Coda Change

SMACCForce: Neemo by Marc O Griofa

Join Celia Bradford as she discusses blood pressure control in intracranial haemorrhage in neuro critical care. Intracranial haemorrhage risk factors include hypertension. The question becomes, what do you do with hypertension in the management of intracranial haemorrhage? Does blood pressure being high cause the bleed to be more severe or does a severe bleed cause increased blood pressure? It is a classic chicken or egg scenario. Celia takes you through two prominent trials in the area and gives you valuable and practical tips on how to manage these patients. The INTERACT-1 trial looked at haematoma expansion in two groups randomised to blood pressures of

The information we consume leads us to believe that failure isn’t an option. Stories and movie depictions of characters who avoid the odds at all costs, tell us that failure is unacceptable and should be avoided. We expect elite performance and hyper competence. In medicine, where we are responsible for the lives of our patients, it is easy to understand why we set the bar high for ourselves and somewhat expect ourselves never to fail. The reality is however, that this is all a myth. Any complex system you can observe from around the world has experienced failure. In fact, the biggest lessons usually come from the biggest failures. In healthcare, we work in the ultimate complex system, where nobody is hyper competent and failure will always occur. It is inevitable. According to sociologist Diane Vaughan, wherever science, technology and risk to human life coincide, failure is inevitable. The answer is in finding ways to appropriately deal with failure and to overcome these challenges. So, given that failure is inevitable, is there a better way to fail? How do we fail gracefully? We need to learn to fail and understand that we do so out of a love for our profession. By savings lives and helping others. Our system needs to allow for failure to occur but also to ensure that we fail gracefully. Kevin Fong shares a compelling talk on how to prepare to fail, how to expect failure and most importantly, how to forgive yourself for failing. A talk that Kevin describes as “useful advice for failing at everything.” From DAS SMACC, we hope you enjoy this podcast and we hope that it inspires you to embrace failure in a new light. For more like this, head to https://codachange.org/podcasts/ 

Laszlo Hetzman discusses cost effective high fidelity simulation training for performance in pre-hospital and hospital critical care. One the great benefits of simulation training is the diversity of training it provides for all levels of experience. Based on his own hugely positive experiences of simulation, Laszlo was compelled to implement effective simulation in his country. The trouble was budget constraints. However, with a little bit of lateral thinking, Laszlo will show you that low budget does not necessarily mean low fidelity. Laszlo discusses the three areas of fidelity that are needed to have a successful simulation. These are equipment, environmental and psychological fidelity. Life like equipment, life like environment and a strong fiction contract. The later referring to the agreement that is held between all participants and trainers that the plastic mannikin they are working on is a real-life dying patient that they must help. Laszlo divulges seven tips and tricks he has developed to make training with any budget effective and to help sign the fiction contract for less! First, use real stories in your scenarios. Get credible and well-prepared instructors - they paint the picture of the training scenario. With good instructors it is possible to minimise “God’s voice” (instructions coming from people external to the scenario.) It is useful to use participants voices, or cheap applications to deliver vital signs, and having distractions/actors to steer the scenario. Similarly, background noise (be it farm noise, train stations or industrial sounds) can be found for nothing on YouTube and enhances the emotions of the situation. Clothing is important – Laszlo stresses everyone in the scenario should be dressed up to resemble the role they are playing. Additionally, models and mannikins can be altered cheapy and easily using whatever is lying around the ward or house. On the same theme, think outside the box when considering equipment. DIY is a magical thing. Laszlo describes how he has used useless junk to do everything from making ultrasound probes to simulating a thoracotomy. Finally, be sure there are no spoilers. Help all participants to be believable with their actions and words and to stay in character to enhance the experience for all. Follow these simple tips to make all simulation experiences the best they can be. As Laszlo says, medium fidelity rules. For more like this, head to https://codachange.org/podcasts/ 

SMACCForce: Suspension Trauma - Discussion - Demo by Jason van der Velde & Karel Habig

A study showed that 15% of healthcare responders hesitated to start CPR because they thought that they would harm the patient. 21% didn’t want to start defibrillation because they thought that they were doing something bad. Hesitation means time. We are harming the patient by not starting sooner. A culture of excellence in resuscitation relies on an excellent system, not excellent individuals. As individuals, we could have all of the training in the world but the reality is that all parts of the system need to function or we will sink. Maaret Castren suggests that culture of excellence is a choice. We need to choose to be extraordinary and we need to commit to implementing systems that aspire for excellence. Maaret inspires us to think outside of the box and to think about what we can do to be better. When you look around the world it is evident that there isn’t one single system that has actually achieved excellence. We need to encourage our team not to settle. To avoid saying things like “this is the way that we’ve always done things.” Local implementation is usually the weakest link in the chain. We have good science, we have highly educated people but we don’t implement optimal systems into our normal everyday lives. This is where we go wrong. Leadership is key, even in scenarios where there are only two first responders performing a cardiac arrest. Maaret outlines the three key elements of achieving a culture of excellence: 1. Leadership 2. Training 3. Quality improvement All parts of the system need to be optimised, to allow for us to achieve greatness. From DAS SMACC, we hope that you enjoy this podcast and we hope that it inspires you to achieve a culture of excellence in your workplace. For more like this, head to https://codachange.org/podcasts/ 

Simulation, assessment and technology in medical education. This session brings together a panel of educators with a track record of innovation and design in medical education. Chris Nickson, Daniel Cabrera, Jenny Rudolph, Sandra Viggers, Simon Carley, Victoria Brazil, Walter Eppich & Jesse Spurr join to discuss the past, present and most importantly the future of how we will teach and learn critical care. They address some burning questions including, what does it mean to be an educator? Is simulation the answer to everything? What do we need from medical education to encourage healthcare professionals to thrive into the future? They explore the future changing role of the medical educator from one of information delivery and assessment to co-learner and developer. This is particularly challenging when asking senior healthcare professionals to unlearn processes and to be flexible and open to new ways of doing things. We are encouraged to consider the role of culture... how can we create a culture which embraces learning and new ways of doing things? How do we establish a system where positive role models are in abundance and lead by example in challenging situations? Furthermore, the panel consider whether new technologies really change education or simply form adjuncts to traditional learning models? FOAMed is so easily accessible and is an excellent tool for learning but how do we also integrate and adapt traditional models of learning? From DAS SMACC, our panel of experts light the flame of medical education and challenge the audience to consider the complexities and role of simulation, assessment and technology in medical education. Tune in for an interesting and engaging discussion about medical education in healthcare. For more like this, head to https://codachange.org/podcasts/ 

SMACCForce: Top 10 PHARM Papers of the last year by Conor Deasy & MJ Slabbert

Panelist participation in the "Resuscitation for the Resuscitationist" panel session.

Jordan Bonomo delivers the run down on intracranial haemorrhage and anticoagulants in critical care. Jordan freely admits – this is not a simple topic. For the simple reason that intracranial haemorrhage (ICH) sucks – and that’s a problem. There are no treatments for it. Nothing seems to work. Add an anticoagulant and it is even worse. The mortality for an ICH is around 30-50%. With an anticoagulant onboard it goes up to 40-65%. So how do you manage an ICH in an anti-coagulated patient? The critical care starts in the Emergency Department. Roughly speaking 30% of intracerebral haemorrhages will increase in size by 30% in 3 hours. Time matters. In the Emergency Department there are three immediate actions that need to take place. 1) Control the blood pressure, 2) get the specific history and, 3) deliberately ascertain what medications the patient is taking. What to do about the anticoagulation? Jordan addresses three areas with his take on the best practice. The PATCH Trial compared standard care to transfusion of platelets. It showed that the platelet transfusion group had worse outcomes using a modified Rankin scale. Although this trial bothered Jordan – he was concerned about all the patients he HAD transfused with platelets in the past – it changed his practice. His hospital no longer transfuses platelets in ICH patients. With patients that are on a NOAC/DOAC there are 50% fewer ICHs. Compounding this, there seems to be less expansion of ICH in patients on a DOAC compared to on a Vitamin K antagonist (ie Warfarin). You bleed less and are less likely to expand on a DOAC. However, it is far more practical to test for VKA, and possibly easier to reverse them. Jordan takes you through your options. Finally, Jordan addresses tPA. He will discuss the rationale for use tranexamic acid to reverse tPA and why he uses it in practice. Jordan makes the complicated a little less complicated when discussing intracranial haemorrhage and anticoagulants in critical care. For more like this, head to https://codachange.org/podcasts/