Ronan O'Leary's guest appearances

Ronan O'Leary

Coda Change

James Tooley

Chris Fox

Chris Nickson

John Hinds

Paul Marik

Zack Shinar

Joe Bellezzo

George Kovacs

Bryan Hayes

Rich Levitan

Karim Brohi

Sara Gray

Ashley Shreves

Jason Brooks

Darren Braude

OwlTail

Neuroimaging Nibble CTP mismatch in Acute Ischemic Stroke - Ronan O'Leary

Ronan O’Leary discusses reversing coagulopathy in traumatic brain injury. The PATCH trial was a trial look at the use of platelets to reverse the effects of aspirin and clopidogrel in patients with spontaneous cerebral haemorrhage. Ronan asserts that overall platelets are harming patients. Through his talk he highlights many studies that have been inconclusive about the benefits of giving platelets in traumatic intracerebral haemorrhage. As one study eloquently described, “It was not possible to determine if platelet transfusion was superior, inferior or not different from control interventions.” So why are platelets given at all? In haemorrhage, reduced platelet activity is associated with adverse outcomes. This is demonstrated with larger haematoma size in patients with lower platelet counts. So, it would make sense that replacing platelets should lead to better outcomes. However, this is not the case. Furthermore, as Ronan articulates, sometimes it just feels better to do something over nothing. The aetiology of the condition probably has nothing to do with platelets in the first place. Instead, non-traumatic intracerebral haemorrhages are likely caused by atherosclerotic disease, with changes in microvascular anatomy and brittle vessels leading to haemorrhage. Further, transfusing a patient with intracerebral haemorrhage with platelets may lead to secondary ischaemic change. Platelets have many proinflammatory and prothrombotic properties. So are the harms of platelets outweighed by the benefits… probably not. Ronan will go on to discuss the potential to extrapolate this evidence to traumatic brain injury patients. He concludes, probably not, mainly due to the mechanism of haemorrhage being the transmission of kinetic energy which is at odds with that of spontaneous intracerebral haemorrhage. For more like this, head to https://codachange.org/podcasts/ 

Ronan O’Leary discusses reversing coagulopathy in traumatic brain injury. The PATCH trial was a trial look at the use of platelets to reverse the effects of aspirin and clopidogrel in patients with spontaneous cerebral haemorrhage. Ronan asserts that overall platelets are harming patients. Through his talk he highlights many studies that have been inconclusive about the benefits of giving platelets in traumatic intracerebral haemorrhage. As one study eloquently described, “It was not possible to determine if platelet transfusion was superior, inferior or not different from control interventions.” So why are platelets given at all? In haemorrhage, reduced platelet activity is associated with adverse outcomes. This is demonstrated with larger haematoma size in patients with lower platelet counts. So, it would make sense that replacing platelets should lead to better outcomes. However, this is not the case. Furthermore, as Ronan articulates, sometimes it just feels better to do something over nothing. The aetiology of the condition probably has nothing to do with platelets in the first place. Instead, non-traumatic intracerebral haemorrhages are likely caused by atherosclerotic disease, with changes in microvascular anatomy and brittle vessels leading to haemorrhage. Further, transfusing a patient with intracerebral haemorrhage with platelets may lead to secondary ischaemic change. Platelets have many proinflammatory and prothrombotic properties. So are the harms of platelets outweighed by the benefits… probably not. Ronan will go on to discuss the potential to extrapolate this evidence to traumatic brain injury patients. He concludes, probably not, mainly due to the mechanism of haemorrhage being the transmission of kinetic energy which is at odds with that of spontaneous intracerebral haemorrhage. For more like this, head to <a href="https://codachange.org/podcasts/" rel="nofollow" target="_blank">https://codachange.org/podcasts/</a>

Reversing Coagulopathy in Traumatic Brain Injury: PATCH Trial

Autoimmune versus infective encephalitis by Ronan O'Leary

Autoimmune versus infective encephalitis by Ronan O'Leary

Autoimmune vs. infective encephalitis - Ronan O'Leary

In this entertaining talk, Ronan O’Leary discusses conflict in critical care. Ronan explains how to make a team decision about whether or not to perform a decompressive craniectomy. Undertaking a decompressive craniectomy is perhaps one of the most challenging decisions we face within critical care. Ronan contends that we do not know if we should do the operation. As he explains, even if we think we should do it, we don’t know when, or even how. Perhaps more importantly, intensivists do not perform the operation, the neurosurgeons do. However, we frequently put them in the position of doing the operation when we are at our wits end. Alternatively, they do the operation without asking us when we still feel we have space to play. Ronan poses the question - how can we resolve this, in a workplace environment which is already fraught with competing interests, beliefs, values and approaches? Evidence based medicine is not going to provide an answer soon and it is unlikely that a superficial approach to improving teamwork will either. An important component will be the future structure of clinical training. Our current systems reflect the way hospitals worked decades ago and the specialties we now have exist almost independently of the training which leads to consultant posts. Ronan posits that training should involve exposure to collegiate decision making and consensus building. However, this will be difficult to achieve within our current nationally co-ordinated training schemes. How to manage conflict in Critical Care: Ronan O’Leary Finally, for more like this head to our podcast page. #CodaPodcast

In this entertaining talk, Ronan O’Leary discusses conflict in critical care. Ronan explains how to make a team decision about whether or not to perform a decompressive craniectomy. Undertaking a decompressive craniectomy is perhaps one of the most challenging decisions we face within critical care. Ronan contends that we do not know if we should do the operation. As he explains, even if we think we should do it, we don’t know when, or even how. Perhaps more importantly, intensivists do not perform the operation, the neurosurgeons do. However, we frequently put them in the position of doing the operation when we are at our wits end. Alternatively, they do the operation without asking us when we still feel we have space to play. Ronan poses the question - how can we resolve this, in a workplace environment which is already fraught with competing interests, beliefs, values and approaches? Evidence based medicine is not going to provide an answer soon and it is unlikely that a superficial approach to improving teamwork will either. An important component will be the future structure of clinical training. Our current systems reflect the way hospitals worked decades ago and the specialties we now have exist almost independently of the training which leads to consultant posts. Ronan posits that training should involve exposure to collegiate decision making and consensus building. However, this will be difficult to achieve within our current nationally co-ordinated training schemes. How to manage conflict in Critical Care: Ronan O’Leary Finally, for more like this head to our <a href="https://codachange.org/podcasts/" rel="nofollow" target="_blank">podcast page</a>. #CodaPodcast