This is a quick update about a new project from the RAGE team and friends… The Resuscitology Course.

This is a two-day residential course for resuscitationists in the Blue Mountains, New South Wales, Australia on May 9-10th 2018.

The faculty are  Brian Burns, Karel Habig, Geoff Healy, Nat May, Chris Nickson, and Cliff Reid.

Find out more by listening to the podcast and visiting Resuscitology.com.

Thanks again for listening to the RAGE!

The post Introducing… Resuscitology appeared first on The RAGE Podcast.

This one is 85:26 min long and includes:

• Introduction… kind of (starts 00:00 min)
• ‘What’s bubbling up?’ (starts 02:08 min) — Dr Smith’s ECG blog, DAS Guidelines for tracheal intubation of the critically ill, “The Human Factor” and trauma team performance.
•  ‘DNR’ (starts 14:58 min) — the RAGE team discuss the concept of ‘do not resuscitate’ and consensus resuscitation plans, challenges and tips for family discussions and decision-making, and a host of tricky situations (e.g. the family that wants ‘everything’, patients who want to be organ donors, suspension of DNR orders for operations, and patients with advance care plans who attempt suicide)..
• ‘A blast from the past’ by Peter Brindley on ‘Joseph Lister’ (starts  80:44 min)
• ‘Words of Wisdom’ from Karel Habig (starts  83:41 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

• This one features Peter Brindley (@docpgb), Karel Habig (@karelhabig), and me (Chris Nickson, @precordialthump).

What’s bubbling up?

• Dr. Smith’s ECG Blog
• Higgs A, McGrath B, Goddard C et al. Guidelines for the management of tracheal intubation in critically ill adults British Journal of Anaesthesia. 2017 (published online) [article]
• Hicks C, Petrosoniak A. The Human Factor: Optimizing Trauma Team Performance in Dynamic Clinical Environments. Emergency medicine clinics of North America. 2018; 36(1):1-17. [pubmed]

“DNR”

• Burns JP, Truog RD. The DNR Order after 40 Years N Engl J Med. 2016; 375(6):504-506. [website]
• Patients and families that want “everything” done (LITFL CCC)
• Quill TE, Arnold R, Back AL. Discussing treatment preferences with patients who want “everything”. Annals of internal medicine. 151(5):345-9. 2009. [pubmed]
• Advance Care Planning Australia
• Medical Treatment Planning and Decisions Act 2016 (Victoria, Australia)
• Holt GE, Sarmento B, Kett D, Goodman KW. An Unconscious Patient with a DNR Tattoo N Engl J Med. 2017; 377(22):2192-2193. [article]
• Cooper L, Aronowitz P. DNR tattoos: a cautionary tale. Journal of general internal medicine. 2012; 27(10):1383. [article]
• ‘Unacceptable’ that families ‘not told of resuscitation plans’ (BBC, 2016) – base on an RCP audit
• Doctors ‘forced’ to allow suicide (BBC, 2013)
• Geppert C. Saving Life or Respecting Autonomy: The Ethical Dilemma of DNR Orders in Patients Who Attempt Suicide. The Internet Journal of Law, Healthcare and Ethics. 2010; 7(1) [article]
• Henman MP. Suicidal Patients with a Do-Not-Resuscitate Order The Journal of Emergency Medicine. 2017; 52(1):117-120. [article]
• Household words (LITFL CCC)
• Cessation of CPR (LITFL CCC)

Blast from the Past

• Joseph Lister (Wikipedia)
• The Butchering Art by Lindsey Fitzharris review – grisly medicine (The Guardian)

Words of Wisdom

• Spike Milligan’s epitaph ‘I told you I was ill’ voted UK’s favourite (The Telegraph)
• “Two weeks in ICU can save an hour of conversation”
  — Dr Will Cairns (hat tip to Alex Psirides; @psirides)
• Cairns W. We can improve how we deal with death, now. MJA Insight. [Cited 20 July 2016] Available at URL: https://www.mja.com.au/insight/2016/10/we-can-improve-how-we-deal-death-now

Thanks again for listening to the RAGE!

The post RAGE Session: Do Not Resuscitate appeared first on The RAGE Podcast.

The next ‘proper’ RAGE session is on track for recording in about a week or so.

In the meantime, here is a talk on ‘Simulation for Elite Performers’ by Chris Nickson from last year’s Performance Psychology in Medicine Conference run by the Institute of Prehospital Care in London. The podcast is 34 min 38 sec duration.

Thanks to Tom Evens and the conference organisers for such a great event, as well as Mads Astvad (ScanFOAM) for managing to rescue the audio! Mads also put together the video version below:

Mads also pointed out (another) error I made… I mistook Walda for Wally!

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

Thanks again for listening to the RAGE!

The post Simulation for Elite Performers appeared first on The RAGE Podcast.

This one is 61:38 min long and includes:

• Introduction… kind of (starts 00:00 min)
• ‘What’s bubbling up?’ (starts 04:48 min) — an ED checklist for cognitive debiasing, are ‘cold’ platelets ready for primetime, the ART trial and the open lung approach to ventilation using recruitment manoeuvres
•  ‘What’s The Sats Target?’ (starts 22:55 min) — the RAGE team discuss what SpO2 targets to aim for, in which patients and diseases, and the tricks and traps of real-world clinical practice.
• ‘A blast from the past’ by Chris Nickson on ‘Rudolph Virchow’ (starts  52:52 min)
• ‘Words of Wisdom’ from Cliff Reid (starts  57:10 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?

• Graber ML, Sorensen AV, Biswas J et al. Developing checklists to prevent diagnostic error in Emergency Room settings . 2014; 1(3). [article]
• Mike Clancy’s Cognitive Checklist
• Diagnosis: Interpreting the Shadows by Pat Croskerry et al (Google Books)
• All Doctors Are Jackasses by Chris Nickson (LITFL)
• Johnson L, Tan S, Wood B, Davis A, Marks DC. Refrigeration and cryopreservation of platelets differentially affect platelet metabolism and function: a comparison with conventional platelet storage conditions. Transfusion. 2016; 56(7):1807-1818. [pubmed]
• FDA Approves Cold Platelets For Resuscitation
• ART investigators writing group. Effect of Lung Recruitment and Titrated Positive End-Expiratory Pressure (PEEP) vs Low PEEP on Mortality in Patients With Acute Respiratory Distress Syndrome: A Randomized Clinical Trial. JAMA. 2017; 318(14):1335-1345. [pubmed] [article]
• Open Lung Approach To Ventilation (LITFL CCC)
• Lung Recruitment Manoeuvres (LITFL CCC)

What’s The Sats Target?

• Oxygen Saturation Targets in Critical Care (LITFL CCC)
• Oxygen: The Molecule that Made the World by Nick Lane
• Grocott MP, Martin DS, Levett DZ, et al. Arterial blood gases and oxygen content in climbers on Mount Everest. The New England journal of medicine. 2009; 360(2):140-9. [pubmed]
• Unger S, Cunningham S. Effect of oxygen supplementation on length of stay for infants hospitalized with acute viral bronchiolitis. Pediatrics. 2008; 121(3):470-5. [pubmed]
• Schroeder AR, Marmor AK, Pantell RH, Newman TB. Impact of pulse oximetry and oxygen therapy on length of stay in bronchiolitis hospitalizations. Archives of pediatrics & adolescent medicine. 2004; 158(6):527-30. [pubmed]
• BTS Guidelines for Oxygen use in Adults in Healthcare and Emergency Settings and the  prehospital appendix
• TSANZ Acute Oxygen Guidelines
• Oxygen and CO2 Retention in COPD (LITFL CCC)

Blast from the Past

• Rudolph Virchow (Wikipedia)
• Rudolph Virchow (Whonamedit.com)
• Refugees (Amnesty International)
• UN Slams Australia’s Human Rights Record (The Conversation)

Words of Wisdom

• “We have room to act, to shape our stories, though as time goes on it is within narrower and narrower confines. A few conclusions become clear when we understand this: that our most cruel failure in how we treat the sick and the aged is the failure to recognize that they have priorities beyond merely being safe and living longer; that the chance to shape one’s story is essential to sustaining meaning in life; that we have the opportunity to refashion our institutions, our culture, and our conversations in ways that transform the possibilities for the last chapters of everyone’s lives.”
  — Atul Gawande, Being Mortal:: Illness, Medicine and What Matters in the End

Thanks again for listening to the RAGE!

The post RAGE Session: “What’s the Sats Target?” appeared first on The RAGE Podcast.

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

• ‘How to give an unforgettable talk’ (LITFL) — a story about Gile Brindley (not a blood relative of Peter Brindley…)

What’s bubbling up?

• The Procedures Course
• Head Rotation for Mask Ventilation (Resus.ME)
• Everybody’s free – Top Tips for the Class of 2017 (St Emlyns)
• The Ties that Bind: Social Capital and the Psychology of FOAM by Mike Lauria (EMCrit)

Optimizing Crisis Resource Management

• ‘Optimizing Crisis Resource Management’ (free ebook from the Royal College of Physicians and Surgeons of Canada)
• ‘Crisis Management in Acute Care Settings: Human Factors and Team Psychology in a High-Stakes Environment’ (3rd edn, 2016) by Michael St.Pierre, Gesine Hofinger, and Robert Simon
• ‘Thinking, Fast and Slow’ by Daniel Kahneman (Google Books)
• ‘Streetlights and Shadows: Searching for the Keys to Adaptive Decision Making’ by Gary Klein (Google Books)
• Talks by Pat Croskerry at SMACC Chicago (2015)
• Robin Dunbar (Wikipedia) and his books: ‘Grooming, Gossip, and the Evolution of Language’ (Google Books) and ‘How Many Friends Does One Person Need? Dunbar’s Number and Other Evolutionary Quirks‘ (Google Books)

dasSMACC Reflections

• The SMACC website
• Talks by Peter Brindley at previous SMACCs
• Look out for the upcoming podcast release of all the talks from dasSMACC…

Blast from the Past

• John Scott Haldane (Wikipedia)
• ‘Suffer and Survive: Gas Attacks, Miners’ Canaries, Spacesuits, and the Bends : the Extreme Life of Dr. J.S. Haldane’ by Martin Goodman (Google Books)

Words of Wisdom

• “To be a better doctor, be a better human” — Peter Brindley

Thanks again for listening to the RAGE!

The post RAGE talks CRM Brindley-style and dasSMACC appeared first on The RAGE Podcast.

• 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…

Thanks again for listening to the RAGE!

The post Three Men and a Microphone appeared first on The RAGE Podcast.

His discussion included:

• the difficulties with ECPR definitions and selection criteria
• Approaches to ECPR, ranging from cannulation techniques and types of cannula, to role cards and the importance of teamwork
• Outcomes for ECPR and the evidence for the technique

Listen to the talk to find out more – the podcast is 37 minutes long.

THE VIDEO

THE SLIDES

For more on ECMO check out INTENSIVE and EDECMO.org.

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

Thanks again for listening to the RAGE!

The post ECPR by Vincent Pellegrino appeared first on The RAGE Podcast.

John brings all his usual wit and mischievousness to the defence of the tried and true way of getting a tube between the cords anywhere and at anytime.

The audio has been released on the RAGE podcast, and is 7 minutes 30 seconds long.

For more John Hinds, go to RAGE’s John Hinds tribute page.

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

Thanks again for listening to the RAGE!

The post John Hinds Defends Direct Laryngoscopy appeared first on The RAGE Podcast.

He discussed:

• Recent data from registries on in-hospital and out-of-hospital cardiac arrest (OHCA), particularly from Victoria, and the reasons why OHCA results may be improving
• Options for treatment of refractory VT/VF, including the CHEER2 trial
• The RINSE trial: is intra-arrest cooling with ice cold IV saline for OHCA a good thing?
• Highlights from the recently released updated ILCOR guidelines, which will form the basis for the next ARC guideline update

Listen to the talk to find out more – the podcast is 47 minutes long.

For more talks by Steve Bernard, check out INTENSIVE.

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

Thanks again for listening to the RAGE!

The post Steve Bernard’s Resuscitation Update 2015 appeared first on The RAGE Podcast.

Register for SMACC Chicago 2015 now and come up and say ‘Hi’ to the RAGE team! 

FIRST HALF

The first half of this miniRAGE is a preview of what the RAGE gang are doing at SMACC Chicago 2015… Including “IT’S A KNOCKOUT”:

SECOND HALF

The second part of the podcast is all substance, with discussions of the following:

• our favourite app, the GoodSAM App
• Oxygen therapy, specifically this trial led by Dion Stubbs and Steve Bernard from The Alfred: AVOID: Air Versus Oxygen in ST-Segment Elevation Myocardial Infarction and the trial by friend of RAGE, Paul Young titled HOT or NOT trial: HyperOxic Therapy OR NormOxic Therapy after out-of-hospital cardiac arrest (HOT OR NOT): a randomised controlled feasibility trial.

• John discusses Helicopter Emergency Medical Services, including Survival benefit of a physician-staffed HEMS assistance for severely injured patients and  Willingness to pay for lives saved by HEMS
• … and Cliff continues his intraosseous obsession with (1) Intraosseous infusion rates under high pressure: a cadaveric comparison of anatomic sites, (2) Intraosseous hypertonic saline: myonecrosis in swine, (3) Intraosseous hypertonic saline: safe in swine and (4) Discussion post about intraosseous hypertonic saline at Sydney HEMS
• Finally, listeners will find out why handstands are awesome:  Handstands: a treatment for supraventricular tachycardia?, Impact of a modified Valsalva manoeuvre in the termination of paroxysmal supraventricular tachycardia and Handstands keep you awake.

By the way, because someone actually bought a pair of RAGE shoes they are still in production – check ’em out and buy ’em here: http://aliveshoes.com/rage

Thanks again for listening to the RAGE!

The post PreSMACC MiniRAGE appeared first on The RAGE Podcast.