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

SCAD will also screw you up by David Carr

Coda Conference: Clinical Knowledge, Advocacy and Community.
Melbourne: 11-14 Sept 2022
codachange.org

Medicine

Science & Medicine

Health & Fitness

David Anderson describes the current state of play with airway management in the prehospital setting. There are important differences between airway management in the prehospital environment and airway management in hospital. Prehospital intubation has been practiced for over 50 years and continues to evolve, with many techniques and procedures devised from prehospital use finding their way into ED and ICU practice. The main indications for prehospital intubation are cardiac arrest and severe TBI. 3 large studies show no evidence to support prehospital intubation in cardiac arrest and this practice should probably be reserved for specific cases. Prehospital RSI for TBI remains controversial as the evidence available to date is conflicting and isn’t high quality. While scene time if often commented on, there is no evidence available prehospital RSI increases time to CT or OR for patients with a severe TBI. There is no evidence that any one craft group is better at intubation than any other. In order to make prehospital airway management as safe as possible, innovations such as checklists, kit dumps and pre-drawn syringes are common. Many prehospital services invest much more heavily in the training and maintenance of airway skills than in-hospital specialties. This session was recorded at the SAS workshop at CODA22 which took place in Melbourne in September 2022. For more information about the CODA Project go to: https://codachange.org/ 

Prehospital airway management

Adam Rehak and Gerri Khong walk through the good, the bad and the ugly of human factors in airway management. Using video footage of a highly realistic (tachycardia inducing) simulated airway emergency, the multi-stage case discussion canvases both audience responses and the input of a panel of human factors experts: David Brewster, Brooke Dench, Ben Meadley and Ian Summers, to illustrate that airway management is far more than just a technical skill. Instead, it will become clear that success is equally dependent on careful preparation, coordinated teamwork, precise communication and effective cognitive tools. This session was recorded at the SAS workshop at CODA22 which took place in Melbourne in September 2022. For more information about the CODA Project go to: https://codachange.org/ 

Human Factors in Airway Management

David Brewster describes the current state of play with airway management in the critical care setting, including a summary of the INTUBE study and the Safe Airway Society guidelines for airway management in COVID-19 patients. This session was recorded at the SAS workshop at CODA22 which took place in Melbourne in September 2022. For more information about the CODA Project go to: https://codachange.org/         

Critical Care Airway Management

This discussion discusses the use of ketamine in fibre-optic intubation.  This session was recorded at the SAS workshop at CODA22 which took place in Melbourne in September 2022. For more information about the CODA Project go to: https://codachange.org/ 

Airway Innovators 3 - Ketamine in fibre-optic airway management

Adam Rehak addresses confusion and lack of awareness around these combined techniques that are making their way into the armament of airway operators.  This session was recorded at the SAS workshop at CODA22 which took place in Melbourne in September 2022. For more information about the CODA Project go to: https://codachange.org/ 

SCAD will also screw you up by David Carr

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