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
Fler avsnitt från "Coda Change"
Safety-II, Drugs and Design Sprints in Intensive Care
39:38Tune 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.
How the pandemic narrowed the great divide between ICU and ward care
18:43Irma 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
Gender Equity in Medicine – What is it & Why Does it Matter?
44:34In 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
Impella and modern mechanical support
14:19From 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
Brain injury outcomes and predictors
9:28Brain 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/
COVID-19: A patient's experience
14:39In 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/
Vascular Access: RaCeVa, RaPeVa, Micropuncture, Tip position
14:25In 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/
Prehospital resuscitation of TBI
10:09The prehospital management of patients with moderate and severe TBI can be complex. In this podcast, Marty Nichols talks us through managing patients with TBI in a prehospital environment. This involves avoiding hypoxia and hypotension, ensuring a safe transportation and getting to the right treatment centre the first time. Notably, due to the nature of the accident, patients with a severe head injury also often present with other injuries. Managing multiple injuries at the same time has implications for how TBI's are managed and treated in prehospital settings. First and foremost, clinician's should prioritise the prevention of hypoxia and hypotension when managing TBI patients. This includes effective airway management, however, airway management and the prevention of hypotension present some of the greatest challenges to clinicians. Marty discusses the challenges in treating patients with TBI in prehospital environments. Furthermore, he discusses the processes in place which help to ensure that these patients have the best possible outcomes. For more head to https://codachange.org/podcasts/
Top 10 Critical Care Papers of 2020
19:02In this podcast, Ed Litton summarises 10 clinical trials in 10 minutes. Ed invites you to choose, based on the title alone, whether the findings were consistent with, or contrary to, the study hypothesis. Ed discusses 10 non-covid clinical trials, all published in 2020. Notably, all of these were published in the New England Journal, JAMA or Lancet and had important findings. The following hypothesises are discussed: 10. Firstly, the impact of resident physician schedules and the affect on patient safety. 9. Early initiation of renal replacement therapy and whether this improved outcomes for Acute Kidney Injury. 8. Does the implementation of early ECMO improve outcomes for patients with refractory VF and out of hospital cardiac arrest? 7. Then, can a machine learning algorithm reduce hypotensive severity? 6. In mechanically ventilated patients, is an approach of non sedation superior to light sedation? 5. Moreover, in patients who are ready for decannulation, does timing based on the suctioning frequency improve outcomes? 4. Does administering high dose tranexamic acid in patients with upper or lower GI bleeds decrease mortality? 3. Next, does a decreased exposure to vasopressors improve outcomes in older critically ill patients? 2. Will starting Dexmedetomidine at the time of cardiac surgery reduce AF and delirium in patients? 1. Also, will being conservative with oxygen in patients with ARDS improve outcomes? Tune in to a talk by Ed Litton as he shares the top 10 papers of 2020 in 10 minutes. Finally, for more podcasts head to https://codachange.org/podcasts/
The importance of communication in pain management
12:45In this podcast, Claire discusses the role of clinician communication and its impact on acute pain management. Claire explains how pain management outcomes can be optimised by enhancing patient expectations of benefit via patient-provider communication. Firstly, what we say to patients matters. Secondly, how we say it also matters. Pain is a complex phenomenon and managing expectations of pain and people’s experience of empathy is crucial. As healthcare professionals, we see multiple patients and are often run off our feet, but, as the studies clearly demonstrate… communication matters. And it matters a lot in pain management. This presentation shares research demonstrating the impact of clinician communication. Specifically, this includes how clinicians' talk about pain and pain management. Claire discusses the importance of patients' experience of pain, the effectiveness of pain management and patients' treatment outcomes. From CodaZero Live, tune in to a fascinating discussion on the importance of communication. For more like this, head to https://codachange.org/podcasts/