Coda Change

Bias by design in medicine with Tarlan Hedayati

In the last episode of Carr's Clinic, David Carr chats to Tarlan Hedayati about bias in medicine.

A patient comes into the emergency department and they are complaining of shortness of breath.

Typical measurements are taken including heart rate, blood pressure, temperature, rest rate and O2 sat.

Once the patient has been treated, they want to go home and we rely on vital signs and devices such as a pulse oximeter to determine if it is safe to do so.

But... what if the pulse oximeter measurement is flawed, biased and could potentially harm your patient?

Tragically the pulse oximeter has been proven to be inaccurate for non-white people.

The consequences of this can be devastating and these devices need to be reviewed to acknowledge the bias in their design and correct the flaw in their products.

What's even more concerning? Tarlan encourages us to consider what other sources of racial bias we might already have in clinical medicine that we haven't even considered or acknowledged yet?

Tune in to a great discussion with David Carr and Tarlan Hedayati on bias by design in medicine.

For more head to: codachange.org/podcasts

ECMO CPR ECMO in Cardiac arrest has increased exponentially in the past 10 years, on the back of, up until very recently, non-randomised, predominantly retrospective studies. What is the efficacy? Appropriate patient selection? Cost effectiveness and model of delivery of ECPR? Finally is ECMO really the intervention or just optimising the chain of survival? For more head to: codachange.org/podcasts

Burns Fluid Resuscitation.

The first 24 hours for burns management is crucial.

The ability to deliver just the right amount of fluid in a patient with burns is the holy grail.

From #CodaZero Claire Seiffert presents on Burns Fluid Resuscitation.

Claire covers fluid overloaded with compartment syndrome, to underdone with an AKI and extension of burns.

This short update will provide an overview of how to achieve the "just right" fluid balance and targets for resuscitation, ultimately enhancing patient outcomes.

For more head to: codachange.org/podcasts

Carr's Clinic is back but this time - with the man himself. David Carr walks us through a case which had him spooked (and for good reason).

A 33 year old female comes into the Emergency Room with crushing chest pain.

She has terrible pain radiating down her arm and it has only been 36 hours since she gave birth to her fifth kid.

Her ECG showed a STEMI. But, 33 year old women who just gave birth don't have MI's. Do they?

Turns out, she has SCAD - Spontaneous coronary artery dissection.

SCAD represents 1 to 4% of all ACS angiograms.

30% of the time it presents as a STEMI and 70% of the time as a non-STEMI.

The kicker? SCAD looks like STEMI. It has the same story, the same ECG, the same biomarker that is positive... it just depends on who is getting it.

91% of people with SCAD are less than the age of 25 and 85-94% are women.

It also represents 43% of MIs in women under the age of 50.

So how do we catch it? Think about the plus ones.

ACS plus young woman with no risk factors.

ACS plus pregnant or postpartum.

ACS plus some significant stressor.

SCAD is something we need to remember and we need to consider.

For more head to: codachange.org/podcasts

What went wrong with publishing in COVID19. Naomi Hammond walks us through the good, the bad and the ugly aspects of COVID19 publications. The ability for researchers to rapidly design and conduct trials in the midst of a pandemic was valuable. With that however, came an 'infodemic' where consumers struggled to keep up with the abundance of information. In April 2020, there were 6,000 articles published in one month. This caused concerns regarding the quality of publications, the increase in opinion articles and the number of articles which were retracted over the course of Covid. Tune in to a fascinating talk about what went wrong with publishing in COVID19. For more head to: codachange.org/podcasts

From #CodaZero Live, Phil Parry shares the impact a medical retrieval team can have on the treatment and outcome of patients suffering from major burns. Over a two year period, the team were involved with 203 major burns in NSW. Phil discusses the benefits of a medical retrieval response to prehospital patients suffering from major burns. He explains what the response might look like and the treatment that they are capable of in the field that will set them down the correct treatment path. Despite being a small team, what they can offer to a patient with major burns is significant. Senior medical decision making capability, advanced pain management, the ability for an anaesthetic and airway control, the list goes on. First, they determine how much of the patient is burnt. Then, they commence treatment. Tune into the podcast to hear firsthand, the impact this team has on the outcome of patients suffering from major burns. For more head to: codachange.org/podcasts

Making a medical diagnosis with limited information is at the heart of emergency medicine.

Emergency physicians often have to make decisions without all of the information.

Dr Anand Swaminathan shares a case where EMS rolled into emergency with a patient who was short of breath, hypotensive, tachycardic and hypoxic.

She had syncopized at a rehabilitation centre and by the time she got to emergency, she was seriously unwell and unable to provide much information.

Dr Swaminathan shares the steps he took in diagnosing a patient who was too sick to go for a CT scan.

His first piece of advice? Ultrasound is key.

Ideally, we all want to have diagnostic closure before prescribing medication which could be harmful, however this isn't always possible if a patient is too sick.

So how do we make the call without a definitive diagnosis? Think about the exclusions, weigh up all the options and do what is right for the patient.

For more head to: codachange.org/podcasts

From #CodaZero Live, Khairil Musa presents on Sepsis in different contexts. Sepsis is the leading cause of death for people in low income countries. Khairil shares his story of managing Covid-19 and Trauma in Yemen and Iraq whilst working with Doctors Without Borders in 2020. Khairil had never imagined his work with MSF would coincide with a global pandemic. He shares his experience and the challenges of managing Covid-19 in places where resources are scarce. To treat sepsis in different contexts, we must first start by learning and sharing knowledge. For more head to: codachange.org/podcasts

How a Crisis Resource Management failure led to a full-blown medical emergency.

It is estimated that 70% of avoidable deaths in healthcare involve a breakdown of the principles of CRM.

Crisis resource management, involves seven crucial steps:

1. Know your environment
2. Anticipate and plan
3. Take a leadership role
4. Communicate effectively
5. Call for help early enough
6. Allocate attention wisely, use all information
7. Distribute workload, use all available resources

Unfortunately, a failure in adhering to the 7 principles of CRM lead to serious complications for the birth of Tamara & Garry Hills's son.

We hear from Tamara and Garry as they explain the human and systemic factors that ultimately led to a full-blown medical emergency.

A lack of situation awareness, combined with poor communication, unfortunately led to Christopher Hills suffering a severe brain injury. This likely occurred during the 17 minutes of terminal Bradycardia.

Tamara, Garry and Christopher bravely share their story to inspire healthcare workers to embrace crisis resource management.

For more head to: codachange.org/podcasts

From #CodaZero Live, David Carr chats with Sara Gray about treating recurrent ventricular tachycardia.

A 50-year-old male arrives in the emergency room with chest pain. Upon examination, it is clear that he is experiencing recurrent episodes of V-tach.

Defibrillation isn't working, so what happens next?

Treating recurrent ventricular tachycardia with Dr Sara Gray.

For more head to: codachange.org/podcasts