Amal Mattu on Lessons from The Princess Bride
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A successful career in emergency medicine can be accomplished by following some basic principles in life. These principles are known to all…they are learned from parents, mentors and colleagues, but they are often at first not appreciated or recognized. Amal discusses many of these principles as he discusses an all-time classic movie, The Princess Bride. This movie, beloved by millions around the world, demonstrates and teaches many of those basic principles that, the speaker argues, can lead to a successful career in emergency medicine.
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Stuart Browne is a Neuro Rehab specialist from Sydney. These slides accompany a talk he gave at the Brian Symposium in 2023. He discusses what "severe disability" really means.
Severe disability is more common than many realise - about 6% of the Australian population.
Stuart discusses how health is more than simply physical recovery and how it is a multidimensional construct. He covers how permanent disability doesn't necessarily equate to a poor quality of life. He also discusses the long timespan of recovery, which is often much longer than appreciated.
He specifically discusses "Locked-in Syndrome" and how the survivors have surprisingly positive self-reported health-related quality of life and well-being.
Stuart also covers how severely disabled people face various forms of discrimination.
Paediatric Stroke by Shree Basu
Shree Basu is a Paediatirc Intensivist in Sydney. These slides from the Brain Symposium 2023 accompany the talk she gave. She discusses how Paediatric stroke presents, what neuroimaging is required and what interventions are available, including thrombolysis and the role of endovascular thrombectomy.
Hypertensing Spinal Cord Injury - gold standard or wacky?
This document discusses the concept of maintaining higher blood pressure levels, known as hypertension, after a spinal cord injury to improve spinal cord perfusion pressure and reduce secondary injury. It notes that while animal studies and some human trials have shown improved neurological outcomes, the evidence is still limited. It calls for larger randomized controlled trials in humans that also incorporate multi-modal monitoring and standardized outcome measures to further evaluate if inducing hypertension after spinal cord injury should be considered the gold standard of care.
Optimal Cerebral Perfusion Pressure
Mark Weedon takes us through the increasingly utilised concept of an optimal cerebral perfusion pressure (CPPopt) for each unique patient. He discusses the background to CPPopt, including intrcranial pressure (ICP), the Monroe Kelly hypothesis, neurovascular coupling, and cerebral autoregulation in health and following brain injury. He shows how intracranial pressure is affected by intracranial compliance and how this affects ICP waveforms. Cerebral perfusion pressure in relation to the Brain Trauma Foundation guidelines is covered including management of elevated ICP (EICP). The currently recommended tiered approach to managing cerebral perfusion pressure and EICP is mentioned citing recent guidelines. He uses a clinical case of a TBI to illustrate how the CPPopt can be ascertained and used to guide therapy, including the easy to perform “MAP Challenge”. Mark also describes the Pressure Reactivity Index (PRx) and how it can be used as a target for therapy. Finally, he covers the exciting results of the preliminary COGiTATE pilot study.
The Power of Words - Death and Language.ppt
Social Worker Victoria Whitfield and Bereavement councilor Louise Sayers discuss the power of words when health professionals are communicating topics around of death and serious injury with relatives and patients in critical care. They use role plays to bring theories to life.
Sepsis and Antimicrobial Stewardship - Two Sides of the Same Coin
Undertreatment of sepsis can lead to mortality, while overdiagnosis and overtreatment can increase future risk of antimicrobial resistance. Antimicrobial stewardship aims to balance these risks by prioritizing patient safety and appropriate antimicrobial use. Data shows variability in appropriateness of antimicrobial prescribing between different types of hospitals. Embedding antimicrobial stewardship principles throughout sepsis diagnosis and treatment, from initial microbiology testing to post-treatment review, can help standardize care and optimize outcomes.
Brain injury outcomes and predictors
Being able to prognosticate in the aftermath of a traumatic brain injury (TBI) is important as it assists with counselling patients and families. Moreover, it helps rationally allocate healthcare resources.
However, due to the heterogenous nature of TBI and variable pre brain injury patient factors and post brain injury course, this has proven to be a difficult task.
Large cohort studies have enabled improved accuracy in the prediction of 6 month mortality and unfavourable outcome.
Furthermore, many of the factors that contribute to long-term outcome have also emerged. However, it is not yet possible to use them in prediction algorithms or mathematical models.
There is emerging evidence that pre injury psychosocial and demographic factors may be of more relevance than injury severity. Moreover, that 'outcome' becomes increasingly subjective and complex as the post injury duration increases.
We end with three brief vignettes which highlight the fraught nature of long term outcome prediction.
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1. Define an electrocardiogram (ECG) and electrocardiography
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Amal Mattu on Lessons from The Princess Bride
- 1. Lessons Learned From A Career in Emergency Medicine Amal Mattu, MD, FAAEM, FACEP Professor and Vice Chair Department of Emergency Medicine University of Maryland School of Medicine Baltimore, Maryland
- 2. Lessons Learned From A Career in Emergency Medicine
- 4. Lessons Learned From A Career in EM Amal Mattu, MD, FAAEM, FACEP Professor and Vice Chair Department of Emergency Medicine University of Maryland School of Medicine
- 5. Amal Mattu, MD, FAAEM, FACEP Professor and Vice Chair Department of Emergency Medicine University of Maryland School of Medicine Lessons Learned From A Career in EM
- 8. The Princess Bride vs. EM • Fencing stabbings • Fighting …fighting • Torture fingers and tubes in every orifice • Revenge fibromyalgia, dizzy, percocetopenia • Giants morbid obesity • Monsters neurosurgeons, orthopods • Chases finding admission beds • Escapes pts. leaving without being seen • (True?) love chlamydia, GC, trichomonas • Miracles bringing back the mostly-dead
- 10. Princess Bride Truisms • Death cannot stop true love…all it can do is delay it for a while
- 11. Princess Bride Truisms • Never get involved in a land war in Asia
- 12. Princess Bride Truisms • Inconcievable!!
- 13. Princess Bride Truisms • There’s not a lot of money in revenge
- 14. Princess Bride Truisms • People in masks cannot be trusted
- 15. Princess Bride Truisms • People in masks cannot be trusted
- 16. Princess Bride Truisms • Don’t mock people’s pain
- 17. Princess Bride Truisms • Chocolate coating makes it go down easier
- 18. My Favorite Princess Bride Life Lessons For a Career in Emergency Medicine
- 19. “He’s only mostly dead. Mostly dead is still partly alive!”
- 20. Find the positives, be an optimist! “Be a Tigger, not an Eeyore.” -- Randy Pausch (1960 – 2008)
- 21. Find the positives, be an optimist! “Mine for gold, not dirt.” -- Dale Carnegie (?) (1888 – 1955)
- 25. Prepare to face the 6-fingered man
- 26. Prepare for the future…now!
- 27. Prepare for the future…now!
- 28. Prepare for the future…now!
- 29. Prepare for the future…now!
- 30. Prepare for the future…now!
- 31. Develop a resistance to iocaine powder
- 32. Develop a resistance to iocaine powder
- 33. “Who says life is fair? Where is that written?”
- 34. “Who says life is fair? Where is that written?” “If you spend your time comparing yourself to others you will become vain or bitter, for there will always be greater and lesser persons than yourself.” –Desiderata
- 35. Beware the 3 hazards of The Fire Swamp
- 36. The 3 hazards of The Fire Swamp
- 38. The Flame Spurt
- 39. “How far you go in life Depends on you being Tender with the young, Compassionate with the aged, Sympathetic with the striving, And tolerant of the weak and strong Because someday in life… You will have been all of these.” -- George Washington Carver (1864 – 1943)
- 40. Lightning Sand
- 41. Lightning Sand
- 42. Lightning Sand • Mr. Miyagi: “Either karate do, or karate do not. Karate do half-way get squished like grape.”
- 43. Lightning Sand • Mr. Miyagi: “Either karate do, or karate do not. Karate do half-way get squished like grape.” • “Emergency medicine, same way!”
- 44. ROUS’s
- 45. ROUS’s
- 47. Boo! Boo! Boooo! “You had love in your hands, and you gave it up. You treated it like garbage!”
- 48. Treat those you love well, and don’t let go
- 49. Treat those you love well, and don’t let go
- 53. You are making a difference!
- 54. You are making a difference!
- 55. You are making a difference!
- 56. You are making a difference!
- 57. You are making a difference!
- 73. Thanks for all you do!