Coda Change

As part of the Sepsis Workshop, this presentation will briefly touch on the challenges that patients and their families face on discharge from hospital after an admission for sepsis.  For more head to our podcast page #CodaPodcast

As an ICU registrar you meet septic patients at different points in time: as the first responder, asking ‘could this be sepsis?’; as the second responder, admitting the patient to the ICU; or the third responder, having to consider adjuncts in the deteriorating patient. Each of these presents different challenges and learning experiences, making the reality of managing sepsis more complex than one might first expect. For more head to our podcast page #CodaPodcast

As with everything else, ICU management of sepsis should ideally the evidence based. Evidence based practice combines the best scientific knowledge (evidence) with patient preferences and clinical assessment and judgement.   While the pursuit of specific pharmaceutical agents to treat Sepsis has resulted in the expenditure of billions of dollars without producing a single effective agent, much of what we do in the treatment of patience with Sepsis can be evidence based. Clinicians make literally hundreds of decisions day on the management of an individual patient in the ICU, often these decisions are made routinely without a great deal of thought about the reasoning behind them. Every decision made about the treatment of a critically ill patient should be based on evidence or the belief that the action resulting from that decision will improve a patient centred outcome for that particular patient. A patient centred outcome is an outcome that affects how the patient feels, functions or survives meaning we should question every decision we make to ask whether it is going to improve one of those outcomes.   The best evidence on which to base of such decisions comes from large robust randomised controlled trials conducted by unbiased investigators. The last 20 years has seen the emergence and maturing of regional and national clinical trials groups who conduct such studies and increasingly collaborate with each other. (2) Such collaboration is often essential to perform studies large enough to provide evidence to guide clinical practice such collaboration is often essential to perform studies large enough to provide evidence to guide clinical practice. As someone who designs and contacts clinical trials I am well aware that they provide evidence on a population basis. Each trial result is the net of harm and benefit resulting from the treatment being studied and even when a treatment is proven to have a net benefit there may be some patients who are harmed by the use of that treatment. A graphic example of this is someone who suffers a massive intracranial haemorrhage when treated with thrombolysis. Causing visible harm to a patient may shake a clinician's faith in an effective treatment making it important that we accept such tragic events without changing our practice to deny that effective treatment to future patients.   Research, like clinical practice, has inherent imperfections. Researchers, like clinicians, need to recognise this and be prepared to put their hand up and admit when they have been wrong. Conducting robust studies of appropriate size in an effective collaborative research group is the best way to avoid being wrong too often!   For more head to our podcast page #CodaPodcast

Sepsis causes organ and tissue dysfunction in response to severe infection, resulting in significant physical and cognitive morbidities. For patients diagnosed with severe sepsis, admission to an intensive care unit and use of an artificial airway are often required. The sequalae of severe sepsis necessitating critical care can result in significant changes to a patient’s swallowing and communication function. These negative changes and impacts to function can occur during and after a diagnosis of sepsis, and ultimately impact a patient’s health and functional status. The nature and long-term recovery of swallowing and communication function is still to be completely understood; however evidence affirms recovery continues well beyond hospital discharge.   This presentation will focus on tasks we do daily – eating, drinking and speaking. Specifically, the nature of swallow impairments will be described, and the impact of this new disability will be explored from the perspective of the patient’s body structure, function and activities. Core components of swallowing safety and efficiency will be described, alongside the role of assessment and management within and beyond the ICU. Changes to communication including altered voice, speech and language function will be described. Outcomes of altered communication function over the continuum of care during, and after hospital will be explored. The evidence base and the lived experience of sepsis and patient stories will underpin the content delivered in this presentation.   The final aim of the presentation will be to describe and highlight the role of speech pathology, an allied health profession, in the management of swallowing and communication function. Following the workshop attendees will be able to (1) describe the characteristics of swallowing and communication disorders; (2) have knowledge of the impact of these new disabilities; and (3) will be able to describe the role of speech pathology in the healthcare team for the patient with sepsis.   For more head to our podcast page #CodaPodcast

Dr Greg Kelly – a paediatric intensivist at Westmead Children’s Hospital – is today’s guest, on the #Coda22 podcast, during which he discusses a little girl called Abbie, who has lived in ICU for almost two years, and how she represents a very important group of patients – who are a tiny fraction of admissions, but a huge proportion of the workload at Westmead Children’s Hospital. Such patients are complex in such a way that no-one knows exactly what to do with them; nor how to respond to them. He goes on to discuss the problems they see every day at Westmead Children’s Hospital, and what the practitioners can do about them.

This session presents a series of medical cases with important clinical caveats. Additionally, a contextual discussion follows, focussing on the social determinants of health and their integral importance in delivering high quality care. The practice of acute medicine requires many skills to ensure the delivery of the highest quality care. Clinical knowledge and skill are essential, but equally communication, empathy, social/cultural awareness and advocacy are also vital. Knowing our patients and understanding their circumstances provides a foundation on which clinical practice can then be contextually applied. Without context raw facts can be misleading and even result in misdirected treatment plans.

In this week’s episode of the #CodaPodcast, Gemma Figtree – a Cardiologist and Professor discusses the profound inequality of gender issues.

In this week’s episode of the #CodaPodcast, Dr Daniel Nour – who founded Street Side Medics a not-for-profit, GP-led mobile medical service for people experiencing homelessness - in August 2020 talks about his grave concern for the homeless who have gone untreated for years. He talks about how it was seeing the inequality in healthcare among the homeless that made him want to do something about it and how we often think about their need for shelter and food, but not for suitable healthcare. He also discusses the barriers that face homeless people and what it was that led him to launch Street Side Medics.

There is a moment that regularly occurs in the life of a clinician working at a major trauma service - where a rotating registrar, a keen sponge - appears, and a discussion about learning goals for the rotation is had. Its always about trauma, I'm here to learn procedures, intercostal catheter insertion, thoracotomies etc etc and if there is a trauma call, I'd love to be involved. But when I point to an older woman in the corner who has fallen from standing height, suggesting that perhaps we start our trauma education there, there are looks of confusion, annoyance even. This patient doesn't fit their expectation of what trauma physician needs to learn. But a trauma physician's paradigm, must evolve.

Healthcare Saves! Healthcare Pollutes! Healthcare is responsible for 7% of Australia's carbon emissions, consumes 10% of Australia's GDP, and has numerous other adverse environmental effects. In this talk, Forbes McGain, an anaesthetist and intensive care physician, introduces healthcare's polluting ways, and how clinicians can mitigate their own carbon footprint. Action is the Antidote to Anxiety!   For more head to our podcast page #CodaPodcast