Coda Change

Muscle wasting in intensive care is the thief of future health. Hugh Montgomery shows us what a big issue this is and what can be done to mitigate the problem.

Neurological insults such as trauma and haemorrhage disturb the brain in complex ways, affecting multiple outcome domains. A substantial number of patients with even mild brain injury experience long-term emotional, cognitive and physical deficits. Measuring these deficits is at the core of prognostication and research in neurocritical care. However, the most commonly used outcome measures are simplistic scales that focus on functional outcome. There is increasing concern that the way we define and measure outcomes is failing to capture the multidimensional patient experience. This presentation of 3 case studies will explore the complexity of assessing long term outcome from brain injury and explore the need for improved outcome assessment measures that better capture patient recovery.

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.

Chris Nickson talks about personal moments in his career in critical care that have really challenged him. Jenny Rudolph then builds on the work in the previous sessions. She shows us how to react, accept, reset and engage and outlines the psychological principles which underpin these concepts. Hopefully, these sessions will really help us deal with the workplace stressors we all encounter.

Emotion is always present in critical conversations. When we recognize emotion, validate feelings and respond with empathy and curiosity, we allow patients and their families to engage in the process, to build trust, and to better understand their values. When emotions are too intense, or feelings are not validated, people become disengaged, less trusting, and often fail to explore and understand the deeper values‚and instead may act on raw, surface emotions that actually may not be in their best interest. We often answer feelings with facts. Instead, we should G.I.V.E. when we encounter emotion. G.I.V.E. is a mnemonic tool that offers a simple approach to responding when an emotion arises in conversations. First, get that there are emotion present and pause. Identify what you think the emotion might be or describe what behaviours you are noticing. Validate the feelings expressed. Explore to understand better and offer your curiosity and caring. And if you can't remember what G.I.V.E. is prompting you to do, it may be enough to give your attention and patience to the other person at that moment.

The secret of success in teams is not individual behaviour, it's team-based.At the core of every elite team is psychological safety -- defined as shared belief in a team environment that permits interpersonal risk-taking.Risk in this context means the ability to be open, honest, ask questions, seek input, admit mistakes and drive relentlessly towards being better: key behaviours for high performing team leaders and members alike.Psychological safety in health care is both elusive and difficult to achieve.Social contagion theory can help explain how each team member can contribute to a study team environment that accelerates group performance.Be a positive emotional contagion.Carry the fire.

The rehabilitation of people who have cognitive impairment after TBI should be based on an understanding of what is the likely cause of that impairment,

Crystalloids and colloids used in critically ill patients have different fluid composition. The composition may affect many things, including response to administration, clinical outcomes, and adverse effects. This talk with discuss the evidence behind the different types of fluids in critically ill patients, including a discussion of pros and cons of each fluid type.The session will be an interactive discussion led by investigators who have conducted randomized trials of different types of intravenous fluids.