Category Archives: RAGE session

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 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!

 

NeuroRAGE Special Edition

NeuroRAGE is a special edition of the RAGE podcast featuring these special guests:

  •  Mark Wilson, prehospitalist with London HEMS and neurosurgeon with the NeuroTrauma unit at Imperial in London
  •  Oli Flower, intensivist and NeuroICU enthusiast at Royal North Shore Hospital in Sydney – co-organiser of SMACC and Intensive Care Network.

This edition is 82 min 03 sec long and includes:

  • Introduction, including a welcome to Mark and Oli, along with usual supsects Cliff and Karel… (starts 00:00 min)
  • ‘What’s bubbling up?’ (starts )1:31 min) — shout outs and interesting discoveries from the world of FOAM and elsewhere featuring the GoodSam app (again), A talk on transport of Ebola patients, SMACC Chicago, ESICM’s live feed of ‘Hot Topics’ such as the ARISE trial results, and Cliff Reid’s ‘through the rabbit hole’ experience with ketamine as a patient.
  • the NeuroRAGE participants discussing ‘Traumatic Brain Injury and a bit about the Spine’ (starts 17:13 min)
  • the NeuroRAGE participants discussing ‘ICP Monitoring’ (starts 45:22  min)
  • the NeuroRAGE participants discussing ‘Intracerebral haemorrhage and Subarachnoid Haemorrhage’ (starts 55:09  min)
  • the NeuroRAGE participants discussing a ‘smorgasbord’ of other neurocritical care questions, including the ‘cranial screwtop manoeuvre’ (starts 79:14  min)
  • ‘A blast from the past’ by Oli Flower on the origins of the EEG  (starts ? min)
  • ‘Words of Wisdom’ from Mark Wilson (starts 80:36 min)

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

Here are the show notes for the NeuroRAGE Special Edition:

Introduction

Ketamine-induced dysphoria and hallucinations:


Traumatic Brain Injury and a bit about the Spine

ICP Monitoring

Intracerebral Haemorrhage and Subarachnoid Haemorrhage

Smorgasbord

Blast from the Past

Words of Wisdom

  • just listen!

Thanks again for listening to the RAGE!

RAGE Session Four

RAGE Session Four is here! (at last…. you say)

It is 61  min 46 sec long and includes:

  • Introduction, including a welcome to new RAGE team recruit John Hinds and apologies from Cliff… (starts 00:00 min)
  • ‘What’s bubbling up?’ (starts 01:16 min) — shout outs and interesting discoveries from the world of FOAM and elsewhere featuring regional anaesthesia, the GoodSam app, the Surviving Sepsis Campaign response to the ProCESS Trial, Brain Impact Apnoea and the ‘Tamiflu’ debacle.
  • the RAGE team discussing ‘Getting The Right Side Right: RV infarction and RV failure’ (starts 13:39  min)
  • the RAGE team discussing another ‘Humans in the Resus Room’ topic: ‘I Want to Stop, But Someone Else Doesn’t’ (starts 37:03 min)
  • ‘A blast from the past’ by me (Chris Nickson) on ‘Jack Barnes and the Irukandji Enigma’ (starts 55:07 min)
  • ‘Words of Wisdom’ from motorcycle legend Guy Martin via John Hinds (starts 59:14 min)

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

Here are the show notes for RAGE Session Four:

Introduction

What’s bubbling up?

Regional Anaesthesia

  • Beaudoin FL, Haran JP, Liebmann O. A comparison of ultrasound-guided three-in-one femoral nerve block versus parenteral opioids alone for analgesia in emergency department patients with hip fractures: a randomized controlled trial. Acad Emerg Med. 2013 Jun;20(6):584-91. doi: 10.1111/acem.12154. PubMed PMID: 23758305.
  • Black KJ, Bevan CA, Murphy NG, Howard JJ. Nerve blocks for initial pain management of femoral fractures in children. Cochrane Database Syst Rev. 2013 Dec 17;12:CD009587. doi: 10.1002/14651858.CD009587.pub2. Review. PubMed PMID: 24343768.
  • De Buck F, Devroe S, Missant C, Van de Velde M. Regional anesthesia outside the operating room: indications and techniques. Curr Opin Anaesthesiol. 2012 Aug;25(4):501-7. doi: 10.1097/ACO.0b013e3283556f58. Review. PubMed PMID: 22673788.
  • Gadsen J. Regional Anesthesia in Trauma: A Case-Based Approach. Cambridge University Press; 1 edition (November 12, 2012) (website)
  • Wu JJ, Lollo L, Grabinsky A. Regional anesthesia in trauma medicine. Anesthesiol Res Pract. 2011;2011:713281. doi: 10.1155/2011/713281. Epub 2011 Nov 21. PubMed PMID: 22162684; PubMed Central PMCID: PMC3227428.
  • Mike Stone’s video showing how to perform a fascia iliaca block with ultrasound:

FICB Refresher from Mike Stone on Vimeo.

Other topics ‘bubbling up’:

Getting The Right Side Right: RV Infarction and RV failure

  • The ‘OH CRAP’ mnemonic for optimising oxygen delivery and haemodynamics: Oxygen, Haemoglobin, Contractility, Rate & rhythm, Afterload and Preload (for both the right and the left heart – need to do different things for each!)
  • Inohara T, Kohsaka S, Fukuda K, Menon V. The challenges in the management of right ventricular infarction. Eur Heart J Acute Cardiovasc Care. 2013 Sep;2(3):226-34. doi: 10.1177/2048872613490122. Review. PubMed PMID: 24222834; PubMed Central PMCID: PMC3821821.
  • Vandenheuvel MA, Bouchez S, Wouters PF, De Hert SG. A pathophysiological approach towards right ventricular function and failure. Eur J Anaesthesiol. 2013 Jul;30(7):386-94. doi: 10.1097/EJA.0b013e3283607a2d. Review. PubMed PMID: 23571479.
  • Right ventricular infarction (LITFL ECG Library)
  • Right Ventricular Failure (LITFL CCC)
  • Right Ventricular Function and Haemodynamic Assessment (LITFL CCC)
  • Pulmonary Artery Catheters (LITFL CCC)
  • Pulmonary Hypertension (LITFL CCC)

Humans in the Resus Room: I Want To Stop, But Someone Else Doesn’t

Blast from the Past

Words of Wisdom

Thanks again for listening to the RAGE!

RAGE smaccGOLD Edition

As promised in SMACCGOLD IS ALL THE RAGE here is the smaccGOLD edition of the RAGE podcast.

This podcast represents the first time all the RAGE podcasters have been together in person. In addition to the RAGE team we had a bunch of friends helping us out:

RAGE at smaccGOLD
Photo via @markhwilson

From left to right:

Unfortunately, missing from the photo is my great friend and SMACC co-conspirator Oli Flower (@oliflower). Also, the third founder of SMACC, the ‘SMACC Big Cheese’ Roger Harris (@RogerRDHarris)  wasn’t included because we’d just have to bleep  out everything he’d say anyway… Sorry Rog!

The audio quality is a tad marginal in places, but that’s what you get with an impromptu recording of 10 slightly manic people in a room with one mic. All the same, we hope it is an engaging audio experience and gives a good insight into the SMACC experience and what to look out for as the talks are released online. Thanks to Haney for helping me get this audio into the best shape possible.

This is ’17 minutes’, the amazing video by Tamara Hills and family mentioned in the podcast (nearly 7,000 views and counting):

Look out for all the talks being released on the SMACC podcast and the affiliated FOAM websites in the coming months. Follow the @smaccteam on Twitter for updates.

For other accounts of smaccGOLD (based on a list originally made by Alan Batt), check out:

Thanks again for listening to the RAGE!

RAGE SESSION THREE

Just in time for smaccGOLD, RAGE Session Three is here!

It is 67 min 53 sec long and includes:

  • Introduction, including an ERCAST shout out and apologies from Haney… (starts 00:00 min)
  • ‘What’s bubbling up?’ (starts 01:30 min) — shout outs and interesting discoveries from the world of FOAM and elsewhere featuring pre-hospital spinal immobilisation, astronaut Chris Hadfield, ‘Mistakes were made’, EMA’s 25th anniversary edition and the need to tailor blood pressure targets to the individual.
  • the RAGE team discussing acute  life-threatening asthma (starts 15:52  min)
  • the RAGE team discussing ‘Medical Reversal’ (starts 52:52 min)
  • ‘A blast from the past’ by Karel Habig on ‘Ether Day’ and the origins of general anaesthesia (starts 63:42 min)
  • ‘Words of Wisdom’ featuring a quote from Cliff Reid’s role model, and some other guy (starts 66:32 min)

The RAGE podcast is on  iTunes here and the RAGE podcast audio feed is available here. Here are the show notes for RAGE Session Three:

Introduction

What’s bubbling up?

Life-threatening severe asthma

Medical reversal

  • Medical Reversal (LITFL CCC)
  • Mac Sweeney’s Top Ten Critical Care Papers for 2013 (LITFL)
  • Prasad V, et al. A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices. Mayo Clin Proc. 2013 Jul 12. doi:pii: S0025-6196(13)00405-9. 10.1016/j.mayocp.2013.05.012. [Epub ahead of print] PubMed PMID: 23871230. [Free Full Text] (includes a video commentary by the lead author)
  • Walters BC, Hadley MN, Hurlbert RJ, Aarabi B, Dhall SS, Gelb DE, Harrigan MR, Rozelle CJ, Ryken TC, Theodore N. Guidelines for the management of acute cervical spine and spinal cord injuries: 2013 update. Neurosurgery. 2013 Aug;60 Suppl 1:82-91. doi: 10.1227/01.neu.0000430319.32247.7f. PubMed PMID: 23839357. [Free Full Text articles]
  • The Nobel Prize in Physiology or Medicine 2005 — Barry J. Marshall, J. Robin Warren (NobelPrize.org)
  • Chesnut RM,  et al; Global Neurotrauma Research Group. A trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med. 2012 Dec 27;367(26):2471-81. doi: 10.1056/NEJMoa1207363. Epub 2012 Dec 12. Erratum in: N Engl J Med. 2013 Dec 19;369(25):2465. PubMed PMID: 23234472; PubMed Central PMCID: PMC3565432.
  • Bellomo R, Chapman M, Finfer S, Hickling K, Myburgh J. Low-dose dopamine in patients with early renal dysfunction: a placebo-controlled randomised trial. Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group. Lancet. 2000 Dec 23-30;356(9248):2139-43. PubMed PMID: 11191541.
  • Jacobs IG, Finn JC, Jelinek GA, Oxer HF, Thompson PL. Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomised double-blind placebo-controlled trial. Resuscitation. 2011 Sep;82(9):1138-43. doi: 10.1016/j.resuscitation.2011.06.029. Epub 2011 Jul 2. PubMed PMID: 21745533.
  • Finfer S, Bellomo R, Boyce N, French J, Myburgh J, Norton R; SAFE Study Investigators. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med. 2004 May 27;350(22):2247-56. PubMed PMID: 15163774.
  • Stroke Thrombolysis (LITFL CCC)

Blast from the Past

Words of Wisdom

Dreams save us

Addendum 30 March 2014:

Thanks again for listening to the RAGE!

RAGE Session Two

The wait is over, RAGE Session Two is here!

RAGE Session Two is 80 min 19 sec long and includes:

  • Introduction, including some bad news… (starts 00:00 min)
  • ‘What’s bubbling up?’ (starts 00:58 min) — shout outs and interesting discoveries from the world of FOAM and elsewhere featuring codeine in kids, post-intubation sedation, adenosine versus verapamil for SVT and how to do a good vagal manoeuvre, the ETM Twitter fiasco, the FOAMcc Google Plus Community and smaccGOLD.
  • the RAGE team discussing a case of submassive pulmonary embolism and the role of thrombolysis (starts 22:14  min)
  • the RAGE team’s discussion on ‘Humans in the resus room: ‘when your back-up gets your back up’’ (starts 51:50 min)
  • ‘A blast from the past’ on WW2 hero and chain-smoking legend Edgar Patz, the only man to complete an entire Masters degree unconscious!  (starts 73:00 min)
  • ‘Wise Words’ featuring the art of observation, the immortal John Hunter and the infinitely wise Sir William Osler (starts 77.55 min)

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

Here are the show notes for RAGE Session Two:

What’s bubbling up?

 Submassive Pulmonary Embolus and Thrombolysis

FOAM:

Journal articles:

  • Dresden S,et al. Right ventricular dilatation on bedside echocardiography performed by emergency physicians AIDS in the diagnosis of pulmonary embolism.  Ann Emerg Med. 2014 Jan;63(1):16-24. doi: 10.1016/j.annemergmed.2013.08.016. Epub 2013 Sep 27. PubMed PMID: 24075286.
  • Kline JA, Steuerwald MT, Marchick MR, Hernandez-Nino J, Rose GA. Prospective evaluation of right ventricular function and functional status 6 months after acute submassive pulmonary embolism: frequency of persistent or subsequent elevation in estimated pulmonary artery pressure. Chest. 2009 Nov;136(5):1202-10. doi: 10.1378/chest.08-2988. Epub 2009 Jun 19. PubMed PMID: 19542256; PubMed Central PMCID: PMC2818852.
  • Howard LS. Thrombolytic therapy for submassive pulmonary embolus? PRO viewpoint. Thorax. 2014 Feb;69(2):103-5. doi: 10.1136/thoraxjnl-2013-203413. Epub 2013 Apr 26. PubMed PMID: 23624534.
  • Konstantinides S, Geibel A, Heusel G, Heinrich F, Kasper W; Management Strategies and Prognosis of Pulmonary Embolism-3 Trial (MAPPET-3) Investigators. Heparin plus alteplase compared with heparin alone in patients with submassive pulmonary embolism. N Engl J Med. 2002 Oct 10;347(15):1143-50. PubMed PMID: 12374874. [Free Full Text]
  • Sharifi M, et al; “MOPETT” Investigators. Moderate pulmonary embolism treated with thrombolysis (from the “MOPETT” Trial). Am J Cardiol. 2013 Jan 15;111(2):273-7. doi: 10.1016/j.amjcard.2012.09.027. Epub 2012 Oct 24. PubMed PMID: 23102885.
  • Simpson AJ. Thrombolysis for acute submassive pulmonary embolism: CON viewpoint. Thorax. 2014 Feb;69(2):105-7. doi: 10.1136/thoraxjnl-2013-204193. Epub 2013 Sep 17. PubMed PMID:24046127.

Humans in the Resus Room: ‘When your Back-Up gets your Back Up’

Blast from the Past

Words of Wisdom

Thanks again for listening to the RAGE!