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Coda Change

Updated about 1 month ago

Health & Fitness
Medicine
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These are the talks recorded live at the last SMACC in 2019. Coda 2020 is set to explode outside Critical Care, and include everyone in healthcare industry. Coming to Melbourne 28.09-02.10.2020, it is the festival of learning you cannot afford to miss. For more information go: codachange.org

Read more

These are the talks recorded live at the last SMACC in 2019. Coda 2020 is set to explode outside Critical Care, and include everyone in healthcare industry. Coming to Melbourne 28.09-02.10.2020, it is the festival of learning you cannot afford to miss. For more information go: codachange.org

iTunes Ratings

77 Ratings
Average Ratings
69
3
2
2
1

TTM2

By GEMacy - Apr 20 2020
Read more
It’s not about TTM but rather Ketamine and AC reversal agents

Inspirational talks

By BiteyBunnie - Jul 26 2016
Read more
Amazing talks and cutting edge!

iTunes Ratings

77 Ratings
Average Ratings
69
3
2
2
1

TTM2

By GEMacy - Apr 20 2020
Read more
It’s not about TTM but rather Ketamine and AC reversal agents

Inspirational talks

By BiteyBunnie - Jul 26 2016
Read more
Amazing talks and cutting edge!
Cover image of Coda Change

Coda Change

Latest release on Jul 13, 2020

Read more

These are the talks recorded live at the last SMACC in 2019. Coda 2020 is set to explode outside Critical Care, and include everyone in healthcare industry. Coming to Melbourne 28.09-02.10.2020, it is the festival of learning you cannot afford to miss. For more information go: codachange.org

Rank #1: Best Emergency Medicine literature of the year 2018/19

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Ken Milne the author of skeptics guide to emergency medicine SGEM reviews the hottest critical care literature for 2018 2019. Ken reviews articles from the Lomaghi trial on magnesium for rate control in Atrial fibrillation, Expulsive therapy for renal calculi with Tamulosin, Oxygen therapy in critical illness in the Iota trial and finally aromatherapy for nausea and vomiting.

Dec 09 2019

14mins

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Rank #2: COVID-19 in NYC - A slow motion mass casualty: Part 2

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This is part 2 of the special podcast featuring Reuben Strayer, sharing his first hand experience of the COVID-19 situation in New York with Ashley Liebig, the medical operations commander for the Travis County and a flight nurse. "There was only a brief period between when we first started noticing coronavirus and when seemingly everyone in the city had coronavirus", "emergency providers are working in an environment that resembles a lake filled with coronavirus".

May 15 2020

17mins

Play

Rank #3: COVID-19 in NYC - A slow motion mass casualty: Part 1

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This is part 1 of the special podcast featuring Reuben Strayer and Ashley Liebig, sharing their first hand experience of the COVID-19 situation in New York. "So many people in the region got infected at the same time, long before we were paying any attention to it. And as the patients got sicker, we started to notice a few things, such as this was oxygen deficit we never seen before".

May 13 2020

19mins

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Rank #4: Managing interprofessional conflict at the bedside

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Laura Rock and Jenny Rudolph give strategies for managing interprofessional conflict at the bedside in a critical care setting.

Feb 01 2020

17mins

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Rank #5: The Great(est) Fluid Debate

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Resuscitation fluids save lives in humans with life-threatening hypovolaemia. The fluid of choice should have biochemical characteristics close to the type of fluid lost and replaced at a rate and volume sufficient to correct the severe fluid deficit. Then stop and consider the early use of catecholamines. There are few indications to give critically ill patients resuscitation fluids after 24 hours of admission. There is no place for synthetic colloids of non-physiological crystalloids. The effects of unnecessary fluids last well beyond the initial resuscitation period and are associated with adverse effects and harm to the patient. Fluids are toxic drugs and must be used with great care.

Jan 24 2020

18mins

Play

Rank #6: Hardcore EM: Vasopressors in the ED

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Hardcore EM: Vasopressors in the ED by John Greenwood

Dec 14 2018

20mins

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Rank #7: Sepsis—The Dark Knight: Prehospital Diagnosis and Treatment - Michael Perlmutter

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Sepsis is a difficult diagnosis to make, even in the hospital, where a plethora of tests are available to assist the clinician. However, the diagnosis remains a challenging one, due to the very nature of sepsis: a shadowy shape-shifter notorious for its ability to hide in plain sight, eluding early diagnosis and treatment. For now, even in-hospital, there is no test with perfect sensitivity or specificity for sepsis. This is especially true in the prehospital environment, where we must rely on tools we can bring into the field: physical exam, point of care tests (lactate/venous gas), assessment of end-tidal CO2, and ultrasound. The aim of prehospital sepsis care is twofold: First, early diagnosis of cases ranging from early sepsis to septic shock. Point of care testing is essential. Lactate can assist in identifying occult sepsis and may also be used to prognosticate. Measurement of EtCO2 serves two purposes: first, in systems where point of care lactate is not available, there is evidence suggesting that EtCO2 is a reasonable surrogate for lactate. Secondly, for spontaneously breathing patients, EtCO2 provides an accurate respiratory rate, a vital sign that is notoriously poorly assessed. Respiratory rate plays a key role in both SIRS and SOFA/qSOFA criteria for sepsis, making an accurate count essential. Ultrasound should also play a pivotal role in prehospital sepsis management. Much has been made of the prehospital FAST exam; however, the ability of POCUS to gauge fluid responsiveness and cardiac function is far more useful. Assessment of the IVC may aid in determining the value of volume resuscitation by helping to identify patients who are responsive to volume and those who would be better served by early initiation of vasopressors. Similarly, assessment of cardiac function may prove extremely useful in selecting a pressor. POCUS may also assist in differentiating sepsis from other etiologies by identifying a source, such as pneumonia. The second fundamental aim is treatment equivalent to that available in-hospital, with judicious administration of balanced IV fluids guided by POCUS and clinical assessment of fluid responsiveness, early pressors (including push-dose pressors during RSI), and early antibiotics, particularly where transport times are significant. When sepsis is diagnosed by EMS, a “sepsis alert” should be communicated to the receiving hospital, in order to facilitate ongoing early, aggressive care upon arrival of the retrieval team. Advanced prehospital diagnosis and treatment can produce dramatic reductions in mortality from sepsis.

Nov 10 2016

11mins

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Rank #8: Post-Intubation Sedation - Scott Weingart

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Scott Weingart discusses Post-Intubation Sedation.

Mar 03 2017

27mins

Play

Rank #9: Prognosis and Palliation in TBI

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Jan 29 2020

18mins

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Rank #10: How Resuscitation Works - David Halliwell

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This talk uses a case study approach to discuss why resuscitation practitioners should focus upon technical accuracy when resuscitating, focussing on all of the facets of a resuscitation, compression, decompression, trans-thoracic impedance. It suggests that many of the smallest of subtleties can have a dramatic effect on patient survival. We focus on the physiological effects of Manual Chest Compression and use historical reference to underpin modern techniques.

Oct 16 2016

28mins

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Rank #11: Emerging Toxicology - Steve Aks

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Poisons and novel agents are a moving target in the clinical arena. This talk begins with a historical look at decontamination and pitfalls that have been discovered along the way. The advent of intubation and critical care was a major boon in the improvement in mortality from poisoning. The Scandinavian Method is described and is an important lesion to this day. The rise of antidotes is mentioned.

Emerging drugs are highlighted in the context of where we have come from. The phenylethylamine compound structure and corresponding variants are described. The importance of the principles of supportive care as learned in the Scandinavian method is emphasized. Other emerging topics including synthetic cannabinoids, and anti-NMDA receptor antagonists are discussed. Emerging interventions of prescription naloxone, and ED ECMO are outlined. High vigilance for new agents, and innovative treatments will enable clinicians deal with these evolving trends.

Mar 14 2016

21mins

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Rank #12: Hardcore EM: How an Emergency Physician Thinks

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Hardcore EM: How an Emergency Physician Thinks

Mar 02 2019

32mins

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Rank #13: Prehospital Ketamine – Is there anything it can’t do?

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PHARM Physician, Per Bredmose, provides an in-depth look at Ketamine in the prehospital setting. Per discusses the uses, benefits and potential complications of Ketamine, providing tips and tricks from his wealth of experience.

Apr 19 2016

30mins

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Rank #14: Disruption, danger, and droperidol: emergency management of the agitated patient - Reuben Strayer

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Agitation poses a direct threat to the safety of both patient and staff, as well as being an important manifestation of dangerous conditions that require rapid identification and treatment. Management of agitation consists primarily of physical and chemical restraint, and the details of how restraint is carried out–usually based more on tradition than considered plans or thoughtful protocols–directly determine case outcome. In this talk, we’ll discuss the initial approach to agitation, focusing on the appropriate role of physical restraint, as well as best practice technique for physical restraint. We will then deliberate the options for chemical sedation and propose a menu of the safest and most effective agents for a variety of common agitation scenarios. Some of the questions we will address include: What are the most important dangerous conditions that cause–or are caused by–agitation? What are dangerous restraint holds, and how can physical restraint be accomplished in the safest manner? In the initial management of an agitated patient, should chemical restraint be administered by the intravenous or intramuscular route? How do haloperidol and droperidol compare speed in efficacy when used for calming the agitated patient? How should providers manage concerns around prolonging the QT interval when using butyrophenones for sedation? Which benzodiazepine is preferred, as a treatment for agitation? How should neuroleptics and benzodiazepines be used as monotherapy or in combination? In which type of patient should ketamine be used as a sedation agent? How should ketamine be dosed for tranquilization, and what adverse effects should providers be mindful of when using ketamine for this indication? Can ketamine be used in patients with hyperdynamic vital signs? What is the role of crystalloids in managing the agitated patient? Once the agitated patient has been calmed, what are the primary, secondary and tertiary resuscitative maneuvers (diagnostics and therapeutic)?

Dec 03 2016

28mins

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Rank #15: Is the Answer Really “Always Ketamine”? - Peter Brindley interrogates: Reuben Strayer

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A no-holes barred series of 6 provocative medical interrogations. We challenge the state of research, social media, pharmacology, social work, women in medicine, medicine in the developed work, and the health of healthcare workers. It should be novel, it may get heated, and it is not scripted. Sometimes to comfort the afflicted you also need to afflict the comfortable. This is why no prisoners will be taken, no topic is out of bounds, and no ego will be pampered. It may even offend: you have been warned.

Apr 29 2018

16mins

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Rank #16: Don't DSI...Rapid Sequence Airway (RSA)! - Darren Braude

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Rapid Sequence Airway (RSA) involves the same preparation and pharmacology as RSI with the immediate planned placement of an extraglottic device (EGD) instead of intubation. Like DSI, RSA is an alternative airway management strategy that may be ideal for preoxygenation of hypoxemic patients as well for prehospital and in-flight use. Depending on the chosen EGD, RSA can facilitate gastric decompression, positive pressure ventilation with PEEP delivered by a ventilator and endoscopic intubation. The speaker presents the evolution of this novel concept in New Mexico, reviews their clinical experience with RSA in both the prehospital and hospital settings and assesses the available literature.

May 03 2017

24mins

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Rank #17: Assault on the RV – Pulmonary Hypertension and Heart-Lung Interactions - John Greenwood

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Pulmonary hypertension (PH) is commonly encountered when managing the patient with an acute critical illness. The impact of PH on cardiac function can be devastating if it is not quickly recognized. The goal of this talk is to arm clinicians with some simple techniques to predict and assess for complications of PH, identify the resuscitation targets in a crashing patient with PH, and finally review some major pitfalls in the management of the patient with PH.

Jan 03 2017

29mins

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Rank #18: Defending Bawa-Garba: When Healthcare Becomes a Crime

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Delivery of safe healthcare currently faces unprecedented challenges in the UK and globally. This arises, at least partly, from a rising involvement of the criminal law in the investigation of medical errors apparently conflicting with the need to respect a "duty of candour". As a result, doctors face enormous pressures in fear of being blamed for medical errors. David Sellu is a consultant surgeon who was convicted for gross negligence manslaughter in late 2013 after the death of a patient in a private hospital. I (@DrJennyVaughan) was the medical lead for a group of David Sellu's friends as we launched a campaign to overturn his conviction. There has never been a successful 'out of time' appeal in this area of the law so we were dealing with almost impossible odds from the start. The positive result was extraordinary, both for David and our whole profession (www.medicalmanslaughter.co.uk). Since these events, I have supported other doctors facing criminal conviction, such as the paediatrician Dr Hadiza Bawa-Garba, through my work with the Doctors Association UK (DAUK, @TheDA_UK). Thousands of doctors crowd-funded a campaign and successfully overturned a court decision to erase her from the UK medical register. Her case proved to be a lightning rod in the UK for a profession at breaking point. Many healthcare staff are working on critically under-staffed wards and in under-resourced departments, with an increasingly unmanageable workload.

DAUK have since launched a "Learn Not Blame" campaign to improve safety for patients and healthcare professionals. We believe that the involvement of the criminal justice system in these cases often does not allow an appreciation of the interplay of individuals within complex health systems. We also remain particularly concerned that a recent analysis of conviction trends shows an excessive conviction rate of black and minority ethnic (BME) healthcare staff.

Dec 18 2019

25mins

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Rank #19: Clot retrieval for stroke in the extended time window

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A case example of a large vessel obstruction of the brain and our current techniques available to treat it. How we make decisions on endovascular treatment and management points for emergency and intensive care colleagues.

Jan 22 2020

20mins

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Rank #20: Bad Blood - Deirdre Murphy

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Critically ill patients frequently have activation of inflammatory and clotting pathways. These are likely adaptive responses in the human. When they run riot or the fine balance between pro- and anti-inflammatory states is shifted however there can be significant morbidity and mortality. This acronym-busting talk will focus on some acquired haematological disorders in critically ill patients. Disseminated Intravascular Coagulation (DIC) is a clinical and laboratory diagnosis that affects about 1% of hospitalised patients. At the most severe end it is associated with bleeding and/or thrombotic complications. Disorders such as thrombotic thrombocytopenia purpura (TTP) and other forms of micro-angiopathic hemolytic anemia (MAHA) will also be described including the role of ADAMST13. HIT is an uncommon but important conditions which is difficult to diagnose in a critically ill patient. An approach to HIT is discussed. Have you always wondered about NETs (neutrophil extracellular traps) and their importance? If so this whistle-stop tour of non-malignant hematology in the ICU is for you!

Oct 25 2016

23mins

Play

The Great(est) Fluid Debate

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Read more

Resuscitation fluids save lives in humans with life-threatening hypovolaemia. The fluid of choice should have biochemical characteristics close to the type of fluid lost and replaced at a rate and volume sufficient to correct severe fluid deficit. Then stop and consider the early use of catecholamines. There are few indications to give critically ill patients resuscitation fluids after 24 hours of admission. There is no place for synthetic colloids of non-physiological crystalloids. The effects of unnecessary fluids last well beyond the initial resuscitation period and are associated with adverse effects and harm to the patient. Fluids are toxic drugs and must be used with great care.

Jul 13 2020

20mins

Play

Post COVID opportunity for a safe and healthy recovery

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"The pandemic is a reminder of the intimate and delicate relationship between people and planet. Any efforts to make our world safer are doomed to fail unless they address the critical interface between people and pathogens, and the existential threat of climate change that is making our earth less habitable." Dr Tedros Adhanom Ghebreyesus, WHO Director-General. In this cross generational catch up on the post COVID world, Roger Harris, Courtney Howard and Omnia El Omrani are talking about the old normal, and the opportunities within the new normal. 

Jul 09 2020

26mins

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POCUS and the “InfoDemic”

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In the second part of the podcast focused on POCUS, Cian, Trish, Kylie and Rachel take a deep dive into the ultrasound process during the COVID-19 pandemic. How do we keep our equipment clean? Who do we turn to as a reliable and up-to-date source of information? Now, that the traditional literature is struggling to keep up with the times, and social learning networks aren’t always best evidence where is the knowledge. The “InfoDemic” has been experienced by all. What we do know is that strong POCUS infrastructure and collaboration underpins flexible opportunities for innovation. Jump into the comments section to join the discussion!

Jun 30 2020

25mins

Play

Live(r) Life

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My experience as physician, mother and organ donator to my son. 

By Dara Kass

Jun 29 2020

15mins

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Pulmonary Embolism: Next Generation

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This talk introduces the concept of a new generation of pulmonary embolism (PE). What was once considered a deadly disease process now carries a mortality rate of <3%, which may be driven by overtesting as well as overdiagnosis. This talk will explore this phenomenon and current evidence-based approaches to the evaluation and treatment of PEs.

By Lauren Westafer

Jun 25 2020

12mins

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Follow up after Critical Care

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Naomi Hammond talks about why follow up after critical illness matters, and why we need to know more about how to do it. Presented at SMACC 2019 in Sydney, Australia

Jun 22 2020

13mins

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Is our collective 'healthcare psyche' in need of post pandemic resuscitation?

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In Australia, we have been hearing from colleagues and the media about how challenging it has been providing healthcare during the pandemic in many parts of the world. We have expected and are prepared for the battle and perhaps to get a chance to be “heroes”. Given that Australia has experienced relatively few COVID infections, some people may feel almost as if they have missed out on their “hero” moment. Some colleagues have expressed feelings such as 'I have had it easy and my colleagues overseas are having it so tough?' There have been an unusual mixture of emotions from relief to guilt. It seems for some of us that after the “hero” phase comes the “disillusionment” phase. What should we do with these emotions? Tune in to join Roger Harris, Mary Freer, Karen Gaunson, and Kym Jenkins in conversation.

Jun 09 2020

20mins

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Critical Care Teams: The New Normal

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The pandemic has turned everything on its head, and, like with any major catastrophic event, there is an abundance of lessons, take-aways and the new opportunities to be explored in the healthcare setting. By harnessing the power of digital technology, we are now able to connect with the people from different departments, and open up to new ways to communicate. Sliding briefing and debriefing into the frontline work- briefing at the beginning of the shift and debriefing at the end, including mental rehearsal- provides the comfort of predictability, which enables us to better cope with the unexpected. What lessons have you learnt from the COVID-19 pandemic, and what does your new normal look like? Read more

Jun 08 2020

21mins

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CARDMEDIC: improving communication with our patients

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An anaesthetist, Dr Rachael Grimaldi is a mum of 3 children under the age of 4, and is currently on maternity leave. Frustrated at not being able to join the frontline in the fight against COVID-19, Rachael saw an opportunity to improve communications with the patients whilst in full PPE by developing an innovative and simple resource, an app called CardMedic. Launched in 72 hours, the app is now improving patient care in 50 counties across the world. Tune in to hear Rachael tell Roger her remarkable story. MORE

Jun 03 2020

18mins

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Carr's Clinic Part Two - lessons from The Last Dance: the sports/health interface

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Jesse, David and Swami are back in the second part of the Carr's Clinic podcast, nerding out on the ESPN's Last Dance documentary, featuring Michael Jordan and the Chicago Bulls. It's interesting to see how the popularity of sport is leaning into the public health. What are the lessons can we learn from the NBA and The Last Dance documentary? Let's chat! https://codachange.org/2020/06/01/carrs-clinic-part-two/

Jun 01 2020

24mins

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Carr's Clinic Part One - lessons from life with Swami

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After being in the trenches for 3 months, just how different will the medicine be in the future? Jesse, David and Swami talk about pivoting, steering the dinosaurs, and the lessons learnt along the way. One thing is certain- social inter-connectedness in healthcare is very important. To stay connected with Coda, subscribe https://codachange.org/you

May 28 2020

21mins

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When everything is not COVID

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In the part 2 of the special podcast with Simon Carley we touch on the issues of cognitive bias, that everything you see is COVID-related. Surrounded by the sea of COVID, just how do you manage the strokes, the acute myocardial infarcts, fractured neck aphemas, and the rest of it amidst this catastrophe? Simon shares his thoughts on the life outside COVID.

May 25 2020

20mins

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What to believe & when to change?

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The legendary professor Simon Carley is joining us all the way from Manchester, UK to talk about positive innovations and evidence based agility. There is a fine balance between being slow to change and missing out on something that might benefit the patients, and jumping in too quickly into something harmful. The panic is understandable, what can we do about this virus, how can we treat it? The pressure to change is so high that the people are losing the plot with the evidence based medicine. 

May 21 2020

16mins

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Innovation in Critical Care during the times of COVID-19

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Haney Mallemat is sharing his experiences in Baltimore with Roger and Oli, talking innovation and the phases of creating and culling, as well as the importance of communication in the implementation stages. It's all about finding balance between what would protect you as a provider and give good outcomes for the patient. And sticking to the five principles for assessing new treatments and processes - Safe, Simple, Familiar, Reproducible and Robust. 

May 18 2020

22mins

Play

COVID-19 in NYC - A slow motion mass casualty: Part 2

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This is part 2 of the special podcast featuring Reuben Strayer, sharing his first hand experience of the COVID-19 situation in New York with Ashley Liebig, the medical operations commander for the Travis County and a flight nurse. "There was only a brief period between when we first started noticing coronavirus and when seemingly everyone in the city had coronavirus", "emergency providers are working in an environment that resembles a lake filled with coronavirus".

May 15 2020

17mins

Play

COVID-19 in NYC - A slow motion mass casualty: Part 1

Podcast cover
Read more

This is part 1 of the special podcast featuring Reuben Strayer and Ashley Liebig, sharing their first hand experience of the COVID-19 situation in New York. "So many people in the region got infected at the same time, long before we were paying any attention to it. And as the patients got sicker, we started to notice a few things, such as this was oxygen deficit we never seen before".

May 13 2020

19mins

Play

Does fear and uncertainty impact communication in critical care resuscitation teams?

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Fear. Is it normal to be frightened during this pandemic, in this period of uncertainty, when we're so used to being very certain about what we do in an emergency and critical care? Does fear and uncertainty impact our communication? Do different departments use different language, do different departments communicate differently? And what do we need to address to help open the flow of communication, and make sure we are closing the loop?

Liz, Roger, Chris and Jon talk about communication and interdepartmental collaboration becoming the norm. If one good thing can come about from this COVID-19 crisis, it's that it could help us, staff members, but also more importantly, the patients in the future.

May 08 2020

20mins

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Difficult Intubation in the highly infectious respiratory patient

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This is the second episode of the three part series of the podcast dedicated to technical and communications aspects of managing the airways of COVID patients. In this episode we are breaking down the case of a particular difficult airway case published online by Chris Hicks earlier, and discovering that the approach is not all that different to the guiding principles, communications and checklists we would have used in the non-COVID related intubations.

What seems to trip us up is the process, precautions and PPE. Sticking to general principles and processes is the rule here but we have to be careful in how we’re communicating, and the specific terminology we’re using.

Bottom line, COVID or no COVID, best way to manage a difficult intubation is via the tried and tested emergency resuscitation procedures that have proven to be safe, effective, simple and familiar.

Join Coda community of healthcare leaders: codachange.org/you

May 01 2020

22mins

Play

Emergency intubation in the crashing critical patient with infectious respiratory pathogens.

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The Coda v COVID podcasts have been focusing on the non-technical skills we need to manage the pandemic crisis, but we have received increased requests to discuss more technical aspects of management. Accordingly, this is the first in a three part series dealing with the process for emergency intubation in the crashing patient with the novel corona virus. Here we discuss the technical protocols and the nomenclature around aerosol generating and airborne type precautions. Importantly, we also discuss the recent decision by some UK and Australasian bodies to designate chest compressions as a non-aerosol generating procedure, a decision that has caused ripples of confusion with different craft groups. This has added to confusion around PPE, again with different professional bodies providing conflicting advice for their members. Tune in to join the conversation as we attempt to decipher the messages and give our take on what we are doing and why.

Apr 30 2020

20mins

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There's nothing Novel about the effect of COVID on Gender Equality

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Mary Freer, Roger Harris and Jane Sloane digging deep into the issues of gender equality during the current pandemic. At least 70% of those in the front line as health and community workers are women- and so they have a higher exposure to the virus. But often policies are designed by men, with no diverse representation of women, highlighting the issues of social inclusion. One thing is certain, when women contribute to strategies, we save lives.

Apr 27 2020

21mins

Play

iTunes Ratings

77 Ratings
Average Ratings
69
3
2
2
1

TTM2

By GEMacy - Apr 20 2020
Read more
It’s not about TTM but rather Ketamine and AC reversal agents

Inspirational talks

By BiteyBunnie - Jul 26 2016
Read more
Amazing talks and cutting edge!