It's all about function NOT movement re-education!
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The document discusses the importance of early rehabilitation after a stroke to maximize recovery. It emphasizes starting rehabilitation as early as possible, within 24 hours of the stroke, and ensuring it is repetitive and intensive. The document also shares an inspiring story of a young woman who survived a severe stroke and defied expectations with her recovery through hard work. It advocates for patients not lowering their expectations and voices the importance of self-belief and peer support. Finally, it proposes potential areas for further stroke rehabilitation research.
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Dr Anne Creaton talks about the healthcare capacity building in Fiji.
Fiji was struck by Cyclone Winston in 2016. It caused widespread devastation and the impact will be felt for a long time in the future.
The most important thing that Fiji has taught her is faith, patience and persistence.
Anne begins by talking about the three Rs that are essential in trainees who want to work in Fiji or similar situations.
The three Rs being: Realistic, Resilient and Resourceful.
Emotional intelligence is also very important. Most of the people are highly trained, but always in a high resource environment. Dysfunctional systems in places like Fiji, can impact the clinician’s welfare and performance.
Critical care systems are made up of multiple building blocks with doctors playing a small part. Anne compares critical care systems in Fiji to a game of Jenga. This is because multiple blocks that are essential for critical care systems are non-existent.
Anne divides the Jenga blocks of a critical care system into three: a pre-hospital block, a hospital block, and an administration and governance block.
The pre-hospital block consists of scene care, transport care, communication, hazmat, decontamination and retrieval.
The hospital blocks consist of factors like triage, medical assessment, equipment, drugs and patient flow.
The administrative and governance block provides data, audits, leadership and human resource activities such as training, recruitment and retention.
All these blocks put together form the critical care system. This illustrates how when the different blocks in critical care services are removed, it makes it very difficult to successfully treat a patient.
She explains how doctors face multiple difficulties like faulty equipment, untrained staff, lack of timely transport vehicles, inaccessibility to interventional cardiology, lack of risk management and quality improvement. They also lack hazmat, decontamination, personal protective equipment (PPE), proper communication.
Anne then gives an example of using the three Rs technique to reduce VF arrest by early defibrillation.
Realistic: Automatic external defibrillator (AED) for all health facilities.
Resilient: Placed all AEDs in pelican cases.
Resourceful: Acquired the AEDs via Twitter.
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So, are you ready to play critical care Jenga?
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Marius wants this to change and is passionate about increasing the quantity and quality of prehospital research.
Prehospital research that examines patient pathophysiology should dictate care – as it does in the hospital environment. However, Evidence based practice pertaining to the prehospital environment is minimal. This needs to change.
Evidence based medicine in the prehospital setting can dictate care, critically appraise practice and enable improvements in process and cost effectiveness whilst decreasing harms.
Evidently, in-hospital evidence is different to the field application. Ultimately, prehospital research is critical, 5.8 million people die from injury every year – around 10% of the world’s deaths. Unfortunately, pre-hospital research is underfunded.
So, how can we take interventions from the hospital to the streets?
Marius shares three important steps:
The research that is needed
How to interpret the evidence
Why all research is important to consider (from case studies to randomised controlled trials)
Moreover, Marius highlights the need to lean on other members of the scientific community when conducting your own research. For example, a statistician is worth their weight in gold in observational studies when fleshing out regression analysis.
Finally, Marius discusses the importance of information dissemination across all platforms, including peer reviewed journals and informal FOAMed platforms such as Twitter. They all have their place.
For more like this, head to our podcast page. #CodaPodcast
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Supplemental oxygen can worsen the pulmonary to systemic blood flow ratio in single ventricle patients and cause them to have rising lactate levels and cardiac arrest from low systemic cardiac output. Intubation and positive pressure ventilation may impede pulmonary blood flow in patients with a Glenn shunt and the patient can become more desaturated. With increasing PEEP and higher respiratory rates, the patients will continue to deteriorate and desaturate. Regular dosing of adrenaline boluses in patients with single ventricle physiology who are nearly arrest, can worsen their systemic output by increasing systemic vascular resistance and promoting pulmonary overcirculation. Cardioversion of a previously healthy paediatric patient might be tempting when you see what looks like a stable ventricular tachycardia. This wide complex rhythm has fooled many people into shocking it. You might in fact be dealing with something else and can make the patient infinitely worse by shocking.
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The Role of the Immediate Responder in Mass Casualty Trauma
Christina Hernon describes a traumatic experience in gripping detail.
In doing so, she shares her deeply personal insights into what it is to be an Immediate Responder. Christina suggests that the medical system must change to support these people.
After a major formative experience at a life-threatening mass casualty incident, Christina felt incredibly unprepared despite over two decades of training in emergency and first response.
Christina reflects that all the training that students undergo does not prepare them for every scenario. The standard approach to emergency care, is this scene safe? is completely inadequate for those present the very moment an incident occurs. These people are then amidst and surrounded by an unsecured and potentially unsafe scene.
After her experience Christina had an acute stress reaction exactly like after rough calls in prehospital Emergency Medical Services.
However, Christina wasn't offered the usual support given in these circumstances. She felt somehow betrayed, but unsure who to be mad at. Therefore, Christina tried to understand why she felt so unprepared and overlooked.
In deconstructing and reflecting on the experience, she self-identified neither as bystander nor first responder. Instead she was an on scene, immediate responder, victimised rescuer. Realising that she did not fit into any already existing category, she uncovered an undefined time period that we need to give attention to.
The Disaster Gap is the time between the moment an incident occurs, through the first call for help, and until the clearheaded First Responders arrives.
In this definable time gap, the only available rescuers are people who are on scene when the event happens. These Immediate Responders, who are traumatised by their experience themselves, take immediate action to help another person or make the situation better.
They are present at virtually every scene and have been for all of time. However, we know very little about them, their actions, their safety, their impact, and their recovery.
By trying to understand the Disaster Gap and Immediate Responders, we can improve training, preparedness, resilience, and recovery.
The Role of the Immediate Responder in Mass Casualty Trauma
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It’s natural that as doctors we fear failure. In Health, never has so much been asked by so many of so few. Every day feels like a battle zone. Engage a Chief Medical Informatics Officer (CMIO) to introduce technology. That will save us. Established with structure, status and enough support to create and translate innovative models of change in the mindsets of clinicians and healthcare politicians alike, this role could work. However reality is so different. So lets understand failing early to succeed sooner, simplifing and standardising the clinical arena for clinician interoperability, and driving clinician inclusion in the business of health.
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ECMO or extracorporeal membrane oxygenation has shown promise in the use of cardiac arrest patients. Zack Shinar and his crew from San Diego have lead the way in emergency physician initiated ECMO for patients in cardiac arrest.
In this lecture he explains briefly how ECMO works, what their outcomes have been and where ECMO is moving. Initially 5 of their first 8 patients were neurologically intact survivors. Their first patient had over an hour of downtime when cardiac bypass was initiated. He walked out of the hospital completely neurologically intact nine days later and now has been featured on the film “Code Black”. Physicians from their hospital, Sharp Memorial, were also recently featured on the television show “Untold Stories in the ER” for a save of a 21 year old female arresting from hyperkalemia. Dr. Shinar also discusses some of the latest physiologic questions as the Australians have pushed for smaller diameter catheters that allow for smaller flow volumes.
He also discusses how in Paris pre-hospital ECMO is being done by physicians in various places like the subway, apartment buildings and even the Louvre.
In the end, Dr. Shinar discusses the biggest question in any novel resuscitation technique: cost. Prolongation of life and particularly after a cardiac arrest is expensive and many people do not survive.
Dr. Shinar uses various pioneers in the world of technology to tell how true genius is not in technologic advancements but in making those advancements available to the masses. He ends with a story about Linus Torvalds. Dr. Shinar shows how this man through the use of the collective minds of computer programmers worldwide created one of the best operating systems ever created: Linux. He asks the medical community to endorse this idea and introduces the concept of “free open access medical innovation”.
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Jim Manning - Selective Aortic Arch Perfusion
Selective Aortic Arch Perfusion -
Summary by: Jim Manning
Selective Aortic Arch Perfusion (SAAP) is an endovascular-extracorporeal perfusion resuscitation technique designed specifically to treat cardiac arrest. SAAP involves the blind insertion of a large-lumen balloon occlusion catheter into the descending thoracic aortic arch via a femoral artery. With the SAAP catheter balloon inflated in the thoracic aorta, the heart and brain are relatively isolated for resuscitative perfusion through the SAAP catheter lumen with an oxygen-carrying fluid (such as blood, hemoglobin-based oxygen carrier or fluorocarbon emulsion). SAAP promotes restoration of spontaneous circulation (ROSC) by the heart while protecting the brain from further ischemic insult. SAAP can be used to treat both hemorrhage-induced traumatic cardiac arrest and medical, non-traumatic cardiac arrest.
In traumatic cardiac arrest, SAAP provides the combination of (1) thoracic aortic balloon occlusion for control of hemorrhage below the diaphragm, (2) rapid volume replacement in hemorrhage-induced hypovolemia to restore normovolemia and (3) perfusion of the heart and brain in an effort to achieve ROSC. SAAP also allows titration of small doses of intra-aortic adrenaline or other medications to achieve ROSC.
In medical cardiac arrest, SAAP catheter balloon occlusion of the thoracic aorta limits the distribution of oxygenated perfusate toward the heart and brain. Since medical cardiac arrest patients are not typically hypovolemic, SAAP with an exogenous oxygen-carrier is a volume loading intervention that can only be used for a short time period (5-10 min). If ROSC is not achieved with the limited volume of exogenous oxygen-carrier, femoral venous access during initial SAAP infusion allows venous blood withdrawal for continued SAAP support to promote ROSC without further volume loading (autologous blood SAAP or, essentially, aortic arch ECMO). Intra-aortic adrenaline and anti-reperfusion agents can also be used. Even if ROSC is not rapidly achieved, SAAP serves as a bridge that limits hypoperfusion until cannulation for full body ECMO can be achieved.
Spinal Trauma: The Legend of the C-Spine Collar - A Case Report
A 27-year old female presented with persistent central intrascapular pain after a high-speed skiing injury in Japan. Imaging revealed fractures at C7, T1 spinous processes, and T7 vertebral body. She was initially managed conservatively with a cervical collar and neuro checks. However, evidence shows cervical collars may do more harm than good and their use is based more on tradition than clinical evidence. Proper history and exam, along with imaging as indicated, are more important for assessing spinal injury and instability than routine hard collar use.
Scott Weingart - Emergent Intubation Resequenced
Pretty much everything I learned as a resident in terms of the sequencing of airway management in ED has changed over the past 15 years. No longer is there simply RSI or stick a laryngoscope in with nothing and use pure brute force to intubate a patient; we have a host of different options and pathways when approaching airway management in the emergency department.
This lecture discusses some of these updated ways of getting from a sick patient requiring airway management to a tube between the cords…with only minor technical mishaps.
Emergency Care Of Stroke
1. The document discusses pre-hospital and emergency department management of acute stroke. It emphasizes the importance of rapid detection, transport, and treatment to maximize outcomes for stroke patients.
2. Treatment guidelines recommend administering intravenous tissue plasminogen activator (tPA) for ischemic stroke within 3 hours of symptom onset to reduce disability and mortality.
3. In the emergency department, the focus is on quick assessment, diagnosis of hemorrhagic vs ischemic stroke using CT scan, and treatment or referral for definitive care such as thrombolysis within the treatment window.
Debate: Prehospital Doctors add little value in Trauma
Anthony Holley and Marietjie ‘MJ’ Slabbert debate the value of prehospital doctors in trauma.
Anthony argues that doctors in the prehospital setting add little value.
He does so with the upmost respect for prehospital doctors and having worked in this setting himself. He makes the point that across the globe, the employment of doctors in the prehospital setting is a rarity.
Working in this environment is diverse and every situation encountered requires a different skillset. This presents a logistical challenge.
Anthony continues to discuss the evidence, or lack thereof, in this space. He raises the point of competing interests from paramedics, flight nurses and doctors themselves.
This leads to apples being compared to oranges most of the time.
Anthony goes on to suggest all the advanced clinical interventions that are necessary in prehospital situations can be competently undertaken by paramedics.
MJ argues for the negative.
In doing so, she concedes that the evidence base for prehospital medicine is scarce.
This is due to inherent biases, the difficulty of gathering data and the issues with methodology. However, MJ believes that care provided outside of the hospital should be of the same level as care received in hospital.
This provides a seamless patient journey from the prehospital setting into the hospital and improving the chain of survival.
Furthermore, MJ posits that prehospital doctors not only improve care of patients outside of the hospital, but care for those in the hospital and clinics too.
Prehospital physicians add value wherever they practise. They bring leadership, knowledge, additional skills, and training as well as innovation and collaboration.
Tune in as Anthony and MJ debate over the value of prehospital doctors in trauma.
For more like this, head to our podcast page. #CodaPodcast
Technology will save lives
Technology is helping advance medicine in several ways. Brain implants like Ted Berger's are expected to help treat Alzheimer's and brain injuries by mimicking normal brain functions. Pacemakers, invented by Rune Elmqvist, use electrical pulses to regulate irregular heartbeats and have improved millions of lives. Electronic medical records now allow doctors and pharmacists to easily access patient information, reducing errors. While technologies save lives, they also raise ethical issues and costs that limit widespread adoption.
Invisa Engr245 2022 Lessons Learned
The document summarizes the development of Invisa Bio over 10 weeks as they pivoted between different medical applications and solutions for their self-assembling medical device technology. They initially focused on manufacturing and delivery but shifted to leveraging drug delivery mechanisms. They considered applications in cardiology, neurology, and orthopedics before focusing on brain aneurysms based on feedback from physicians. The company incorporated, raised funding, and began shadowing doctors to further develop their technology to address unmet needs in difficult to reach areas.
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Healthcare Capacity Building in Fiji
Dr Anne Creaton talks about the healthcare capacity building in Fiji.
Fiji was struck by Cyclone Winston in 2016. It caused widespread devastation and the impact will be felt for a long time in the future.
The most important thing that Fiji has taught her is faith, patience and persistence.
Anne begins by talking about the three Rs that are essential in trainees who want to work in Fiji or similar situations.
The three Rs being: Realistic, Resilient and Resourceful.
Emotional intelligence is also very important. Most of the people are highly trained, but always in a high resource environment. Dysfunctional systems in places like Fiji, can impact the clinician’s welfare and performance.
Critical care systems are made up of multiple building blocks with doctors playing a small part. Anne compares critical care systems in Fiji to a game of Jenga. This is because multiple blocks that are essential for critical care systems are non-existent.
Anne divides the Jenga blocks of a critical care system into three: a pre-hospital block, a hospital block, and an administration and governance block.
The pre-hospital block consists of scene care, transport care, communication, hazmat, decontamination and retrieval.
The hospital blocks consist of factors like triage, medical assessment, equipment, drugs and patient flow.
The administrative and governance block provides data, audits, leadership and human resource activities such as training, recruitment and retention.
All these blocks put together form the critical care system. This illustrates how when the different blocks in critical care services are removed, it makes it very difficult to successfully treat a patient.
She explains how doctors face multiple difficulties like faulty equipment, untrained staff, lack of timely transport vehicles, inaccessibility to interventional cardiology, lack of risk management and quality improvement. They also lack hazmat, decontamination, personal protective equipment (PPE), proper communication.
Anne then gives an example of using the three Rs technique to reduce VF arrest by early defibrillation.
Realistic: Automatic external defibrillator (AED) for all health facilities.
Resilient: Placed all AEDs in pelican cases.
Resourceful: Acquired the AEDs via Twitter.
Anne ends by saying that life is about expectation management and you need to understand that there will be a gap between the type of care you want to provide and what you will be able to provide in situations like Fiji.
So, are you ready to play critical care Jenga?
For more like this, head to our podcast page. #CodaPodcast
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Peter McCanny is part of the LearnECMO team. In this podcast he explains some of the background and history of ECMO CPR, what evidence there is to support its use and where we're heading in the future.
Evidence Based Medicine in Prehospital Resuscitation
Marius Rehn examines the difficulties and importance of evidence based medicine in prehospital resuscitation. Notably, combining academic activity with pre- and in-hospital clinical practice is hard work. Being an academic in a flight suit can be quite lonely.
Marius wants this to change and is passionate about increasing the quantity and quality of prehospital research.
Prehospital research that examines patient pathophysiology should dictate care – as it does in the hospital environment. However, Evidence based practice pertaining to the prehospital environment is minimal. This needs to change.
Evidence based medicine in the prehospital setting can dictate care, critically appraise practice and enable improvements in process and cost effectiveness whilst decreasing harms.
Evidently, in-hospital evidence is different to the field application. Ultimately, prehospital research is critical, 5.8 million people die from injury every year – around 10% of the world’s deaths. Unfortunately, pre-hospital research is underfunded.
So, how can we take interventions from the hospital to the streets?
Marius shares three important steps:
The research that is needed
How to interpret the evidence
Why all research is important to consider (from case studies to randomised controlled trials)
Moreover, Marius highlights the need to lean on other members of the scientific community when conducting your own research. For example, a statistician is worth their weight in gold in observational studies when fleshing out regression analysis.
Finally, Marius discusses the importance of information dissemination across all platforms, including peer reviewed journals and informal FOAMed platforms such as Twitter. They all have their place.
For more like this, head to our podcast page. #CodaPodcast
Resuscitation in Paediatric Cardiac Patients: Michele Domico
Michele Domico presents a talk on the pitfalls of common paediatric resuscitative manoeuvres in paediatric cardiac patients. Emergency and critical care physicians are all well accustomed to items such as oxygen, bolus adrenaline, intubation and cardioversion. However, as Michele explains, these ‘go to’ interventions may in fact be harmful for the paediatric cardiac patient presenting to the emergency department in extremis. Due to the physiology of certain complex congenital heart diseases, the usual resuscitation manoeuvres may in fact kill the patient instead of helping.
Supplemental oxygen can worsen the pulmonary to systemic blood flow ratio in single ventricle patients and cause them to have rising lactate levels and cardiac arrest from low systemic cardiac output. Intubation and positive pressure ventilation may impede pulmonary blood flow in patients with a Glenn shunt and the patient can become more desaturated. With increasing PEEP and higher respiratory rates, the patients will continue to deteriorate and desaturate. Regular dosing of adrenaline boluses in patients with single ventricle physiology who are nearly arrest, can worsen their systemic output by increasing systemic vascular resistance and promoting pulmonary overcirculation. Cardioversion of a previously healthy paediatric patient might be tempting when you see what looks like a stable ventricular tachycardia. This wide complex rhythm has fooled many people into shocking it. You might in fact be dealing with something else and can make the patient infinitely worse by shocking.
In her talk, Michele highlights the importance of understanding the physiology of your patients. This particularly applies to paediatric cardiac patients. In this population, the change from typical physiology means standard models of care are harmful. Tune in to hear what not to do!
For more like this, head to our podcast page. #CodaPodcast
The Role of the Immediate Responder in Mass Casualty Trauma
The Role of the Immediate Responder in Mass Casualty Trauma
Christina Hernon describes a traumatic experience in gripping detail.
In doing so, she shares her deeply personal insights into what it is to be an Immediate Responder. Christina suggests that the medical system must change to support these people.
After a major formative experience at a life-threatening mass casualty incident, Christina felt incredibly unprepared despite over two decades of training in emergency and first response.
Christina reflects that all the training that students undergo does not prepare them for every scenario. The standard approach to emergency care, is this scene safe? is completely inadequate for those present the very moment an incident occurs. These people are then amidst and surrounded by an unsecured and potentially unsafe scene.
After her experience Christina had an acute stress reaction exactly like after rough calls in prehospital Emergency Medical Services.
However, Christina wasn't offered the usual support given in these circumstances. She felt somehow betrayed, but unsure who to be mad at. Therefore, Christina tried to understand why she felt so unprepared and overlooked.
In deconstructing and reflecting on the experience, she self-identified neither as bystander nor first responder. Instead she was an on scene, immediate responder, victimised rescuer. Realising that she did not fit into any already existing category, she uncovered an undefined time period that we need to give attention to.
The Disaster Gap is the time between the moment an incident occurs, through the first call for help, and until the clearheaded First Responders arrives.
In this definable time gap, the only available rescuers are people who are on scene when the event happens. These Immediate Responders, who are traumatised by their experience themselves, take immediate action to help another person or make the situation better.
They are present at virtually every scene and have been for all of time. However, we know very little about them, their actions, their safety, their impact, and their recovery.
By trying to understand the Disaster Gap and Immediate Responders, we can improve training, preparedness, resilience, and recovery.
The Role of the Immediate Responder in Mass Casualty Trauma
For more like this, head to our podcast page. #CodaPodcast
Interprofessional Communication: Challenges and Opportunities - Walter Eppich
This document discusses interprofessional communication challenges and opportunities. It notes that competent individuals may form incompetent teams, and that communication breakdowns can impair learning and team performance. It emphasizes that a supportive workplace culture with psychological safety is key. When people feel safe speaking up about concerns, mistakes, or asking questions, teams can achieve collective competence through open communication and learning conversations. Specific aids like checklists and frameworks can help facilitate productive discussions. Leaders play an important role in establishing a culture where input is welcomed and people are empowered to solve problems together.
Gadgets and Simulation by Jon Gatward
The Sim revolution. Jon Gatward on the future of simulation in critical care. Strategies for pulling it off, no matter your resources. See smacc.net.au and intensivecarenetwork.com for more.
Chief Medical Informatics Officer- I could do that!
It’s natural that as doctors we fear failure. In Health, never has so much been asked by so many of so few. Every day feels like a battle zone. Engage a Chief Medical Informatics Officer (CMIO) to introduce technology. That will save us. Established with structure, status and enough support to create and translate innovative models of change in the mindsets of clinicians and healthcare politicians alike, this role could work. However reality is so different. So lets understand failing early to succeed sooner, simplifing and standardising the clinical arena for clinician interoperability, and driving clinician inclusion in the business of health.
Zack Shinar - How we do ED– ECMO
ECMO or extracorporeal membrane oxygenation has shown promise in the use of cardiac arrest patients. Zack Shinar and his crew from San Diego have lead the way in emergency physician initiated ECMO for patients in cardiac arrest.
In this lecture he explains briefly how ECMO works, what their outcomes have been and where ECMO is moving. Initially 5 of their first 8 patients were neurologically intact survivors. Their first patient had over an hour of downtime when cardiac bypass was initiated. He walked out of the hospital completely neurologically intact nine days later and now has been featured on the film “Code Black”. Physicians from their hospital, Sharp Memorial, were also recently featured on the television show “Untold Stories in the ER” for a save of a 21 year old female arresting from hyperkalemia. Dr. Shinar also discusses some of the latest physiologic questions as the Australians have pushed for smaller diameter catheters that allow for smaller flow volumes.
He also discusses how in Paris pre-hospital ECMO is being done by physicians in various places like the subway, apartment buildings and even the Louvre.
In the end, Dr. Shinar discusses the biggest question in any novel resuscitation technique: cost. Prolongation of life and particularly after a cardiac arrest is expensive and many people do not survive.
Dr. Shinar uses various pioneers in the world of technology to tell how true genius is not in technologic advancements but in making those advancements available to the masses. He ends with a story about Linus Torvalds. Dr. Shinar shows how this man through the use of the collective minds of computer programmers worldwide created one of the best operating systems ever created: Linux. He asks the medical community to endorse this idea and introduces the concept of “free open access medical innovation”.
It's time to do away with the hard Cervical Collar
The document argues that hard cervical collars should be done away with based on three assumptions that are unsupported or proven false. Hard collars are unlikely to provide benefits to patients and can clearly cause harm. Instead of hard collars, the document recommends using softer "reminder collars" or vacuum mattresses for obtunded patients, and limiting energy deposition by not restricting motion for uncooperative patients. Hard collars are compared to other medical ideas that seemed good initially but were later disproven.
Jim Manning - Selective Aortic Arch Perfusion
Selective Aortic Arch Perfusion -
Summary by: Jim Manning
Selective Aortic Arch Perfusion (SAAP) is an endovascular-extracorporeal perfusion resuscitation technique designed specifically to treat cardiac arrest. SAAP involves the blind insertion of a large-lumen balloon occlusion catheter into the descending thoracic aortic arch via a femoral artery. With the SAAP catheter balloon inflated in the thoracic aorta, the heart and brain are relatively isolated for resuscitative perfusion through the SAAP catheter lumen with an oxygen-carrying fluid (such as blood, hemoglobin-based oxygen carrier or fluorocarbon emulsion). SAAP promotes restoration of spontaneous circulation (ROSC) by the heart while protecting the brain from further ischemic insult. SAAP can be used to treat both hemorrhage-induced traumatic cardiac arrest and medical, non-traumatic cardiac arrest.
In traumatic cardiac arrest, SAAP provides the combination of (1) thoracic aortic balloon occlusion for control of hemorrhage below the diaphragm, (2) rapid volume replacement in hemorrhage-induced hypovolemia to restore normovolemia and (3) perfusion of the heart and brain in an effort to achieve ROSC. SAAP also allows titration of small doses of intra-aortic adrenaline or other medications to achieve ROSC.
In medical cardiac arrest, SAAP catheter balloon occlusion of the thoracic aorta limits the distribution of oxygenated perfusate toward the heart and brain. Since medical cardiac arrest patients are not typically hypovolemic, SAAP with an exogenous oxygen-carrier is a volume loading intervention that can only be used for a short time period (5-10 min). If ROSC is not achieved with the limited volume of exogenous oxygen-carrier, femoral venous access during initial SAAP infusion allows venous blood withdrawal for continued SAAP support to promote ROSC without further volume loading (autologous blood SAAP or, essentially, aortic arch ECMO). Intra-aortic adrenaline and anti-reperfusion agents can also be used. Even if ROSC is not rapidly achieved, SAAP serves as a bridge that limits hypoperfusion until cannulation for full body ECMO can be achieved.
Spinal Trauma: The Legend of the C-Spine Collar - A Case Report
A 27-year old female presented with persistent central intrascapular pain after a high-speed skiing injury in Japan. Imaging revealed fractures at C7, T1 spinous processes, and T7 vertebral body. She was initially managed conservatively with a cervical collar and neuro checks. However, evidence shows cervical collars may do more harm than good and their use is based more on tradition than clinical evidence. Proper history and exam, along with imaging as indicated, are more important for assessing spinal injury and instability than routine hard collar use.
Scott Weingart - Emergent Intubation Resequenced
Pretty much everything I learned as a resident in terms of the sequencing of airway management in ED has changed over the past 15 years. No longer is there simply RSI or stick a laryngoscope in with nothing and use pure brute force to intubate a patient; we have a host of different options and pathways when approaching airway management in the emergency department.
This lecture discusses some of these updated ways of getting from a sick patient requiring airway management to a tube between the cords…with only minor technical mishaps.
Emergency Care Of Stroke
1. The document discusses pre-hospital and emergency department management of acute stroke. It emphasizes the importance of rapid detection, transport, and treatment to maximize outcomes for stroke patients.
2. Treatment guidelines recommend administering intravenous tissue plasminogen activator (tPA) for ischemic stroke within 3 hours of symptom onset to reduce disability and mortality.
3. In the emergency department, the focus is on quick assessment, diagnosis of hemorrhagic vs ischemic stroke using CT scan, and treatment or referral for definitive care such as thrombolysis within the treatment window.
Debate: Prehospital Doctors add little value in Trauma
Anthony Holley and Marietjie ‘MJ’ Slabbert debate the value of prehospital doctors in trauma.
Anthony argues that doctors in the prehospital setting add little value.
He does so with the upmost respect for prehospital doctors and having worked in this setting himself. He makes the point that across the globe, the employment of doctors in the prehospital setting is a rarity.
Working in this environment is diverse and every situation encountered requires a different skillset. This presents a logistical challenge.
Anthony continues to discuss the evidence, or lack thereof, in this space. He raises the point of competing interests from paramedics, flight nurses and doctors themselves.
This leads to apples being compared to oranges most of the time.
Anthony goes on to suggest all the advanced clinical interventions that are necessary in prehospital situations can be competently undertaken by paramedics.
MJ argues for the negative.
In doing so, she concedes that the evidence base for prehospital medicine is scarce.
This is due to inherent biases, the difficulty of gathering data and the issues with methodology. However, MJ believes that care provided outside of the hospital should be of the same level as care received in hospital.
This provides a seamless patient journey from the prehospital setting into the hospital and improving the chain of survival.
Furthermore, MJ posits that prehospital doctors not only improve care of patients outside of the hospital, but care for those in the hospital and clinics too.
Prehospital physicians add value wherever they practise. They bring leadership, knowledge, additional skills, and training as well as innovation and collaboration.
Tune in as Anthony and MJ debate over the value of prehospital doctors in trauma.
For more like this, head to our podcast page. #CodaPodcast
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It's all about function NOT movement re-education!
- 1. Trust me, it’s all about FUNCTION! 30th September 2016, Edinburgh @KateAllatt
- 2. @Kate Allatt Q Learning Objectives Function then movement re-education Don’t lower patients expectations Mind-blowing stories Future research ideas?
- 3. @Kate Allatt Q The stroke improvement facts 1/2: “The brain appears to be primed to recover EARLY after stroke” Schallert et al http://stroke.ahajournals.org/content/36/2/215.short “Rehabilitation has been shown to be most beneficial when started EARLY” Teasell http://www.ebrsr.com/sites/default/files/Chapter3_Background-Concepts_FINAL_16ed.pdf “These studies emphasize the importance of EARLY rehabilitation for good outcomes.” Teasell & Kalra http://stroke.ahajournals.org/content/36/2/215.full “VEM of patients within 24 hours of acute stroke appears safe and feasible.” AVERT http://m.stroke.ahajournals.org/content/39/2/390.full
- 4. @Kate Allatt Q 2/2 Repetitive Frequency Intensive Teasell http://www.ebrsr.com/sites/default/files/Chapter3_Background-Concepts_FINAL_16ed.pdf 250 x per week 7 Days per week Nagai et el https://www.jstage.jst.go.jp/article/jjcrs/2/0/2_0_77/_pdf
- 6. @KateAllatt
- 8. @Kate Allatt
- 9. GOALS
- 10. Is the technology we innovate about recording statistics & movement re- education ? Eg. Heel Strike, Distance travelled, Balance?
- 11. @Kate Allatt Q I’m not the exception ………. 13yr USA brainstem stroke locked in syndrome SURVIVOR! “The doctor didn't believe she was having a stroke because of her age …… …… The therapists are surprised at how much she is able to do and how much she fights to recover 3 months later …… about 2 weeks ago her rehab doctor said he can longer classify her as being locked in because of all the movement she is making” Candice Gier, Florida
- 12. Fighting Strokes 2011 – 2016 The ultimate PEER SUPPORT! ‘Lemon & Limes’ SELF-BELIEF!
- 13. @Kate Allatt NEVER EVER LET ANYONE LOWER YOUR EXPECTATIONS! “VOICINGinner thoughts matters!” TEDx @KateAllatt KateAllatt.com
- 14. @ESCAPS Research A feasibility randomised controlled trial of … Early electrical stimulation to the wrist extensors and wrist flexors to prevent the post-stroke complications of pain and contractures in the paretic arm’ @KateAllatt @Research_OT
- 15. More OT research ideas…? How can we motivate stroke patients to carry out everyday activities essential for health & wellbeing. Existing digital innovations to motivate people to carry out everyday activities To coach & motivate stroke survivors back into paid work ASK ME TO COLLABORATE! ;)
- 16. @KateAllatt
- 17. ‘DREAM BIG HAVE BIG AMBITIONS WORK HARD & YOU WILL ACHIEVE’ @MoFarah #Rio2016 What will you take away from hearing me? Tweet me? @KateAllatt
Editor's Notes
- Thanks for asking me Here to talk about client centred goals Questions at end
- Thanks for asking me Here to talk about client centred goals Questions at end
- Thanks for asking me Here to talk about client centred goals Questions at end
- Thanks for asking me Here to talk about client centred goals Questions at end
- 39, suddenly, Think feel hear see assuming head but move nothing after 2 weeks I blinked once no twice yes Lonely, frightening, life support, worth keeping, bored nil by mouth? Like buried alive or waking up coffin
- As you can see I needed my roots doing! but what saved me when the doctors have never explained my completely unexpected recovery? Play next
- Patient functionality versus clinicians achieving normal movement patterns? What do you think is more important?
- Mischievous rule breaker, bloke trapped in female body, marcos bird, drinking games, best years of life, dating mark allatt rugby widow
- Thanks for asking me Here to talk about client centred goals Questions at end
- Thanks for asking me Here to talk about client centred goals Questions at end
- So important not to lower expectations like mine were for example PLAY If you believe in something and want to do it badly, don’t listen to any doubters just DO IT!
- Segmented according to DLAs –eg Eating/walking/bathing/dexterity
- So did I run again? You are damn right I did play (just 21 mths after stroke)
- Mischievous rule breaker, bloke trapped in female body, marcos bird, drinking games, best years of life, dating mark allatt rugby widow