and ARDS. Perhaps if we consider the current pandemic through a Sepsis lens, we can avoid making the same mistakes that we have made in Sepsis research for decades resulting in no licenced treatments for the Sepsis Syndrome. Derek Angus agrees but makes the case that there are two distinct differences. Firstly that the endothelial dysfunction appears different in Covid-19 and secondly unlike sepsis in the case of Covid-19 the pathogen itself proceeds unabated by any currently proven treatment. This means we need a two pronged approach in Covid19 research: 1: Strategies purely aimed at combating the virus 2: Strategies aimed at applying Sepsis lessons to the pandemic response. codachange.org/codazero

Rhonda Cadena talks IV Alteplase for wake up strokes using MRI criteria. Tiger territory! After a NEJM paper in 2018 this is now on the table - hear the perspective from Rhonda, an ED / neurocritical care specialist from North Carolina. For more head to: codachange.org/podcasts