RAGE Session: Do Not Resuscitate

We’re ready to RAGE again!

This one is 85:26 min long and includes:

  • Introduction… kind of (starts 00:00 min)
  • ‘What’s bubbling up?’ (starts 02:08 min) — Dr Smith’s ECG blog, DAS Guidelines for tracheal intubation of the critically ill, “The Human Factor” and trauma team performance.
  •  ‘DNR’ (starts 14:58 min) — the RAGE team discuss the concept of ‘do not resuscitate’ and consensus resuscitation plans, challenges and tips for family discussions and decision-making, and a host of tricky situations (e.g. the family that wants ‘everything’, patients who want to be organ donors, suspension of DNR orders for operations, and patients with advance care plans who attempt suicide)..
  • ‘A blast from the past’ by Peter Brindley on ‘Joseph Lister’ (starts  80:44 min)
  • ‘Words of Wisdom’ from Karel Habig (starts  83:41 min)

The RAGE podcast is on  iTunes here and the RAGE podcast audio feed is available here.

Here are the show notes for this RAGE Session :

Introduction

What’s bubbling up?

  • Dr. Smith’s ECG Blog
  • Higgs A, McGrath B, Goddard C et al. Guidelines for the management of tracheal intubation in critically ill adults British Journal of Anaesthesia. 2017 (published online) [article]
  • Hicks C, Petrosoniak A. The Human Factor: Optimizing Trauma Team Performance in Dynamic Clinical Environments. Emergency medicine clinics of North America. 2018; 36(1):1-17. [pubmed]

“DNR”

Blast from the Past

Words of Wisdom

Thanks again for listening to the RAGE!

Simulation for Elite Performers

Happy New Year!

The next ‘proper’ RAGE session is on track for recording in about a week or so.

In the meantime, here is a talk on ‘Simulation for Elite Performers’ by Chris Nickson from last year’s Performance Psychology in Medicine Conference run by the Institute of Prehospital Care in London. The podcast is 34 min 38 sec duration.

Thanks to Tom Evens and the conference organisers for such a great event, as well as Mads Astvad (ScanFOAM) for managing to rescue the audio! Mads also put together the video version below:

Mads also pointed out (another) error I made… I mistook Walda for Wally!

The RAGE podcast is on  iTunes here and the RAGE podcast audio feed is available here.

Thanks again for listening to the RAGE!

RAGE Session: “What’s the Sats Target?”

It is time to RAGE again!

This one is 61:38 min long and includes:

  • Introduction… kind of (starts 00:00 min)
  • ‘What’s bubbling up?’ (starts 04:48 min) — an ED checklist for cognitive debiasing, are ‘cold’ platelets ready for primetime, the ART trial and the open lung approach to ventilation using recruitment manoeuvres
  •  ‘What’s The Sats Target?’ (starts 22:55 min) — the RAGE team discuss what SpO2 targets to aim for, in which patients and diseases, and the tricks and traps of real-world clinical practice.
  • ‘A blast from the past’ by Chris Nickson on ‘Rudolph Virchow’ (starts  52:52 min)
  • ‘Words of Wisdom’ from Cliff Reid (starts  57:10 min)

The RAGE podcast is on  iTunes here and the RAGE podcast audio feed is available here.

Here are the show notes for this RAGE Session :

Introduction

  • :-)

What’s bubbling up?

What’s The Sats Target?

Blast from the Past

Words of Wisdom

  • “We have room to act, to shape our stories, though as time goes on it is within narrower and narrower confines. A few conclusions become clear when we understand this: that our most cruel failure in how we treat the sick and the aged is the failure to recognize that they have priorities beyond merely being safe and living longer; that the chance to shape one’s story is essential to sustaining meaning in life; that we have the opportunity to refashion our institutions, our culture, and our conversations in ways that transform the possibilities for the last chapters of everyone’s lives.”
    — Atul Gawande, Being Mortal:: Illness, Medicine and What Matters in the End

Thanks again for listening to the RAGE!

RAGE talks CRM Brindley-style and dasSMACC

The next RAGE session is here! (we’re no longer numbering them as the low numbers are depressing…)

This one is 95 min long and includes:

  • Introduction and ‘What’s bubbling up?’ (starts 00:00 min) — head rotation for effective ventilation, The Procedures Course, FOAM social capital and wellness, Tips for New Doctors..
  •  ‘Optimizing Crisis Resource Management’ (starts   14.29 min) — an interview with Peter Brindley followed by thoughts from Karel Habig
  • ‘dasSMACC reflections’ (starts  67.09 min)
  • ‘A blast from the past’ by Karel Habig on ‘John Scott Haldane’ (starts  87:55 min)
  • ‘Words of Wisdom’ from Peter Brindley (starts  92:36 min)

The RAGE podcast is on  iTunes here and the RAGE podcast audio feed is available here.

Here are the show notes for this RAGE Session :

Introduction

What’s bubbling up?

Optimizing Crisis Resource Management

dasSMACC Reflections

Blast from the Past

Words of Wisdom

  • “To be a better doctor, be a better human” — Peter Brindley

Thanks again for listening to the RAGE!

Three Men and a Microphone

‘Three Men and a Microphone’ is a special edition of the RAGE podcast (let’s face it, RAGE podcasts are so infrequent they’re all special!) featuring RAGE Resusciteer Cliff Reid in conversation with these special guest RAGErs:

  • Geoff Healy (prehospitalist/ retrievalist/ anaesthetist)
  • Brian Burns (prehospitalist/ retrievalist/ emergency physician)

This one is a monster – it is 2h 48 min 59 sec long!!!  It is NSFW (contains some profane verbiage) so don’t let your kids listen in…

Here is the run sheet so the you can skip to the bits you want:

 

Introduction
0:00 Intro: NSFW
2:38 Welcome – what we’re busy with at the moment
10:13 Highly functioning organisations
18:00 Airway audit
19:06 Operations research and A.P. Rowe
23:42 Role of SOPs, SOPs vs protocols

 

28:37 QUESTION: Describe training experiences that have shaped you
Anaesthesia in Australia -Geoff getting patronised
Trauma in Ireland – Brian being unsupported
EM in England – Cliff getting pimped
Importance of honesty and humility as a mentor
Mike Clancy’s public cerebration – teaching you how to think
Phoning a friend when you’re the boss
Calling the boss in – differences between the UK & Australia
3 reasons to call the boss: to let you know, to seek advice, to ask you to come in.

 

1:05:05 QUESTION: What is your experience of trainees, and what attributes of good and bad trainees do you observe?
The lurker, the stalkers, the shopper, the sharp-elbows
Our experiences as underconfident trainees
Turning yourself into the (mythical) shit magnet
John Hinds’ approach to keeping sharp
Consultants who are hummingbirds
Avoiding institutionalisation – getting experience in remote/rural units

 

1:29:24 QUESTION: Give your advice on how to be a good resuscitationist
The word resuscitationist
EMS Gathering in Cork and big wave surfers
Extending your training – fellow posts and other experiences
Acquiring experience with restrictions on working hours
The limitations of learning from textbooks and life support courses
Can we accelerate the acquisition of experience using technology?
Lionel Lamault & prehospital ECMO
Comfort zones and task fixation
Geoff likes to ‘bosh’ people
Cognitive rally points
Unexplained different approaches to fluids in paeds resuscitation
Being treated as a gas monkey in ED
A new word  – resuscitationism
The Jason Bourne game and developing spider-sense
Too sick to be intubated?

 

2:07:30 QUESTION: What are you currently struggling with in your careers?
Being a coach
Having trainees who are better than we are / were
Top Gun pilot caution against overperformers
Thoughts for bosses who have trainees who are smarter or more skilled than they are: (1) They make you look good; (2) You might learn something; (3) The future is brighter for patients
The challenge of getting senior clinicians involved in simulation
Struggling to improve and get outside our comfort zones, and continue to evolve as consultants
A pantyhose anaesthetic
Work-life balance
Sustainability and recovery from travel and shift working as you get older
Family first
Stress vs passion and Simon Sinek
Misquoting Lincoln and sharpening the tree
Emptying your cumulative stress bucket
Risks of PTSD especially in paramedics
Debriefing

 

Thanks again for listening to the RAGE!

 

ECPR by Vincent Pellegrino

On August 17th 2016, Associate Professor Vincent Pellegrino, Head of the ECMO service at The Alfred ICU, discussed ECPR during an in-house education session.

His discussion included:

  • the difficulties with ECPR definitions and selection criteria
  • Approaches to ECPR, ranging from cannulation techniques and types of cannula, to role cards and the importance of teamwork
  • Outcomes for ECPR and the evidence for the technique

Listen to the talk to find out more – the podcast is 37 minutes long.

THE VIDEO

THE SLIDES

For more on ECMO check out INTENSIVE and EDECMO.org.

The RAGE podcast is on  iTunes here and the RAGE podcast audio feed is available here.

Thanks again for listening to the RAGE!

First Among Equals

Being part of SMACC is an incredible privilege for me. Helping provide a tribute to John Hinds at SMACCDUB was an even greater privilege.

I tip my hat to Janet Acheson, Fred MacSorley, Brian Burns and all those who contributed to showing the world why John Hinds was without any doubt, first among equals.

THE VIDEO

THE AUDIO

THE SLIDES

The video, podcast and slides were originally posted on the SMACC website.