Category Archives: smacc

Cricoid: To Press or Not to Press?

Just in case you still thought cricoid pressure was a good idea, listen to the RAGE team’s newest member John Hinds at smaccGOLD. Hinds is an anaesthetist, intensivist and a motorcycle-riding prehospital resuscitationist based in Northern Ireland. In this debate he will tell you about ‘cricolol’.

What?

John parodies cricoid pressure by encouraging us to imagine that this procedure is a drug… Yep, might as well use it as a suppository.

Would you give it?

RAGE listeners have already heard Scott Weingart in RAGE: smaccGOLD edition call this the ‘most brilliant cutting away at the knees of an opponent…”

Listen to the talk below (John starts about halfway through at 12min 55sec if you’re impatient).

Here are the slides to flick through as you listen:

Or why not go straight to the video:

BTW, big ups to Brent May for valiantly putting forward the case for cricoid pressure… An unenviable task.

Learn more here:

Otherwise check out John’s references:

  1. Sellick BA. Cricoid pressure to control regurgitation of stomach contents during induction of anaesthesia. Lancet 1961;2:404-6.
  2. Koziol CA, Cuddeford JD, Moos DD. Assessing the force generated with application of cricoid pressure. AORN journal 2000;72:1018-28, 30.
  3. Smith KJ, Dobranowski J, Yip G, Dauphin A, Choi PT. Cricoid pressure displaces the esophagus: an observational study using magnetic resonance imaging. Anesthesiology 2003;99:60-4.
  4. Hartsilver EL, Vanner RG. Airway obstruction with cricoid pressure. Anaesthesia 2000;55:208-11.
  5. Allman KG. The effect of cricoid pressure application on airway patency. Journal of clinical anesthesia 1995;7:197-9.
  6. Levitan RM, Kinkle WC, Levin WJ, Everett WW. Laryngeal view during laryngoscopy: a randomized trial comparing cricoid pressure, backward-upward-rightward pressure, and bimanual laryngoscopy. Annals of emergency medicine 2006;47:548-55.
  7. Garrard A, Campbell AE, Turley A, Hall JE. The effect of mechanically-induced cricoid force on lower oesophageal sphincter pressure in anaesthetised patients. Anaesthesia 2004;59:435-9.
  8. Chassard D, Tournadre JP, Berrada KR, Bouletreau P. Cricoid pressure decreases lower oesophageal sphincter tone in anaesthetized pigs. Canadian journal of anaesthesia = Journal canadien d’anesthesie 1996;43:414-7.
  9. Heath KJ, Palmer M, Fletcher SJ. Fracture of the cricoid cartilage after Sellick’s manoeuvre. British journal of anaesthesia 1996;76:877-8.
  10. Ralph SJ, Wareham CA. Rupture of the oesophagus during cricoid pressure. Anaesthesia 1991;46:40-1.

The Art and Science of Fluid Responsiveness

Unavoidable delays mean you’ll have to wait a bit longer for RAGE Session 4… But it is in the works, we promise!

In the meantime check out this masterful smaccGOLD presentation by the RAGE team’s very own Haney Mallemat: ‘The Art and Science of Fluid Responsiveness’.

Here is the audio (download the mp3 directly here):

Here is the video:

Learn more about related topics via the LITFL CCC:

To listen to all the smaccGOLD talks as they are released subscribe to the SMACC podcast on iTunes.

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!

smaccGOLD is all the RAGE

The entire RAGE team were at smaccGOLD, and we loved every minute of it.

Of course, Cliff Reid stole the show as per usual with his talk on ‘When should resuscitation stop?” (look out for it on the SMACC podcast in the coming months) but all the RAGE team made huge contributions to the critical care conference of the millennium.

Photo courtesy of SMACC
Photo courtesy of SMACC

This was the first time the entire RAGE team were in one place at the same time – rather than connected via Skype over the Internet – so we took the chance to record some audio. We managed to include a few friends too… Though, as always, the best bits will probably have to be edited out 😉

Look out for the next RAGE podcast featuring these SMACCers:

RAGE at smaccGOLD
Photo via @markhwilson

From left to right:

Unfortunately Oli Flower (@oliflower) is missing from the photo, but he’ll be in the next podcast too.

PS. Hat tip to @alittlemedic for inspiring the post title

How we train is how we fight

The RAGE team’s sphincters are progressively tightening as the pressure to perform at smaccGOLD mounts… the conference is just a couple of weeks away.

Sydney HEMS submitted a fantastic SimWars GOLD video entry — featuring quotations from HEMS speakers at the first SMACC conference, including RAGE’s Karel Habig and Cliff Reid.

Watch and be inspired…

Be inspired to train harder…

Be inspired to fight harder to save lives.

Top Ten ICU trials for 2013

Wondering what to do while you’re waiting for RAGE Session Two to be released?

Here’s an option.

Check out Mac Sweeney’s Top Ten Critical Care Papers for 2013 (includes links for further reading). I  talked to Rob from Critical Care Reviews about his picks for the ten best trials in the intensive care literature for 2013. It is a fast paced and in depth discussion. I’m still suffering from the cortical burn!

Rob, along with all the RAGE team, will be at smaccGOLD in March 2014. See you there!

Physiology of Inspiration

The RAGE team tasters keep on coming…

Only one talk at SMACC matched Cliff’s How to be a Hero for emotional impact.

It was this, by RAGE resusciteer Michelle Johnston. She took lessons from the classics to explore the physiology of inspiration.

As Michelle says, words have power.

Listen to the audio only version by clicking here. And read MJ’s original post on LITFL.

Subscribe to the free SMACC podcast on iTunes. If you’re going to smaccGOLD, you can join Michellle and colleagues for the ‘Get Creative’ workshop – it will be a revelation.

All Doctors are Jackasses

Yep, here’s another RAGE team taster… Though, unfortunately I’m up next.

One of the dumbest things I’ve ever done was assign myself a spot at SMACC to talk after Cliff’s amazing ‘How to be a Hero‘ speech…

Oh well, the show must go on, eh.

This is what happened — my talk on how System I and System II thinking underpins clinical decision making and how we are affected by, and can overcome, cognitive biases:

Listen to the audio by clicking here and view the slides:

Relevant links and references are available on LITFL here, and for more talks from SMACC subscribe to the SMACC podcast on iTunes.

How to be a Hero

Here’s another RAGE team taster, more Cliff Reid magic from SMACC.

Biased though I may be, this is perhaps the greatest, most inspirational, and most emotionally powerful talk ever given on the art of resuscitation.

Watch the video to see what Cliff can teach us about ‘How to be a Hero’:

Here’s the audio only version:

… and here’s the slides:

Cliff has his references and written version of this talk here.
Remember to subscribe to the SMACC podcast on iTunes and visit Cliff’s blog Resus.ME.

Come RAGE at smaccGOLD

All of the RAGE team will be heavily involved in smaccGOLD. Even Haney is flying out from the States to be part of it.

Various members of the RAGE team are organising the program, selecting the speakers, designing and running the workshops, as well as taking the stage for talks, panel discussions and other mind blowing events during the conference.

So be sure to take our conflict of interest into account when we say that smaccGOLD is going to be AWESOME!

We really hope to meet you there. Come along for a meeting of friends who have never met before and the most inspiring educational experience you can have, at a conference like no other.

smaccGOLD logo
Register ASAP by clicking on the logo 🙂