Coda Change

The battle is on...who will win out? The heroic healthcare individual or the faceless safety checklist? Brindley takes saftey talks to a new level. A true SMACC highlight.

John Hinds shows us why he will be so dearly missed in this superb talk from SMACC Chicago. This is about resuscitative thoracotomy but really so much more.

Opioids are extraordinary agents that have been used for millennia for the relief of pain and suffering; however, the history of opioids is also one of abuse and addiction. In the US, we are in the midst of a devastating iatrogenic chapter in this history, a prescription opioid epidemic that kills 15,000 Americans per year by overdose and destroys hundreds of thousands of lives and families.In this presentation we will consider the magnitude and consequences of the current epidemic; describe how clinical organizations and clinicians were appropriated by the pharmaceutical industry so that Americans–5% of the world’s population–consume more prescription opioids than the rest of the world combined; and discuss strategies for managing patients who present to emergency departments with acute or chronic pain complaints that account for our competing mandates to palliate and protect.These strategies center on an assessment of the likelihood that using opioids will deliver benefit or cause harm. For patients at low risk to be harmed by opioids, utilize aggressive multimodal analgesia, including opioids as needed to control acute pain, and prescribe optimal outpatient non-opioid analgesia with a small number of breakthrough opioids if indicated. For patients at high risk to be harmed by opioids, including patients with chronic pain and patients with flags for opioid misuse, avoid using opioids in the ED and outpatient settings, utilize non-opioids to manage symptoms, and, when misuse is suspected, nudge the patient to addiction treatment. The goals of optimal opioid stewardship are to provide effective symptom relief while preventing de novo cases of addiction, to control the supply of opioids in the community, and to protect existing addicts from further harm while promoting recovery. For slides, the HELPCard treatment referral business card, and phraseology to use when managing patients at risk for opioid misuse, go to http://emupdates.com/help

Kath Maitland, the author of the FEAST study, talks about where we go now with fluids in kids, following FEAST

Personal tragedy will touch all of us. Rob's talk is an incredibly personal story but offers much practical advice for dealing with the inevitable.

Amal Mattu gives Career advice with help from The Princess Bride

Liz Crowe delves into the deeper issues surrounding critical care and religion. She explores how religion influences patients and their families, why doctors can push against faith, and how the healthcare community can integrate an acceptance of faith into their care. The ultimate goal in working with any patient and their family is connection. This guarantees respect, integrity and ensures all communication is understood and goals are worked on together to optimise health outcomes. Connection is also a protective factor for patients and staff as it builds resilience and wellbeing. Health professionals are often uncomfortable or annoyed if people of faith want to integrate their beliefs and hopes into medical conversations and outcomes. Health professionals may perceive faith or religion as a threat or oppositional to science and the reality of the situation. Ideally faith may be an additional resource for health professionals to use with patients and their families in times of crisis, uncertainty, and end of life care. There is a strong connection between faith and hope. Prayer and crisis-orientated faith are commonplace in critical care medicine even for people who have been ambivalent or non-believers of faith in the past. Challenging a person's faith or belief in times of crisis may result in a severing of the therapeutic alliance or relationship which will have the opposite effect to what the health professional may desire. People who 'refuse' to believe a diagnosis or prognosis in the hope of a miracle or divine intervention are vulnerable. To enter a dispute with religion is disrespectful, futile, and unhelpful. To learn more about someone's beliefs and join in a genuine hope for a 'miracle' shows compassion, understanding and respect. Nobody wants to suffer. Most of us are frightened by loss and illness. Inviting and sitting comfortably with faith and prayer while also gently holding their fears and preparing for the worst is a more powerful and honest way to work. Regardless of personal values and beliefs, hoping that others can receive comfort and peace from a sense of spirituality and faith is to remain human. We aim never to fight with a higher being, rather invite the presence into the family room and join with the family in the desire that the family never feel alone or abandoned by either their faith or us as health professionals. Long after we may have forgotten the specifics and details of families, they will remember us. The health professional who can sit with someone, who can build health goals and care based on the beliefs of others, will be those who are most respected and valued. For more like this, head to our podcast page. #CodaPodcast

John Hinds gives his last talk - on the subject he was most passionate about. Back with popular demand, More Cases from the Races.

Chris Ross & Oli Flower discuss the latest update on SMACC Chicago - an incredible cadaver workshop with small group expert tuition on a huge range of critical care procedures. At a hugely discounted price. This will sell out so get in there fast.

A long time ago in a galaxy far, far away.... Watch our fearless masters of Sim battle for galactic supremacy on the SMACC main stage.