Is Your Patient at Risk of Suicide? By Orman
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Rob Orman drills down on what suicidal ideation really means and how you can tell if your patient really has it. Listen to the podcast that go with these slides on smacc.net.au or ercast.org
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The Child in Pain - Greg
Pain in children is often under treated due to practitioners lacking the knowledge or confidence to be aggressive enough. This is partly due to the lack of structure presented in pain management and it is frequently made to seem more complex than it is.
Almost all acute pain in children can be dealt with by a simple stepwise regime using a small number of common, established and easy to use drugs.
Likewise, procedural sedation can be safely and simply performed with simple regimes.
Rick Body - Is Compassion a Patient Right?
Rick Body’s SMACC Chicago talk 'Is compassion a Patients Right?' takes us on a journey of emotions in critical care.
Body, initially focuses on a study conducted within his hospital of 125 patients, who were interviewed when admitted to their emergency department and when they where discharged. From the study it was depicted that, what patients truely wanted was simple human intervention; reassurance, friendliness, explanation, basic care. These responses were then coded into 5 different themes to depict how patients believe their suffering should be addressed;
1. Emotional distress
2. Physical symptoms - including pain (but not restricted to)
3. Information - Included reassurance and explanation
4. Care - Basic care
5. Closure - patients want to put this horrible episode behind them
Body notes that patients are telling us that they want something positive from us. They don’t want us to focus on what we shouldn’t do. They want us to be thinking about what we can do to help… suggesting that if we follow the above ‘EPPIC' we could provide more compassionate care. The problem is this is not compassion as compassion is an emotion and needs to be felt.
Body then explores whats stopping us (care providers) from showing compassion? Sighting the The Good Smaritian Study, The By Standers Affect, Unclear of Who is Responsible, and Personal Reasons.
Body believes that patients don’t have a right to compassion as it is an emotion and means to suffer with but asks for health providers to be emotionally intelligent. Explaining that emotional Intelligence recognises that there is a difference between traditional intelligence, IQ and our ability to form effective forms of interpersonal relationships. Siting the 5 domains of emotions intelligence as;
1. Know your emotions - know what we are feeling
2. Manage your emotions - cool rational and object in the rests room, show emotion with patients and family
3. Motivating ones self
4. Recognising emotions in others - empathy
5. Handling Relationships - interpersonal Skills - relate to other people
Body suggest that these are skills that can be developed as ones life goes on and by building skills in emotional intelligence that maybe one can be both a compassionate and effective doctor.
Body concludes by asking the question 'How are you going to care more for your patients?'
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Through her experiences in hunger emergencies, epidemics, natural disasters and conflict zones, Nikki has gained a wealth of wisdom and lessons.
She shares these from the SMACC stage.
Nikki talks about some of the practical things she does when working in resource poor settings. It starts with hospital hygiene to reduce nosocomial infections, and often entails Nikki working alongside the cleaners due to resource limitations.
Hand hygiene is difficult without running water and Nikki champions using the WHO Handrub Formulation.
Other challenges include cold chain storage, blood donations, limited monitoring and food and nutrition.
Nikki also discusses the challenges of working in different environments. Invariable the environment will be too hot… or too cold!
On top of this, working in remote locations often entails living with the other medical professionals you are working alongside. This presents interpersonal challenges.
Moreover, Nikki touches on the personal dangers of working in some of the more politically unstable locations around the world. Training becomes hugely important in resource poor settings when you are dealing with complex medical and surgical cases. Especially with less-than-ideal resources and equipment.
Nikki expands on what is possible with good training, intuition, and a Swiss army knife. If you do not do anything stupid, and you have basic resources backed up by sound training, it is amazing what you can achieve and who you can help.
She concludes by touching the future direction of care in resource poor settings highlight the potential for technology to make huge changes and advances.
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Imogen initally touches on the stages of physician engagement from aversion, to apathy, to engaged and then outlines the steps to morphing the reluctant physician.
1. Seek out a clinical champion
2. Establish a common purpose/vision
3. Standardise what is standardisable
4. Communication, communication, communication
5. Work out barriers and overcome them
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WARNING: This talk will be ineffective if you have no sense of humour.
In Karim’s hilarious and wonderfully sarcastic way, he takes on the Tranexamic Acid debate which (bizarrely) continues to spark controversy.
CRASH 2 had over 20,000 enrolled patients and demonstrated a 15% mortality relative risk reduction by using tranexamic acid in trauma.
There remain some haters out there, including the authors of this amusing review paper who not only slam TXA but the way in which social media has distributed the results. After openly criticising discussion about CRASH 2 on FOAMed resources such as EMCRIT, St Emlyns and on Twitter in general, the papers author, Sophia Binz, calls for “professional and productive scientific debate” - PLEASE feel free to engage with the authors by discussion in the forum below and this shall be fed back in a professional and productive way.
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Karim is currently being headhunted by the UN for his skills in diplomacy.
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Juurlink starts by educating us on the two different drug-drug interactions (DDI) - effects of one drug altered by the use of another . First of which is Pharmacokinetic where by one drug alters the level of another, the second Pharmacodynamic being no change in drug levels, and uses this as a basis for his following case studies.
Juurlink speaks of the dreadful literature that is available on the thousands of drug interaction per year, stating that most information comes from case reports and volunteer studies, and suggests that majority of these interaction are avoidable.
Juurlink goes on to discuss the findings of 4 case studies involving the following Drug-Drug Interactions and their effects on the patients.
SMX/TMP + sulfonylureas
Macrolides + digoxin
APAP + warfarin
SMX/TMP + ACEI/ARB
Juurlink provides us with a short list of trigger drugs that we should be aware of, a list of meds that warrant extra caution and list of possible safer alternatives. He also suggests that it is of the up most importance to have a good pharmacist to turn to as they are given more information on drugs interactions then physicians. And, to utilise resources such as pharmacy times - where you can get information on drug interactions at a push of the button.
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What is the problem?
Delivering bad news and having an end of life conversation are core skills for any practitioner who deals with critically ill patients. Current data show that while 22% of deaths in the USA now occur in ICU, 54% of families surveyed have a poor understanding of patient’s diagnosis, treatment plan and prognosis. Dr. Kate Granger found this out first hand while admitted to hospital in the UK and started the #hellomynameis campaign.
What is the evidence?
While families feel more validated if given longer to speak, doctors speak for 71% of the time in family meetings. -Longer meetings are also associated with greater patient and family member satisfaction. -Patients perceive that doctors spend longer with them if the doctor is sitting down. -Use of a simple mnemonic increases satisfaction and reduced the incidence of PTSD in family members.
What do experts do?
1. Prepare for the meeting. Decide who will attend, what you will talk about and what your goals are.
2. Introduce everyone and explain the agenda.
3. Gather everyone’s understanding
4. Listen and don’t interrupt5Empathise (physicians express no empathy in 1/3 of family meetings)
6. Make the patient’s voice heard
7. Make your recommendation to go forward
8. Reflect on the meeting after it concludes
What about the difficult situations?
Hope is an issue that comes up often. Many other specialties emphasise the importance of hope, while intensivists are often seen as being nihilistic. But we can still foster a degree of hope in patients and families without being unrealistic. -Techniques for managing conflict are discussed such as identifying discord in the family and avoiding mixed messages from staff. -The importance of spirituality is discussed.
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Howie shows us the tools in his toolkit:
- Tourniquets save lives and do not cause limb ischaemia. The aorta is clamped for many hours in cardiac surgery. Data from the battlefield showed that in >800 cases where tourniquets were applied, there were 3 adverse outcomes (loss of sensation in the distal fingertips).
- Haemorrhage control (Israeli) bandages are tourniquets with a haemostatic agent that can be applied to a bleeding wound
- QuickClot (haemostatic powder) can be used for abdominal wounds but may draw the ire of surgeons because they cause an exothermic reaction that burns surrounding tissue
Howie emphasises that not all bleeding have to be stopped - if it’s not pouring out, it can wait. He teaches us to quantify blood loss in the field - three 335 mL cans of soda worth is when to start worrying.
The talk ends with an interesting mini Q&A session as trauma surgeons and paediatricians also weigh into the debate.
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Joe Lex - Is There a Doctor on the Plane?
How Common Are In-Flight Emergencies?
• Occur on one in every 600 flights
• 44,000 of 2.75B airline passengers / year
What Are Most Common Emergencies
• Lightheadedness or fainting ~37%
• Respiratory problems ~12%
• Nausea or vomiting ~10%
• Cardiac symptoms ~8%
• Seizures ~6%
• Other Emergencies
• Laceration ~0.3%
• Cardiac arrest ~0.3%
• Ear pain ~0.4%
• Obstetrical or gynecological symptoms ~0.5%
• Headache ~1%
Who Responds to the Call?
• Physician passenger responds in ~48%
• Nurse passenger responds in ~20%
• EMT passenger responds in ~5%
Minimum first aid kits on commercial airliners
16 Adhesive bandage compressors, 1 in
20 Antiseptic Swabs
10 Ammonia Inhalants
8 Bandage compressors, 4 in
5 Triangular bandage compressors, 40 in
1 Arm splint, non inflatable
1 Leg splint, non inflatable
4 Roller bandage, 4 in
2 Adhesive tape, 1 in standard roll
1 Bandage Scissors
2 Protective latex gloves pair
2 Insect sting relief pad
2 Triple antibiotic ointment
2 First Aid/burn cream, 9 gm.
2 Povidone iodine infection control wipes
2 Alcohol cleansing pads
2 Gauze dressing pad 2" x 2" in
2 Motion Sickness Tab
4 Ibuprofen tablets
4 Non Aspirin Tablets
2 Sunscreen lotion towelette
2 Trauma pads 5 x 9 in (12,7 x 22,8 cm)
1 Survival rescue blanket
1 Pelican case 1170 waterproof
1 Emergency first aid guide (American Red Cross)
Required medications on flights
• Antihistamine – tablets and injectable
• Atropine 0.5 mg injectable
• Aspirin tablets 325mg
• Bronchodilator MDI
• Dextrose 50% injectable
• Epinephrine 1:1000 and 1:10,000
• Nitroglycerin tablets
• Lidocaine injectable
• IV needle
• 500ml Saline injectable
All crew members are trained for common emergencies. For each flight attendant
¥ Instruction to include performance drills in the proper use of automated external defibrillators
¥ Instruction to include performance drills in cardiopulmonary resuscitation
¥ Recurrent training … at least once every 24 months
The Di 97 2003 And 95 Presentation
The document outlines goals and practical considerations for conducting an initial diagnostic interview. It discusses establishing rapport, exploring the patient's history and current circumstances, assessing for depression and suicidal ideation, and addressing sensitive topics while managing the patient's anxiety. Examples of initial patient contacts from films are also provided, as well as questions to ask while assessing for depression and suicidal thoughts or behaviors.
Mindset Course
This document provides an overview of mindset from Alan, an expert. It discusses that mindset comes from family, friends, and experiences. Negative mindsets are stronger in our brain and come from fears of failure. The brain's role is survival and pain avoidance. There are four levels of mindset: survival, stability, success, and significance. Expectations can create a negativity gap. Positive mindset examples are provided. Taking action involves admitting problems, identifying fears/doubts, listing procrastination habits, and committing to a positive mindset and action. Developing new habits takes time through phases. The document emphasizes overcoming fears to follow your dreams.
Ch7moodandsuic
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Suicide not the only solution
COVID-19 the pandemic has caused an outburst in the Mental health world ... it has crippled mental well being . Spiking anxieties & severe depression have resulted in frequent suicidal attempts.
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The Child in Pain - Greg
Pain in children is often under treated due to practitioners lacking the knowledge or confidence to be aggressive enough. This is partly due to the lack of structure presented in pain management and it is frequently made to seem more complex than it is.
Almost all acute pain in children can be dealt with by a simple stepwise regime using a small number of common, established and easy to use drugs.
Likewise, procedural sedation can be safely and simply performed with simple regimes.
Rick Body - Is Compassion a Patient Right?
Rick Body’s SMACC Chicago talk 'Is compassion a Patients Right?' takes us on a journey of emotions in critical care.
Body, initially focuses on a study conducted within his hospital of 125 patients, who were interviewed when admitted to their emergency department and when they where discharged. From the study it was depicted that, what patients truely wanted was simple human intervention; reassurance, friendliness, explanation, basic care. These responses were then coded into 5 different themes to depict how patients believe their suffering should be addressed;
1. Emotional distress
2. Physical symptoms - including pain (but not restricted to)
3. Information - Included reassurance and explanation
4. Care - Basic care
5. Closure - patients want to put this horrible episode behind them
Body notes that patients are telling us that they want something positive from us. They don’t want us to focus on what we shouldn’t do. They want us to be thinking about what we can do to help… suggesting that if we follow the above ‘EPPIC' we could provide more compassionate care. The problem is this is not compassion as compassion is an emotion and needs to be felt.
Body then explores whats stopping us (care providers) from showing compassion? Sighting the The Good Smaritian Study, The By Standers Affect, Unclear of Who is Responsible, and Personal Reasons.
Body believes that patients don’t have a right to compassion as it is an emotion and means to suffer with but asks for health providers to be emotionally intelligent. Explaining that emotional Intelligence recognises that there is a difference between traditional intelligence, IQ and our ability to form effective forms of interpersonal relationships. Siting the 5 domains of emotions intelligence as;
1. Know your emotions - know what we are feeling
2. Manage your emotions - cool rational and object in the rests room, show emotion with patients and family
3. Motivating ones self
4. Recognising emotions in others - empathy
5. Handling Relationships - interpersonal Skills - relate to other people
Body suggest that these are skills that can be developed as ones life goes on and by building skills in emotional intelligence that maybe one can be both a compassionate and effective doctor.
Body concludes by asking the question 'How are you going to care more for your patients?'
Critical Care in Humanitarian Emergencies: Nikki Blackwell
Nikki Black provides an insight into critical care in humanitarian emergencies.
Through her experiences in hunger emergencies, epidemics, natural disasters and conflict zones, Nikki has gained a wealth of wisdom and lessons.
She shares these from the SMACC stage.
Nikki talks about some of the practical things she does when working in resource poor settings. It starts with hospital hygiene to reduce nosocomial infections, and often entails Nikki working alongside the cleaners due to resource limitations.
Hand hygiene is difficult without running water and Nikki champions using the WHO Handrub Formulation.
Other challenges include cold chain storage, blood donations, limited monitoring and food and nutrition.
Nikki also discusses the challenges of working in different environments. Invariable the environment will be too hot… or too cold!
On top of this, working in remote locations often entails living with the other medical professionals you are working alongside. This presents interpersonal challenges.
Moreover, Nikki touches on the personal dangers of working in some of the more politically unstable locations around the world. Training becomes hugely important in resource poor settings when you are dealing with complex medical and surgical cases. Especially with less-than-ideal resources and equipment.
Nikki expands on what is possible with good training, intuition, and a Swiss army knife. If you do not do anything stupid, and you have basic resources backed up by sound training, it is amazing what you can achieve and who you can help.
She concludes by touching the future direction of care in resource poor settings highlight the potential for technology to make huge changes and advances.
Critical Care in Humanitarian Emergencies: Nikki Blackwell
Finally, for more like this, head to our podcast page. #CodaPodcast
Imogen Mitchell - Morphing the Recalcitrant Clinician
Imogen Mitchell’s SMACC Chicago talk 'Morphing the Recalcitrant Clinician’ talks us through the steps to engage the reluctant physician when implementing change.
Imogen initally touches on the stages of physician engagement from aversion, to apathy, to engaged and then outlines the steps to morphing the reluctant physician.
1. Seek out a clinical champion
2. Establish a common purpose/vision
3. Standardise what is standardisable
4. Communication, communication, communication
5. Work out barriers and overcome them
6. Deal with the ‘Whats in it for me?’WIFM
Explore Steve Aks - Emerging Toxicology
Poisons and novel agents are a moving target in the clinical arena. This talk begins with a historical look at decontamination and pitfalls that have been discovered along the way. The advent of intubation and critical care was a major boon in the improvement in mortality from poisoning. The Scandinavian Method is described and is an important lesion to this day. The rise of antidotes is mentioned.
Emerging drugs are highlighted in the context of where we have come from. The phenylethylamine compound structure and corresponding variants are described. The importance of the principles of supportive care as learned in the Scandinavian method is emphasized. Other emerging topics including synthetic cannabinoids, and anti-NMDA receptor antagonists are discussed. Emerging interventions of prescription naloxone, and ED ECMO are outlined. High vigilance for new agents, and innovative treatments will enable clinicians deal with these evolving trends.
When to STOP Resuscitation by Roger Harris
When to stop resuscitation in probably the biggest question challenging Critical Care and it's a challenge that many of us face virtually every clinical shift. The main problem is that there is little good data to guide us, leaving us to navigate this situation with few coordinates to plot a path forward. When to stop resuscitation explores this problem and suggests some landmarks we can use to navigate by. It examines the inter-relationship between the pillars of our medical ethics Autonomy, Beneficence, Non-Maleficence and Justice. To better understand the clinical challenges we face, the talk also uses a framework provided by modern physics and the 'Space Time Continuum' theorem. Hence the title might more appropriately be – “The will to Live – The courage to die and the space-time continuum”.
If the thought of how Einstein’s theorem on ‘General Relativity’ can help us answer the question of, when to stop resuscitation interests you then don’t miss this.
Tranexamic Acid in Trauma by Karim Brohi
WARNING: This talk will be ineffective if you have no sense of humour.
In Karim’s hilarious and wonderfully sarcastic way, he takes on the Tranexamic Acid debate which (bizarrely) continues to spark controversy.
CRASH 2 had over 20,000 enrolled patients and demonstrated a 15% mortality relative risk reduction by using tranexamic acid in trauma.
There remain some haters out there, including the authors of this amusing review paper who not only slam TXA but the way in which social media has distributed the results. After openly criticising discussion about CRASH 2 on FOAMed resources such as EMCRIT, St Emlyns and on Twitter in general, the papers author, Sophia Binz, calls for “professional and productive scientific debate” - PLEASE feel free to engage with the authors by discussion in the forum below and this shall be fed back in a professional and productive way.
In this talk Karim presents “The Tranexamic Acid Denier’s Handbook”, which describes the multiple strategies we can employ to deny the results of CRASH 2. He tells you how to deflect, how to disrespect the study, how to disrespect the results, how to disrespect the design, how to disrespect the ethics, disrespect the subjects, disrespect the investigators, how to be a scaremonger and finally how to publish (anything) to throw people off the scent.
Now you are empowered to deny the evidence and not use a cheap and effective drug that has been shown to save lives. Go for it!
Karim is currently being headhunted by the UN for his skills in diplomacy.
How to use ketamine fearlessly for all its indications smacc 2015 no builds
SMACC Conference Reuben Strayer Ketamine is best known for producing dissociative anesthesia by a unique mechanism where cardio-respiratory function is preserved. It has an extraordinary safety profile that lends itself well to a variety of uses in the emergency department, intensive care, and pre-hospital environments. We will discuss many of these applications, with a focus on the myths and controversies that might discourage emergency clinicians from taking advantage of this remarkable agent.
David Juurlink - Drug Interactions That Can Kill (and How to Avoid Them)
David Juurlink SMACC Chicago talk 'Drug Interactions That Can Kill (and How to Avoid Them)’ takes us on a journey of drug interactions, case studies, and avoidance strategies.
Juurlink starts by educating us on the two different drug-drug interactions (DDI) - effects of one drug altered by the use of another . First of which is Pharmacokinetic where by one drug alters the level of another, the second Pharmacodynamic being no change in drug levels, and uses this as a basis for his following case studies.
Juurlink speaks of the dreadful literature that is available on the thousands of drug interaction per year, stating that most information comes from case reports and volunteer studies, and suggests that majority of these interaction are avoidable.
Juurlink goes on to discuss the findings of 4 case studies involving the following Drug-Drug Interactions and their effects on the patients.
SMX/TMP + sulfonylureas
Macrolides + digoxin
APAP + warfarin
SMX/TMP + ACEI/ARB
Juurlink provides us with a short list of trigger drugs that we should be aware of, a list of meds that warrant extra caution and list of possible safer alternatives. He also suggests that it is of the up most importance to have a good pharmacist to turn to as they are given more information on drugs interactions then physicians. And, to utilise resources such as pharmacy times - where you can get information on drug interactions at a push of the button.
Juurlink also suggests that an Informed patient is a very useful safety mechanism.
Teaching Airways in Critical care - Jon Gatward
The document discusses teaching airway techniques and provides information on understanding the learner, teaching methods, and evaluation. It includes links to websites related to airway management training resources and simulation tools. Evaluation and understanding the learner are emphasized as important parts of the teaching process.
Lisa McQueen - Pearl or Fecalith?
I’ve long been a fan of David Newman’s “Pseudoaxioms,” those medical proclamations handed down from generation to generation despite growing evidence that they are false. In this talk, I turn a critical eye toward common pseudoaxioms in pediatrics. Does aspirin really cause Reye syndrome? Should you routinely use atropine in preparation for neonatal intubation? Join me in an exploration of these and other pseudoaxioms. I may even debunk the notion that “children are not just little adults.”
Breaking Bad (News) by David Anderson
What is the problem?
Delivering bad news and having an end of life conversation are core skills for any practitioner who deals with critically ill patients. Current data show that while 22% of deaths in the USA now occur in ICU, 54% of families surveyed have a poor understanding of patient’s diagnosis, treatment plan and prognosis. Dr. Kate Granger found this out first hand while admitted to hospital in the UK and started the #hellomynameis campaign.
What is the evidence?
While families feel more validated if given longer to speak, doctors speak for 71% of the time in family meetings. -Longer meetings are also associated with greater patient and family member satisfaction. -Patients perceive that doctors spend longer with them if the doctor is sitting down. -Use of a simple mnemonic increases satisfaction and reduced the incidence of PTSD in family members.
What do experts do?
1. Prepare for the meeting. Decide who will attend, what you will talk about and what your goals are.
2. Introduce everyone and explain the agenda.
3. Gather everyone’s understanding
4. Listen and don’t interrupt5Empathise (physicians express no empathy in 1/3 of family meetings)
6. Make the patient’s voice heard
7. Make your recommendation to go forward
8. Reflect on the meeting after it concludes
What about the difficult situations?
Hope is an issue that comes up often. Many other specialties emphasise the importance of hope, while intensivists are often seen as being nihilistic. But we can still foster a degree of hope in patients and families without being unrealistic. -Techniques for managing conflict are discussed such as identifying discord in the family and avoiding mixed messages from staff. -The importance of spirituality is discussed.
When to Stop Resuscitation in Critical Care: Patricia Gerritsen
The document discusses different degrees of death, from soon-to-be dead to irreversibly dead. It explores categories such as reversibly dead, irreversibly dead, and almost dead. Examples are given of people who were considered dead but later revived, such as cases of extreme hypothermia, hyperkalemia, acidosis, and hypercapnia. The document suggests that not everything that appears dead is irreversibly dead, and questions are posed about determining degrees of death.
Howie Mell - How to Stop Bleeding Without a Hospital
Howie shows us the tools in his toolkit:
- Tourniquets save lives and do not cause limb ischaemia. The aorta is clamped for many hours in cardiac surgery. Data from the battlefield showed that in >800 cases where tourniquets were applied, there were 3 adverse outcomes (loss of sensation in the distal fingertips).
- Haemorrhage control (Israeli) bandages are tourniquets with a haemostatic agent that can be applied to a bleeding wound
- QuickClot (haemostatic powder) can be used for abdominal wounds but may draw the ire of surgeons because they cause an exothermic reaction that burns surrounding tissue
Howie emphasises that not all bleeding have to be stopped - if it’s not pouring out, it can wait. He teaches us to quantify blood loss in the field - three 335 mL cans of soda worth is when to start worrying.
The talk ends with an interesting mini Q&A session as trauma surgeons and paediatricians also weigh into the debate.
Walter Eppich - Interprofessional Communication: Challenges and Opportunities
This document discusses interprofessional communication challenges and opportunities. It notes that competent individuals may form incompetent teams, and that communication breakdowns can lead to learning breakdowns. It emphasizes that a supportive workplace culture with psychological safety is key. Leaders should empower team members, invite input, and show fallibility. Specific communication aids like C-U-S words and S-B-A-R can help improve speaking up about safety issues and disruptive behaviors. Organizational culture and leadership that support open communication are necessary for collective competence and team learning.
Joe Lex - Is There a Doctor on the Plane?
How Common Are In-Flight Emergencies?
• Occur on one in every 600 flights
• 44,000 of 2.75B airline passengers / year
What Are Most Common Emergencies
• Lightheadedness or fainting ~37%
• Respiratory problems ~12%
• Nausea or vomiting ~10%
• Cardiac symptoms ~8%
• Seizures ~6%
• Other Emergencies
• Laceration ~0.3%
• Cardiac arrest ~0.3%
• Ear pain ~0.4%
• Obstetrical or gynecological symptoms ~0.5%
• Headache ~1%
Who Responds to the Call?
• Physician passenger responds in ~48%
• Nurse passenger responds in ~20%
• EMT passenger responds in ~5%
Minimum first aid kits on commercial airliners
16 Adhesive bandage compressors, 1 in
20 Antiseptic Swabs
10 Ammonia Inhalants
8 Bandage compressors, 4 in
5 Triangular bandage compressors, 40 in
1 Arm splint, non inflatable
1 Leg splint, non inflatable
4 Roller bandage, 4 in
2 Adhesive tape, 1 in standard roll
1 Bandage Scissors
2 Protective latex gloves pair
2 Insect sting relief pad
2 Triple antibiotic ointment
2 First Aid/burn cream, 9 gm.
2 Povidone iodine infection control wipes
2 Alcohol cleansing pads
2 Gauze dressing pad 2" x 2" in
2 Motion Sickness Tab
4 Ibuprofen tablets
4 Non Aspirin Tablets
2 Sunscreen lotion towelette
2 Trauma pads 5 x 9 in (12,7 x 22,8 cm)
1 Survival rescue blanket
1 Pelican case 1170 waterproof
1 Emergency first aid guide (American Red Cross)
Required medications on flights
• Antihistamine – tablets and injectable
• Atropine 0.5 mg injectable
• Aspirin tablets 325mg
• Bronchodilator MDI
• Dextrose 50% injectable
• Epinephrine 1:1000 and 1:10,000
• Nitroglycerin tablets
• Lidocaine injectable
• IV needle
• 500ml Saline injectable
All crew members are trained for common emergencies. For each flight attendant
¥ Instruction to include performance drills in the proper use of automated external defibrillators
¥ Instruction to include performance drills in cardiopulmonary resuscitation
¥ Recurrent training … at least once every 24 months
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How to use ketamine fearlessly for all its indications smacc 2015 no builds
How to use ketamine fearlessly for all its indications smacc 2015 no builds
David Juurlink - Drug Interactions That Can Kill (and How to Avoid Them)
David Juurlink - Drug Interactions That Can Kill (and How to Avoid Them)
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Howie Mell - How to Stop Bleeding Without a Hospital
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Precision Medicine in Acute Brain Injury
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Cortical spreading depolarization (CSD) is a spreading loss of ion homeostasis, altered vascular response, change in synaptic architecture, and subsequent depression in electrical activity following an inciting neurological injury.
It was first described by Leão in 1944, a disturbance in neuronal electrophysiology has since been demonstrated in a number of animal studies, and recently a few human studies that examine the occurrence of this depolarizing phenomenon in the setting of a variety of pathological states, including migraines, cerebrovascular accidents, epilepsy, intracranial hemorrhages, and traumatic brain injuries. The onset of CSD has been demonstrated experimentally following a disruption in the neuronal environment leading to glutamate-induced toxicity. This initial event leads to pathological changes in the activity of ion channels that maintain membrane potential. Recovery mechanisms such as sodium-potassium pumps that aim to restore homeostasis fail, leading to osmolar shifts of fluid, swelling of the neuron, and ultimately a measurable depression in cortical activity that spreads in the order of millimeters per minute. Equally important is the resulting change in vascular response. In healthy tissue, increased electrical activity is coupled with release of vasodilatory factors such as nitric oxide and arachidonic acid metabolites that increase local blood flow to meet increased energy expenditure. In damaged tissue, not only is the restorative vascular response lacking but a vasoconstrictive response is promoted and the ischemia that follows adds to the severity of the initial injury. Tissue threatened by this ischemic response is then at elevated risk for CSD propagation and falls into a vicious cycle of electrical and hemodynamic disturbance. Efforts have been made to halt this spreading cortical depression using N-methyl-D-aspartate receptor antagonists and other ion channel blockers to minimize the damaging effects of CSD that can persist long after the triggering insult.
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Tania is a neurologist and epileptologist with expertise in continuous EEG (cEEG) and status epilepticus (SE). This talk covers what a seizure is, what status is, including focal and generalised status epilepticus.
So why do we do cEEGs for patients with suspected SE?
To confirm the diagnosis
To see if patient just post ictal or still seizing
To establish that the clinical and electric seizures have stopped
To see if burst suppression is achieved
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In the questions after the talk, the issue of availability of cEEG in the Australian setting was discussed. Limited montage EEGs are discussed including their pros and cons.
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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.
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Stuart also covers how severely disabled people face various forms of discrimination.
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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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The Nervous and Chemical Regulation of Respiration
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
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Cell Therapy Expansion and Challenges in Autoimmune Disease
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
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Histololgy of Female Reproductive System.pptx
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Is Your Patient at Risk of Suicide? By Orman
- 1. Is my patient suicidal? Rob Orman, MD
- 3. What to say
- 4. What to ask
- 11. Good
- 12. Bad
- 13. Rare
- 14. Complete suicide
- 15. 3% high risk
- 16. 60% low risk
- 17. Lie
- 25. Suicide attempt
- 28. What and Why
- 35. What
- 36. What When
- 37. What When Why
- 38. What Why
- 41. What Why
- 44. What Why
- 47. Behavior
- 50. What Why
- 51. What Why
- 60. Gestalt
- 64. Organized
- 68. How to ask
- 70. 6 questions
- 72. 6 questions
- 74. Have you ever wished you were dead or wished you could go to sleep and not wake up?
- 75. Have you ever had thoughts of killing yourself?
- 76. No?
- 77. Have you ever wished you were dead or wished you could go to sleep and not wake up?
- 78. Have you ever had thoughts of killing yourself?
- 79. No?
- 80. No ideation
- 81. Have you ever done anything, started to do anything, or prepared to do anything to end your life?
- 82. Yes ideation
- 83. Define it
- 86. Vague thoughts
- 89. Is there INTENT
- 90. Have you been thinking about how you might kill yourself?
- 91. Have you had these thoughts and had some intention of acting on them?
- 92. Is there INTENT with a plan
- 93. Have you started to work out the details of how to kill yourself? Do you intend to carry out the plan?
- 94. Have you ever done anything, started to do anything, or prepared to do anything to end your life?
- 95. Obvious
- 96. What did you think would happen when y0u did X?
- 97. How do you feel now that you’re not dead?
- 100. Previous attempts
- 101. What’s stopping you?
- 102. Protective Factors
- 103. Did you want to kill yourself?
- 104. Did part of you want to kill yourself?
- 105. ideation
- 106. ideation intent
- 108. inform
- 109. inform suicide risk
- 110. Organized Systematic
- 111. What Why
- 112. Mindset and Intent
- 113. Impulsive Act
- 114. Short Lived
- 117. hopelessness
- 118. hopelessness trapped
- 122. Remove the Means
- 124. 1-2%
- 125. 1-2% 61%
- 126. 1-2% 61% 82%
- 127. Remove the Means
- 128. Chance of Dying
- 129. Lower
- 133. 40%
- 134. Remove the Means
- 135. Chance of Dying
- 136. Lower
- 137. ASK
- 139. What Why
- 140. Mindset and Intent
- 141. Risk Assessment
- 142. Is there ideation?
- 143. Explore the ideation
- 144. Gestalt
- 148. The what
- 149. Thinking about OD
- 150. The why
- 151. Breakup
- 152. Breakup Lost Job
- 154. 20yo
- 155. 20yo thinking
- 156. 20yo thinking OD
- 158. What Why
- 159. What Why
- 160. Is there ideation?
- 161. Have you ever wished you were dead or wished you could go to sleep and not wake up?
- 162. Yes
- 163. Have you ever had thoughts of killing yourself?
- 164. Tonight
- 165. Yes ideation
- 166. Is there INTENT
- 167. Have you been thinking about how you might kill yourself?
- 168. OD
- 169. Have you had these thoughts and had some intention of acting on them?
- 170. Yes
- 171. Have you started to work out the details of how to kill yourself? Do you intend to carry out the plan?
- 173. Lock self in bathroom family asleep
- 174. Have you ever done anything, started to do anything, or prepared to do anything to end your life?
- 175. Not before tonight
- 176. Explore the ideation
- 178. Previous attempts
- 179. What did you think would happen when y0u did X?
- 180. How do you feel now that you’re not dead?
- 181. What’s stopping you?
- 182. Fear
- 183. Trivial
- 184. Trivial Life threat
- 185. Never Perfect