Coda Change

The challenge of balancing public health and the law, with personal responsibility and freedom, is driven by access to information. We need to invest in public awareness, reflect on the learnings from COVID and use that for messaging at scale. Like Covid, we know that the prevention of sepsis relies on education, early detection, sanitisation, antibiotics stewardship and availability of resources. Post the COVID-19 pandemic, how do we ensure the correct information is available to the public so that people are empowered with a sense of personal responsibility? We need to encourage the community to collectively move together, to raise awareness, and to educate at a global level.

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The logistical challenge of opening a COVID-19 treatment centre in a developing country is enormous. There is a significant lack of resources such as PPE and essential drugs, as well as medical specialists and sophisticated technology. The bottom line is COVID needs a global response. Governments need a united approach, with adequate resources, infrastructure, and medical expertise. In times of uncertainty and tragedy, we need to remember our humility.

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COVID 19 has completely disrupted communities around the globe and caused enormous loss as well as untold human suffering. The development of such effective vaccines has given us hope for the future, but the unprecedented speed at which these have been developed has raised some questions. The WHO recently has identified vaccine hesitancy as one of the top 10 public health issues facing global health. To ensure a high uptake of vaccines globally, the community needs transparent, honest and factual advice from trusted members of the community. There will always be a small minority of people, "Activists" who ignore the science and spread misinformation or worse, conspiracy theories. We mostly cannot reach those activists and should rather concern our efforts with those "hesitant" but undecided. At the same time, we must also consider the logistical limitations of vaccine rollouts on a global scale. These include factors such as lack of infrastructure, accessibility, and financial constraints, to name a few... but if COVID has taught us anything, it has taught us the need for a shared sense of action.

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ECMO is a life-saving intervention for critically ill patients, but patients describe a recovery period that can take months to years.

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Those of us looking after kids know that making confronting situations better for those kids is one our biggest challenges.

A kid's experience of a procedure in hospital is not just about that particular procedure. It colours all their future interactions with health professionals and can impact on their behaviour outside health care settings.

Virtual (VR) and augmented reality (AR) are new technologies that really rely on old techniques - telling a story and transporting a person to another place.

There is now good evidence that these modalities can improve the experience of patients undergoing induction of anaesthesia (1)

having burns care (2)

and even effectively treat phobias (3).

More fundamentally, even brief exposures to VR can alter the way people behave.

Healthcare needs clinicians leading the discussion as to how to make it the best option for patients. Even more importantly, clinicians can use this technology to understand what kids want and how they think about procedures.

It is time for kids to help us design the VR and AR of the future.

This session will cover what we mean by VR and AR, what we already know about it, and how we're trying to learn from kids as we make the procedures of the future a bit better.

Or maybe even fun.

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In the ER, we are taught to turn towards the pain of others.

We are not given as deliberate advice on how to care for ourselves despite the adversity we see, and the inevitability of being hurt by it.

If our role is, at least in part, to steward health towards others, we defy its logic if don't extend the same caring to ourselves.

Being well, and if not, knowing the direction, is as vital as being able to get a blind subclavian line in a bleeding trauma patient.

Our culture, instead of a place of healing, can be toxic in itself, vulnerability almost inadmissible, meanness tolerated.

As we address this, and its root causes, we become better clinicians, more likely to help people in ways that matter most, take our skills and profession to places that need it.

It's possible for the ER becomes a place where, instead of getting beat up by it and recovering, we can live true values.

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Salim and Ken go toe-to-toe debating some hot topics in critical care. They take on mechanical CPR, adrenaline for out of hospital cardiac arrest, stroke ambulances and 1st pass with a bougie. Fun and informative.

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Sepsis is a common and deadly condition, but diagnosis in not always knowable in real-time. The optimal treatment during times of diagnostic uncertainty differs across patients.

Despite this reality, sepsis performance is uniformly assessed and reported for a population knowable only in retrospect—the patients ultimately judged to have sepsis at hospital discharge.

This limits effective audit and feedback to incentivise clinician behaviour. Personalised, real-time assessments of a patient's risk of death and likelihood of infection could instead be used to guide treatment recommendation and performance assessment.

Clinicians and health systems could be judged on whether their responses are appropriately calibrated given the urgency of the situation. Were antibiotics prescribed at an appropriate time given the urgency of the patient's clinical status? With the information available, were the best treatment decisions made? Did treatment plans change as new data became available? Organising treatment recommendations and performance assessment by risk of death and likelihood of infection could optimise sepsis care.

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Mulinda shares how setting up an emergency department at a public tertiary hospital resulted in contributing to improving a district primary care system improvement program in Malawi. The link between performance of a health system can affect the community's health seeking behaviours. Insight into how improving patient care pathways can assist in creating patient centred, efficient and effective emergency care provisions will be shared.

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An overview of causes of surgical vomiting in the neonate.

This includes malrotation-volvulus, intestinal atresias, necrotising enterocolitis.