It is time to RAGE again!

This one is 61:38 min long and includes:

* Introduction… kind of (starts 00:00 min)

* ‘What’s bubbling up?’ (starts 04:48 min) — an ED checklist for cognitive debiasing, are ‘cold’ platelets ready for primetime, the ART trial and the open lung approach to ventilation using recruitment manoeuvres

*  ‘What’s The Sats Target?’ (starts 22:55 min) — the RAGE team discuss what SpO2 targets to aim for, in which patients and diseases, and the tricks and traps of real-world clinical practice.

* ‘A blast from the past’ by Chris Nickson on ‘Rudolph Virchow’ (starts  52:52 min)

* ‘Words of Wisdom’ from Cliff Reid (starts  57:10 min)

The RAGE podcast is on  iTunes here and the RAGE podcast audio feed is available here.

Here are the show notes for this RAGE Session :

Introduction

* :-)

What’s bubbling up?

* Graber ML, Sorensen AV, Biswas J et al. Developing checklists to prevent diagnostic error in Emergency Room settings . 2014; 1(3). [article]

* Mike Clancy’s Cognitive Checklist

Diagnosis: Interpreting the Shadows by Pat Croskerry et al (Google Books)

*

All Doctors Are Jackasses by Chris Nickson (LITFL)

* Johnson L, Tan S, Wood B, Davis A, Marks DC. Refrigeration and cryopreservation of platelets differentially affect platelet metabolism and function: a comparison with conventional platelet storage conditions. Transfusion. 2016; 56(7):1807-1818. [pubmed]

* FDA Approves Cold Platelets For Resuscitation

* ART investigators writing group. Effect of Lung Recruitment and Titrated Positive End-Expiratory Pressure (PEEP) vs Low PEEP on Mortality in Patients With Acute Respiratory Distress Syndrome: A Randomized Clinical Trial. JAMA. 2017; 318(14):1335-1345. [pubmed] [article]

Open Lung Approach To Ventilation (LITFL CCC)

Lung Recruitment Manoeuvres (LITFL CCC)

What’s The Sats Target?

* Oxygen Saturation Targets in Critical Care (LITFL CCC)

* Oxygen: The Molecule that Made the World by Nick Lane

* Grocott MP, Martin DS, Levett DZ, et al. Arterial blood gases and oxygen content in climbers on Mount Everest. The New England journal of medicine. 2009; 360(2):140-9. [pubmed]

* Unger S, Cunningham S. Effect of oxygen supplementation on length of stay for infants hospitalized with acute viral bronchiolitis. Pediatrics. 2008; 121(3):470-5. [

The RAGE team talks to Peter Brindley about a new, free crisis resource management book and CRM Brindley-style, and we reflect on the recent dasSMACC conference. The usual stuff is there too: what's bubbling up?, a blast from the past about John Scott Haldane, and some Words of Wisdom from Peter Brindley to finish.

Show notes available at: http://ragepodcast.com/rage-talks-crm-brindley-style-dassmacc/

This RAGE session, featuring Cliff Reid, Brian Burns, and Geoff Healy,  is a NSFW monster clocking in at 2h 48 min 59 sec long!!!  Following an introduction the crew tackle the following questions: 

Describe training experiences that have shaped you?

What is your experience of trainees, and what attributes of good and bad trainees do you observe?

What is your advice on how to be a good resuscitationist?     What are you currently struggling with in your careers?

 

‘Three Men and a Microphone’ is a special edition of the RAGE podcast (let’s face it, RAGE podcasts are so infrequent they’re all special!) featuring RAGE Resusciteer Cliff Reid in conversation with these special guest RAGErs:

* Geoff Healy (prehospitalist/ retrievalist/ anaesthetist)

* Brian Burns (prehospitalist/ retrievalist/ emergency physician)

This one is a monster – it is 2h 48 min 59 sec long!!!  It is NSFW (contains some profane verbiage) so don’t let your kids listen in…

Here is the run sheet so the you can skip to the bits you want:

 

Introduction

0:00 Intro: NSFW

2:38 Welcome – what we’re busy with at the moment

10:13 Highly functioning organisations

18:00 Airway audit

19:06 Operations research and A.P. Rowe

23:42 Role of SOPs, SOPs vs protocols

 

28:37 QUESTION: Describe training experiences that have shaped you

Anaesthesia in Australia -Geoff getting patronised

Trauma in Ireland – Brian being unsupported

EM in England – Cliff getting pimped

Importance of honesty and humility as a mentor

Mike Clancy’s public cerebration – teaching you how to think

Phoning a friend when you’re the boss

Calling the boss in – differences between the UK & Australia

3 reasons to call the boss: to let you know, to seek advice, to ask you to come in.

 

1:05:05 QUESTION: What is your experience of trainees, and what attributes of good and bad trainees do you observe?

The lurker, the stalkers, the shopper, the sharp-elbows

Our experiences as underconfident trainees

Turning yourself into the (mythical) shit magnet

John Hinds’ approach to keeping sharp

Consultants who are hummingbirds

Avoiding institutionalisation – getting experience in remote/rural units

 

1:29:24 QUESTION: Give your advice on how to be a good resuscitationist

The word resuscitationist

EMS Gathering in Cork and big wave surfers

Extending your training – fellow posts and other experiences

Acquiring experience with restrictions on working hours

The limitations of learning from textbooks and life support courses

Can we accelerate the acquisition of experience using technology?

Lionel Lamault & prehospital ECMO

Comfort zones and task fixation

Geoff likes to ‘bosh’ people

Cognitive rally points

Unexplained different approaches to fluids in paeds resuscitation

Being treated as a gas monkey in ED

A new word  – resuscitationism

The Jason Bourne game and developing spider-sense

Too sick to be intubated?

 

2:07:30 QUESTION: What are you currently struggling with in your careers?

Being a coach

Having trainees who are better than we are / were

Top Gun pilot caution against overperformers

Thoughts for bosses who have trainees who are smarter or more skilled than they are: (1) They make you look good; (2) You might learn something; (3) The future is brighter for patients

The challenge of getting senior clinicians involved in simulation

Struggling to improve and get outside our comfort zones, and continue to evolve as consultants

A pantyhose anaesthetic

On August 17th 2016, Associate Professor Vincent Pellegrino, Head of the ECMO service at The Alfred ICU, discussed ECPR during an in-house education session.

His discussion included:

* the difficulties with ECPR definitions and selection criteria

* Approaches to ECPR, ranging from cannulation techniques and types of cannula, to role cards and the importance of teamwork

* Outcomes for ECPR and the evidence for the technique

Listen to the talk to find out more – the podcast is 37 minutes long.

THE VIDEO

THE SLIDES

For more on ECMO check out INTENSIVE and EDECMO.org.

The RAGE podcast is on  iTunes here and the RAGE podcast audio feed is available here.

Thanks again for listening to the RAGE!

On August 17th 2016, Associate Professor Vincent Pellegrino, Head of the ECMO service at The Alfred ICU, discussed ECPR during an in-house education session.

His discussion included:

• the difficulties with ECPR definitions and selection criteria
• Approaches to ECPR, ranging from cannulation techniques and types of cannula, to role cards and the importance of teamwork
• Outcomes for ECPR and the evidence for the technique

Listen to the talk to find out more – the podcast is 37 minutes long.

Here is the ‘bootlegged’ footage of John Hinds’ defence of direct laryngoscopy in the prehospital setting.

John brings all his usual wit and mischievousness to the defence of the tried and true way of getting a tube between the cords anywhere and at anytime.

On November 11th 2015, Professor Stephen Bernard (@AmbVicMedic), Medical Advisor to Ambulance Victoria, presented a smorgasbord of ‘Updates in Resuscitation‘ at The Alfred ICU junior medical staff teaching session. He discussed:

• Recent data from registries on in-hospital and out-of-hospital cardiac arrest (OHCA), particularly from Victoria, and the reasons why OHCA results may be improving
• Options for treatment of refractory VT/VF, including the CHEER2 trial
• The RINSE trial: is intra-arrest cooling with ice cold IV saline for OHCA a good thing?
• Highlights from the recently released updated ILCOR guidelines, which will form the basis for the next ARC guideline update

On November 11th 2015, Professor Steve Bernard (@AmbVicMedic), Medical Advisor to Ambulance Victoria, presented a smorgasbord of ‘Updates in Resuscitation‘ at The Alfred ICU junior medical staff teaching session.

He discussed:

* Recent data from registries on in-hospital and out-of-hospital cardiac arrest (OHCA), particularly from Victoria, and the reasons why OHCA results may be improving

* Options for treatment of refractory VT/VF, including the CHEER2 trial

* The RINSE trial: is intra-arrest cooling with ice cold IV saline for OHCA a good thing?

* Highlights from the recently released updated ILCOR guidelines, which will form the basis for the next ARC guideline update

Listen to the talk to find out more – the podcast is 47 minutes long.

For more talks by Steve Bernard, check out INTENSIVE.

The RAGE podcast is on  iTunes here and the RAGE podcast audio feed is available here.

Thanks again for listening to the RAGE!

RAGE will be coming out hibernation post-SMACC and the first signs of reanimation come in the form of this ‘preSMACC miniRAGE’ featuring Cliff, John and Karel.

Register for SMACC Chicago 2015 now and come up and say ‘Hi’ to the RAGE team! 

FIRST HALF

The first half of this miniRAGE is a preview of what the RAGE gang are doing at SMACC Chicago 2015… Including “IT’S A KNOCKOUT”:

SECOND HALF

The second part of the podcast is all substance, with discussions of the following:

* our favourite app, the GoodSAM App

* Oxygen therapy, specifically this trial led by Dion Stubbs and Steve Bernard from The Alfred: AVOID: Air Versus Oxygen in ST-Segment Elevation Myocardial Infarction and the trial by friend of RAGE, Paul Young titled HOT or NOT trial: HyperOxic Therapy OR NormOxic Therapy after out-of-hospital cardiac arrest (HOT OR NOT): a randomised controlled feasibility trial.

* John discusses Helicopter Emergency Medical Services, including Survival benefit of a physician-staffed HEMS assistance for severely injured patients and  Willingness to pay for lives saved by HEMS

* … and Cliff continues his intraosseous obsession with (1) Intraosseous infusion rates under high pressure: a cadaveric comparison of anatomic sites, (2) Intraosseous hypertonic saline: myonecrosis in swine, (3) Intraosseous hypertonic saline: safe in swine and (4) Discussion post about intraosseous hypertonic saline at Sydney HEMS

* Finally, listeners will find out why handstands are awesome:  Handstands: a treatment for supraventricular tachycardia?, Impact of a modified Valsalva manoeuvre in the termination of paroxysmal supraventricular tachycardia and Handstands keep you awake.

By the way, because someone actually bought a pair of RAGE shoes they are still in production – check ’em out and buy ’em here: http://aliveshoes.com/rage

Thanks again for listening to the RAGE!