Coda Change podcast

Disaster Survival and Wellbeing for Healthcare

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In this podcast, Roger Harris sits down for a second time with South African Emergency Physician, Victoria Stephen (Tori).

Tori delves deeper into her first hand experience of the frightening political unrest and violence which erupted during the third wave of Covid-19 in Johannesburg in mid-2021. Managing Covid cases and gunshot wounds simultaneously was incredibly challenging both professionally and personally.

In the midst of the violence, Victoria made the courageous decision to leave the safety of her home after curfew and to drive through the riots to get to the hospital. Tori was not rostered on at the hospital that night, but she felt an overwhelming need to help her junior staff manage the chaos that was unfolding. It was a critical and intensely dangerous time in South Africa.

Reflecting on this experience, Tori emphasises the importance of a strong foundation of healthcare worker wellbeing. She identifies the need first to look after ourselves before we can look after others.

Tori speaks candidly about how she managed her own wellbeing through the three waves of Covid in South Africa. This included personally seeing a psychologist to help her process the situation, a regular exercise routine, meditating, and listening to music. In fact, Tori started a ‘survival’ playlist that other clinicians from all over the country listened and contributed to! We’ve included a link to the playlist here.

Ultimately, it is difficult to stay passionate about a job that is physically and emotionally exhausting. Staying focused on clinical medicine helps. But at the end of the day, healthcare is a tough job and it takes its toll!

For more like this, head to our #CodaPodcast page

Fler avsnitt från "Coda Change"

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    Emergency Management of Chronic Pain

    15:17

    In the Emergency Management of Chronic Pain podcast, Duncan Grossman and Reuben Strayer discuss how and why patients with chronic pain present to the ED. Managing patients with chronic pain is challenging and often it feels like these patients present to the ED during every shift. But… is it as common as it feels? Statistics suggest that 20% of American adults suffer from chronic pain. Why? Well, opioids are both the disease and the cure. Opioids are effective for managing acute pain. However, when they are used for (even) more than a couple of days they can start to cause pain. Therefore, we have to understand the spectrum of opioid benefit vs harm. Reuben and Duncan discuss a framework that accounts for the relationship between chronic pain and opioid use. Noting that each patient presents a unique challenge. Take for example, the patient who is on daily, low dose opioids but is otherwise unaffected by their pain medication. Or, the patient who has chronic pain but doesn’t take opioids. We need to be careful here as these patients can be more susceptible to developing an addiction from prescribed opioids due to their ongoing pain. What about the patient who takes opioids daily but is buying them off the street... Reuben takes us through some strategies for helping all of these patients. One such strategy is to talk to the prescribers. We need to help these patients by encouraging their prescribers to take the reins and to move the needle from opioid harm to opioid benefit. Tune in as Duncan Grossman grills Reuben Strayer on chronic pain in patients, how to manage them and how to help them. For more like this, head to our podcast page #CodaPodcast
  • Coda Change podcast

    Disaster Survival and Wellbeing for Healthcare

    22:20

    In this podcast, Roger Harris sits down for a second time with South African Emergency Physician, Victoria Stephen (Tori). Tori delves deeper into her first hand experience of the frightening political unrest and violence which erupted during the third wave of Covid-19 in Johannesburg in mid-2021. Managing Covid cases and gunshot wounds simultaneously was incredibly challenging both professionally and personally. In the midst of the violence, Victoria made the courageous decision to leave the safety of her home after curfew and to drive through the riots to get to the hospital. Tori was not rostered on at the hospital that night, but she felt an overwhelming need to help her junior staff manage the chaos that was unfolding. It was a critical and intensely dangerous time in South Africa. Reflecting on this experience, Tori emphasises the importance of a strong foundation of healthcare worker wellbeing. She identifies the need first to look after ourselves before we can look after others. Tori speaks candidly about how she managed her own wellbeing through the three waves of Covid in South Africa. This included personally seeing a psychologist to help her process the situation, a regular exercise routine, meditating, and listening to music. In fact, Tori started a ‘survival’ playlist that other clinicians from all over the country listened and contributed to! We’ve included a link to the playlist here. Ultimately, it is difficult to stay passionate about a job that is physically and emotionally exhausting. Staying focused on clinical medicine helps. But at the end of the day, healthcare is a tough job and it takes its toll! For more like this, head to our #CodaPodcast page
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    Trauma Resuscitation and the Covid-19 Pandemic in South Africa

    23:39

    Trauma Resuscitation and the Covid-19 Pandemic in South Africa In this podcast, Roger Harris interviews Victoria Stephen about her experience as an emergency physician in a regional South African hospital. Sadly, trauma resuscitation is a big part of working in Emergency Medicine in South Africa.  Blunt force assaults and stab wounds are regular presentations. However, July 2021 was unlike anything Doctor Victoria Stephen had ever experienced. In July, South Africa was deep into its' third wave of Covid-19 infections. Vaccination rates were low and there was a huge burden of Covid patients in the Emergency Department. The ICU was completely overwhelmed, making this by far the worst of the pandemic that they had seen to date. To compound this, piped oxygen levels were running desperately low. The hospital relied on daily oxygen deliveries to keep Covid patients alive. Moreover, to add to the challenge, political unrest broke out and quickly escalated to riots with extreme violence across South Africa. At the time the violence erupted, Tori had over 120 Covid patients in the hospital. Added to this the Trauma resuscitation was managing approximately 34 patients with gunshot wounds per day. With just four doctors working at night and six doctors working during the day, Tori’s team scrambled to manage an overwhelming number of high acuity patients. For the first time in her career, Tori found herself frightened for her safety. Having grown up in South Africa, Tori was no stranger to avoiding danger but this felt very out of control. The thought of managing a busy emergency department inundated with trauma patients in the middle of the covid pandemic is frightening enough for most of us, but to do so in such a resource-limited environment with so few nurses and doctors is truly incredible. Tori believes Emergency Medicine training in South Africa prepares the team to function under such pressure. She believes that the team knows that the lack of resources means they must all pull together. Their training is diverse enough that they have the mental and clinical skills to step up and of course as an ultrasound geek Tori adds that EFAST scanning has a big role to play. Tori is a humble but inspirational clinician on the frontline of providing care in a volatile environment and she believes we can all learn something from her experience. Tune in to a compelling conversation with one of our favourites. Trauma Resuscitation and the Covid-19 Pandemic in South Africa Finally, for more like this head to our podcast page #CodaPodcast
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    Safety-II, Drugs and Design Sprints in Intensive Care

    39:38

    Tune in to a cross over episode with Simulcast, as Jesse Spurr and Victoria Brazil discuss Safety-II, Drugs and Design Sprints in Intensive Care. In this episode, Vic and Jesse catch up to talk through a human centred design project aimed at improving medication safety in the Intensive Care Unit. Vic and Jesse discuss real world applications of Safety-II approaches, the core philosophy and practices of psychological safety and the importance of clinician led approaches to risk in practice. The episode closes with drawing parallels between this work and the skills and practices of simulation. Safety-II, Drugs and Design Sprints in Intensive Care For more like this head to our podcast page #CodaPodcast Or, head to Simulcast to hear more from Vic, Jesse & the team.
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    How the pandemic narrowed the great divide between ICU and ward care

    18:43

    Irma Bilgrami, Alissa Starritt and Paula Lyons believe that the pandemic has narrowed the great divide between ICU and ward care. Covid has put incredible pressure on healthcare systems around the world. This has forced hospitals into overdrive, whereby staff have been redeployed and models of care have changed. Evidently, the pandemic has challenged the strict guidelines which we use to direct patient care and define critical illness. Wards are managing patients with much higher acuity, sparking the danger of normalising the abnormal. How do we navigate these murky waters? Irma, Alissa and Paula take a deep dive into these challenging issues. Irma asks, how are the wards going? How are the staff going? And importantly, what lessons can we take away for the future? Additionally, they address the health and wellbeing of staff in our hospitals after a challenging two years. Evidently, healthcare professionals and nurses have found themselves with increased workloads, providing clinical support, emotional support and teaching support all in one go. Irma, Alissa and Paula explain that there are lessons to be learnt from the pandemic. The pandemic has forced some of the existing hierarchical walls to come down and there is opportunity for us to critically think about how we can work differently in the future. Tune in to hear the full discussion: How the pandemic narrowed the great divide between ICU and ward care. Finally, for more like this head to our podcast page #CodaPodcast
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    Gender Equity in Medicine – What is it & Why Does it Matter?

    44:34

    In this cross over chat between Medical Mums and Coda, Dr Chris Bowles & A/Prof Nada Hamad discuss gender equity – What is it and why does it matter? Chris and Nada take a deep dive into gender equity in medicine, the impact of the pandemic and the possible solutions. First, they discuss the difference between gender equity and equality. Equality is the act of treating everyone the same. Whereas equity, focuses on levelling the playing field so that there is more representation and participation. This includes asking questions such as why inequity exists? And why aren’t women progressing? Evidently, women experience gender inequity at different times of their career. It may be after they’ve had children, or it may be when they want to step up and take on leadership roles. What is most obvious however, is that the impact of gender inequity in medicine extends far past the individual. Gender inequity impacts how we look after female patients, what kinds of questions we ask in research and how we perform and apply that research in the context of women’s healthcare. Chris and Nada discuss what needs to happen to make the system more accommodating. This includes implicit bias training, intersectionality training and leadership training. Investment in leadership skills and training is crucial. We can have all of the right policies in place, however if leadership doesn’t set the standard to encourage uptake, inequity will always exist. Join Emergency & Trauma physician, Dr Chris Bowles and Haematologist, Dr Nada Hamad, as they discuss gender inequity in medicine. They inspire us to identify and challenge the inequity that exists today. For more like this, head to our podcast page. #CodaPodcast
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    Impella and modern mechanical support

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    From CodaZero Live, Steve Morgan talks to us about temporary mechanical circulatory support in cardiogenic shock. Steve gives an example of a patient with refractory cardiogenic shock, who hasn’t responded to pharmacological support. So, how do we go about choosing between temporary circulatory support options? First, Steve acknowledges that critical care echocardiography is central. Additionally, he discusses the use of pulmonary artery catheters.  Finally, Steve hopes that future Randomised Control Trials might contribute to a better evidence base to guide the use of these supports in specific patients. Finally, for more, head to our podcast page #CodaPodcast 
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    Brain injury outcomes and predictors

    9:28

    Brain injury outcomes and predictors by Kiran Lele Being able to prognosticate in the aftermath of a traumatic brain injury (TBI) is important as it assists with counselling patients and families. Moreover, it helps rationally allocate healthcare resources. However, due to the heterogenous nature of TBI and variable pre brain injury patient factors and post brain injury course, this has proven to be a difficult task. Large cohort studies have enabled improved accuracy in the prediction of 6 month mortality and unfavourable outcome. Furthermore, many of the factors that contribute to long-term outcome have also emerged. However, it is not yet possible to use them in prediction algorithms or mathematical models. There is emerging evidence that pre injury psychosocial and demographic factors may be of more relevance than injury severity. Moreover, that 'outcome' becomes increasingly subjective and complex as the post injury duration increases. We end with three brief vignettes which highlight the fraught nature of long term outcome prediction. For more head to, https://codachange.org/podcasts/ 
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    COVID-19: A patient's experience

    14:39

    In this podcast, Celia Bradford talks to Bing Brotohusodo about a challenging time in his life. Early in 2020, Bing contracted COVID-19. This resulted in a two-month hospital stay and admission to the ICU. Celia was one of Bing's physicians and together, they reflect on Bing's time in hospital and his recovery. Bing was as a helpful patient. So much so, that he was able to prone himself! However, Celia recalls how challenging it was treating Covid in those early days. Staff were desperately trying to work out what Covid was and how best to treat it. The question of "are we doing the right thing?" was always in the back of people's minds. Furthermore, this was exacerbated by the confusion of multiple treatments being promoted in the media. There were countless opinions about how Covid should be treated. Information was flowing fast, making it challenging to discern what the best way forward was. Celia and Bing reflect on Bing's time in ICU and his post-COVID recovery. Tune in to a podcast from #CodaZero Live on a patient's perspective of COVID-19. For more head to https://codachange.org/podcasts/ 
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    Vascular Access: RaCeVa, RaPeVa, Micropuncture, Tip position

    14:25

    In this second episode on vascular access, the team from the Australian Vascular Access Society (AVAS) discuss vessel assessment with RaCeVa and RaPeVa as well as the use of Micropuncture and establishing optimal catheter tip position.  Before puncturing a vessel for vascular access it is important to: Trace the anatomy of the vascular pathway for aberrancy Ensure that the vessel calibre is suitable for the chosen catheter Ensure no obstruction with thrombus or occlusion Moreover, it is vital that the catheter doesn't occupy more than one-third of the diameter of the vessel. This will significantly reduce venous blood flow and increase the risk of catheter-related thrombosis. For PICC line insertion the arm can be divided into three zones to select an optimal vessel puncture site. The brachial fossa region is a "Red - no Go" zone, the mid-arm is the "Green - Optimal" zone and the proximal third of the arm is a "Yellow - Axillary" zone. When inserting a line, the catheter tip should be at the cavoatrial junction approximately 3-5cm below the carina on a chest X-ray. The use of a navigation system like catheter tip ECG (intracavitary ECG) is extremely accurate. It is often still useful in patients in atrial fibrillation but more difficult for patients' with paced rhythms. For more like this, head to codachange.org/podcasts/ 

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