Rank #1: Hardcore EM: How an Emergency Physician Thinks
Hardcore EM: How an Emergency Physician Thinks
Rank #2: The PEA Paradox - Haney Mallemat
Patients who present with pulseless electrical activity (PEA) arrest have a high mortality. The treatment of PEA requires finding and reversing the underlying cause, therefore a simple and rapid approach is required. Traditionally we were taught to use the H's and the T's, but this diagnostic tool is cumbersome and of questionable utility overall. This talk will discuss the problems with the traditional H's and T's as well as focusing on newer approaches to PEA arrest. The speaker will discuss tools such as bedside ultrasound and using the width of the QRS complex to rapidly workup and treat patients in PEA arrest.
Rank #3: SMACCMini: The art of induction - how not lose them in the first 15 minutes / Intubating sick kids - small holes, big problems
SMACCMini: The art of induction - how not lose them in the first 15 minutes / Intubating sick kids - small holes, big problems by Charles Larson and Andrew Beck.
Note on podcast: unfortunately this recording from #DasSMACC skips in a couple of places. It doesn't impact the exceptional quality of this talk, we just wanted to give you the heads up. SMACC Team.
Rank #4: Paul Marik - Understanding Lactate
Summary by: Rosy Wang
Lactate has been viewed as a byproduct of anaerobic metabolism and an indicator of tissue hypoperfusion since the 1900s. This theory is still widely believed. Paul busts the myths surrounding lactic acidosis, anaerobic metabolism, tissue hypoxia and the role of lactate in sepsis. Key take-away facts include: - The production of lactate actually consumes hydrogen ions. Lactic acidosis is really lactic alkalosis. - Lactate is produced physiologically and is a precursor for gluconeogenesis. - During exercise, skeletal muscle exports lactate as the primary fuel for the heart and brain. - At VO2max, intracellular oxygen stays the same. Anaerobic metabolism in cells only occur as a pre-terminal event. The exception is in complete arterial occlusion. - Adrenaline promotes lactate production - Lactate infusion has been shown to increase cardiac output in septic and cardiogenic shock - Lactate is a survival advantage!
Rank #5: Post-Intubation Sedation - Scott Weingart
Scott Weingart discusses Post-Intubation Sedation.
Rank #6: SMACCForce: Prehospital Neurosurgery
SMACCForce: Prehospital Neurosurgery by Mark Wilson
Rank #7: SMACCForce: E-CPR - Panel
SMACCForce: E-CPR - Panel by Brian Burns, Paul Gowens, Lional Lamhaut, Steve Bernard, Nikki Stamp, Alice Hutin
Rank #8: EM is a Failed Paradigm - Scott Weingart & Simon Carley
I am presenting the opposing view to Scott Weingart who thinks that emergency medicine is a failed paradigm. He's wrong of course. For a starter, millions of people can't be wrong. Sure, it's not the same as when we started, but such dynamism and adaptation is something to be celebrated not vilified. Emergency Medicine will never die. It will forever adapt and survive.
Rank #9: The Greatest Presentation in the World… Tribute - Ross Fisher
Delivering a presentation is a skill like any other yet few folk are actually develop this skill they merely copy those they observe and reach the same level of mediocrity. There is more to a presentation than your slides. The p cubed concept gives an understanding of presentation design that will change your presentations forever.
Rank #10: Submassive PE should be thrombolysed - Anand Swaminathan & Iain Beardsell
Anand Swaminathan - PRO -
PE is a spectrum of disease and patients on different parts of the spectrum should be treated differently. Subsegmental PE may need no treatment at all whereas massive PE is unlikely to improve without lytics. Between these ends of the spectrum lies the submassive PE - hemodynamically stable but with signs of RV strain portending worse long-term functional outcomes for patients and possible early deterioration. These patients should all be considered for systemic thrombolysis to improve outcomes.
Iain Beardsell - CON -
Some of the most difficult topics in medicine attract considerable debate, The use of thrombolysis for submassive PE is one of these. In this "Con" argument I attempt to highlight some of the most pertinent evidence against the use of thrombolysis.
Rank #11: SMACCForce: Turning up the gain on prehospital ultrasound
SMACCForce: Turning up the gain on prehospital ultrasound by Luke Regan
Rank #12: Hardcore EM: Vasopressors in the ED
Hardcore EM: Vasopressors in the ED by John Greenwood
Rank #13: Neurosurgeons aren't idiots, honestly - Ronan O'Leary
Undertaking a decompressive crainectomy is perhaps one of the most challenging decisions we face within critical care, we don't know if we should do the operation, and even if we think we should we don't know when, or even how. Perhaps more importantly we don't do the operation, the neurosurgeons do, but we frequently put them in the position of doing the operation when we are at our wits end, or they do the operation without asking us when we still feel we have space to play. How can we resolve this, in a workplace environment which is already fraught with competing interests, beliefs, values and approaches? Evidence based medicine isn't 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. Training should involve exposure to collegiate decision making and consensus building but this will be difficult to achieve within our current nationally co-ordinated training schemes.
Rank #14: Disruption, danger, and droperidol: emergency management of the agitated patient - Reuben Strayer
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)?
Rank #15: Resuscitation for the Resuscitationist
Panelist participation in the "Resuscitation for the Resuscitationist" panel session.
Rank #16: Emerging Toxicology - Steve Aks
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.
Rank #17: Prehospital Ketamine – Is there anything it can’t do?
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.
Rank #18: Persistent Critical Illness
While much of resuscitation focuses on the dramatic early minutes to hours of critical illness, many patients stay for days or weeks in the ICU. This talk will ask: why do patients get stuck in the ICU, and what might we do better to improve their care?
Rank #19: Teamwork: The strongest drug in the hospital - Peter Brindley
Modern acute care medicine is eye-wateringly complex and potentially dangerous. It really can't be delivered safely without deliberately addressing our teamwork (in both acute and chronic situations). Unfortunately, historically, human factors were commonly left to chance, and recently have been threatened by decerebrate checklists and meaningless psychobabble. Practical strategies exist (thank goodness!) and will be reviewed. We have much to learn, but must also avoid overly simple answers to exceedingly complex problems. It's time to get back to basics and away from the BS. Come be part of a practical revolution
Rank #20: It is time to throw away the hard cervical collar - Darren Braude & Karim Brohi
Darren Braude and Karim Brohi battle it out in the #SMACCDub Cage Match 'It is time to throw away the hard cervical collar'.