Coda Change

Andrew Dixon from Radiopaedia goes through 5 classic fails - common misses in trauma imaging. Learn from this rather than missing them yourself! See if you can spot the pathology before Andrew explains it to you - you can scroll through the scans on Radiopaedia here: https://radiopaedia.org/playlists/1976c00393ca4c9d9878566c3487d97a?lang=gb

In order to be as good as you can be (self actualisation) you need to understand your own performance and how you are seen in the world. Sadly you cannot do this alone. Arguably all the beliefs about yourself, your actions, your performance and even your own image are skewed, biased and incorrect. You cannot reach your peak without help. Healthcare is complex though. In the resus room decisions are often time critical and information light such that we cannot apply a simple rule as to what is good and what is bad. Similarly, who can judge success? Only those who understand our systems, our aims and what the difference between process and outcome is. That's where Peer Review comes in. As a tool it is a way of gaining insight into how you really perform in the real world. This talk explores the why, the when and gives tips on the how you can maximise the power of peer review in your clinical and education practice.

Sexual assault affects 1 in 3 women and 1 in 6 men during their lifetime worldwide. It is more common than most medical issues we are trained to look for, despite this being a patient population we are going to see by virtue of the "anyone, anytime" nature of an emergency and critical care. Generous estimates find than only 20% of survivors present for medical care and may not disclose this initially in their visit. Look for it during public holidays, large parties or concerts, college or university frosh week, particularly in young women. Other scene awareness clues that a sexual assault may have occurred include sedation that does not match the substances taken or clinical level seen, ripped or missing clothing, or being separated from their group. Documenting your suspicions and findings is key - as this chart is more likely to go to court, but not for 2 years. Direct quotations of what was said by the patient or EMS, body diagrams for what was found, and your clinical decision making are the essentials. Physical findings may be absent or minimal; this does not mean that no assault took place! The discussion that you had with the patient around further treatment and legal options needs to be recorded. Care of a sexually assaulted patient is complex and can have long-lasting detrimental psychological effects if not done well. Referral to a specialized care program to bridge the gap between medical and legal in a patient-centred trauma-informed manner is best. Treating survivors with belief, support and humanity as you assist them with making an informed decision as to the next steps in their care is vital as the first step in healing.

The rising death toll from our nation‚ opioid epidemic has been rivaled in modern history only by that at the peak of the AIDS epidemic in the early 1990s. Consider, in 1995 at the peak of the AIDS epidemic, 51,000 Americans died from the disease. In 2015, 52,000 died from drug overdoses. Emergency departments have stood at the front lines of both crises. As a specialty that prides itself on rising to the occasion at times of great need, our time to lead on this crisis is now. As a response, EDs nationwide are expanding their roles in the care of patients with opioid use disorder (OUD), and many have begun ED-MAT programs. In December of 2017, we launched the Get Waivered Campaign which aimed to get our physicians the DEA X waivers needed to be able to prescribe ED-MAT(buprenorphine) to patients coming to our hospital seeking recovery. In May of 2018, our ED instituted its first ED-MAT protocol and while greater than 90% of our attending physicians had their DEA-X waivers and were able to prescribe buprenorphine, we found that there remained an opportunity to increase the rate of MAT initiation in our ED. Through semi-structured interviews we set out to examine the barriers to providers, use of our MAT initiation protocol and patients‚ willingness to seek help in obtaining OUD treatment in our ED. Our work has identified multiple barriers, affecting both providers and patients, that have limited wide-scale early adoption of our protocol. The barriers identified from our ED-MAT program‚ first year of operation, and the interventions aimed at making the use of our ED-MAT protocol as effortless as possible may serve as useful lessons as other hospitals seek to lead by operationalising their own ED-MAT programs.

For more head to: codachange.org/podcasts

A case example of a large vessel obstruction of the brain and our current techniques available to treat it. How we make decisions on endovascular treatment and management points for emergency and intensive care colleagues.

This talks gives some guidance on how to deal with your anxiety and fear when dealing with children. We will also cover some keytopic areas: sepsis, fluids, seizures, asthma and bronchiolitis

in March 2006, six healthy volunteers underwent cytokine-induced injury and multiorgan failure from a Phase 1 first-in-human drug trial with a novel monoclonal antibody. This talk describes the clinical and incident management ramifications, drawing connections to other non-conventional incidents which may pose a different pattern of clinical, operational and communications challenges to the 'classic' trauma-based model of major incidents.