Coda Change

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 frosh 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.

The rising death toll from our nation‚ opioid epidemic has been rivaled in modern history only by that at the peak of the AIDS epidemic in the early 1990s. Consider, in 1995 at the peak of the AIDS epidemic, 51,000 Americans died from the disease. In 2015, 52,000 died from drug overdoses. Emergency departments have stood at the front lines of both crises. As a specialty that prides itself on rising to the occasion at times of great need, our time to lead on this crisis is now. As a response, EDs nationwide are expanding their roles in the care of patients with opioid use disorder (OUD), and many have begun ED-MAT programs. In December of 2017, we launched the Get Waivered Campaign which aimed to get our physicians the DEA X waivers needed to be able to prescribe ED-MAT(buprenorphine) to patients coming to our hospital seeking recovery. In May of 2018, our ED instituted its first ED-MAT protocol and while greater than 90% of our attending physicians had their DEA-X waivers and were able to prescribe buprenorphine, we found that there remained an opportunity to increase the rate of MAT initiation in our ED. Through semi-structured interviews we set out to examine the barriers to providers, use of our MAT initiation protocol and patients‚ willingness to seek help in obtaining OUD treatment in our ED. Our work has identified multiple barriers, affecting both providers and patients, that have limited wide-scale early adoption of our protocol. The barriers identified from our ED-MAT program‚ first year of operation, and the interventions aimed at making the use of our ED-MAT protocol as effortless as possible may serve as useful lessons as other hospitals seek to lead by operationalising their own ED-MAT programs. For more head to: codachange.org/podcasts

A case example of a large vessel obstruction of the brain and our current techniques available to treat it. How we make decisions on endovascular treatment and management points for emergency and intensive care colleagues.

This talks gives some guidance on how to deal with your anxiety and fear when dealing with children. We will also cover some keytopic areas: sepsis, fluids, seizures, asthma and bronchiolitis

in March 2006, six healthy volunteers underwent cytokine-induced injury and multiorgan failure from a Phase 1 first-in-human drug trial with a novel monoclonal antibody. This talk describes the clinical and incident management ramifications, drawing connections to other non-conventional incidents which may pose a different pattern of clinical, operational and communications challenges to the 'classic' trauma-based model of major incidents.

This talk will introduce the audience to the dynamics and effects of childhood abuse from a human rights framework. It will explore pertinent aspects of recovery and illuminate the healing possibilities that exist within every relationship between a child and any adult professional.

Resuscitation fluids save lives in humans with life-threatening hypovolaemia. The fluid of choice should have biochemical characteristics close to the type of fluid lost and replaced at a rate and volume sufficient to correct the severe fluid deficit. Then stop and consider the early use of catecholamines. There are few indications to give critically ill patients resuscitation fluids after 24 hours of admission. There is no place for synthetic colloids of non-physiological crystalloids. The effects of unnecessary fluids last well beyond the initial resuscitation period and are associated with adverse effects and harm to the patient. Fluids are toxic drugs and must be used with great care.

I am part of the opening panel.