Objectives
With the use of high quality simulation, in a safe learning environment, we aim to:
Click HERE for the simulation timetable
From the 2013 SMACC conference – this is Cliff Reid delivering a talk called ‘Making Things Happen’:
Using trauma as an example, Cliff looks at and provides his solutions for elements of resuscitation that can derail even the most competent team – including cognitive overload, inappropriate team tasking, loss of situational awareness, and the inability to MAKE THINGS HAPPEN…
This talk is a great companion to ‘Own The Resus‘
As part of your AED orientation and departmental CME we will be running through basic airway survival skills on Tuesday the 10th December from 2pm to 4pm.
We will be covering
I have attached some links for pre-reading around the ED airway, RSI and checklists as below:
http://emcrit.org/podcasts/emcrit-intubation-checklist/
– This is a collection of airway based podcasts and resources from Scott Weingart on his EMCRIT blog, presented all on one page and is an invaluable resource. Goes into a little more detail than we will on Tuesday, but the rest we will be covering on another airway session.
– UK Site, based on the outcomes from the NAP4 study. Good, one page RSI checklist developed by anaesthetic regs in the UK and a nice presentation of the rationale behind safer intubation using a pre-intubation checklist.
http://clubmona.org/2013/04/05/using-the-paediatric-rsi-checklist/
– By Cliff Reid (of the resus.me blog). This is an awesome video demonstrating a concise run-through an RSI checklist. Useful for a brush-up on paeds RSI.
http://prehospitalmed.com/2013/01/22/how-to-do-rsi-on-side-of-a-cliff-watch-and-learn-by-gsa-hems/
– Just for a bit of fun! If NSW HEMS can do it safely on the side of a cliff it can be done safely anywhere!
From Dr Fen Moy – drug information sheets. This will be covered in a second session later in the run
Click HERE for the file
If only patients came with labels…
If you have your Auckland Trainee Airway and Procedural Skills logbook – please bring it along with you on the day! Cheers – Alana
AED has a Glidescope video laryngoscope available in the resus area.
This is a step-by-step training video for using the Glidescope.
The technique of use is different from the Macintosh blade. The video link goes through the basic steps.
4 steps to remember –
1) Look at the mouth (to insert the blade in the MIDLINE)
2) Look at the screen (to get the laryngeal view)
3) Look at the mouth (to pass the ETT into the back of the mouth)
4) Look at the screen (to pass the ETT through the cords)
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From Scott Weingart at emcrit.org, this is a (somewhat irreverent!) debate on whether video laryngoscopy should be used for ALL emergency intubations:
I have attempted to gather links to websites both colleagues and I found very useful in the preparation for the ACEM Part 2 Fellowship exam and also for ongoing learning. This list is fairly lengthy but by no means exhaustive (!) .
Read more about Free Open Access Meducation (FOAM) here: http://lifeinthefastlane.com/foam
EM Google: http://emgoogle.com is a unified search of all the FOAMed resources on the Web.
1. Emergency Medicine Blogs: Australasian
Life in the Fast Lane: http://lifeinthefastlane.com Fantastic Emergency Medicine and Critical care educational resource, contains most of the past exam papers for the ACEM Fellowship exam from around 2003 and also CICM fellowship exam papers.
ED Exam: http://www.edexam.com.au
The focus of this blog is mostly around sitting and passing the ACEM fellowship exam. If you register with the site there is a wealth of resources; an online repository of notes and flashcards and podcasts on surviving the “part 2”.
NSW Fellowship Exam: http://www.nswfellowshipcourse.com.au/www.nswfellowshipcourse.com.au
Website for the NSW Fellowship exam course. Links to past papers and mock exams.
Resus.com: http://www.resus.com.au
Check out ResusTV – some very good video blogs of recorded lectures.
Resus ME: http://resus.me
Resus.ME exists to help you keep up to date in all aspects of life-saving medicine, from acute medicine and paediatrics, to emergency and critical care medicine, and even pre-hospital care. For those aiming at being a resuscitation specialist.
Resus Room Management: http://resusroom.mx
Managing the resuscitation – crew resource management and human factors blog.
EM Tutorials: http://emtutorials.com
A good resource for junior ED Docs – NZ based site.
ACEM E-Learning: http://acem.moodle.com.au
ACEM resource to keep up to date with courses and resources – including clinical ethics, communication, ultrasound accreditation, overcrowding, management, toxicology and trauma. Needs your ACEM site logon to access. Includes online “moodles” (e-learning modules), forums and discussion papers.
Intensive Care Network: http://www.intensivecarenetwork.com
Aimed at Australasian Intensive Care Trainees. Blog posts, exam resources and podcasts.
The Sharp End: http://thesharpend.org
An emergency medicine resource by our Auckland collegues at Middlemore Hospital.
Broome Docs: http://broomedocs.com
Online resource for Rural GP’s and Proceduralists, has a very interesting clinical case section.
Club Mona: Emergency Medicine Education: http://clubmona.org
A blog much like our own, worth a look especially for the paeds RSI checklist video.
KeeWee Doc: http://keeweedoc.com
Rural EM in New Zealand – some good cases discussed, useful for junior EM docs.
2. Emergency Medicine Blogs: International
Emergency Medicine Updates: http://emupdates.com
Huge repository of flashcards, developed by the author when studying for the US EM Board exams (developed from Rosens 5th Edition). Useful revision tool for ACEM Fellowship exam.
St Emlyns: http://stemlynsblog.org
Is a collection of people and projects aimed at improving Emergency Medicine. Linked to the Manchester based “Best-Bets” EBM team.
Academic Life in Emergency Medicine: http://academiclifeinem.blogspot.co.nz
Blog posts also condensed into “paucis verbis” cards – a useful study website.
I Teach EM: http://iteachem.net
The art and science of teaching and learning emergency medicine and critical care.
Better in Emergency Medicine: http://betterinem.blogspot.co.nz
A blog to “explore topics related to becoming a better academician, running a better emergency department, making emergency care safer, and becoming a leading force for change”.
Emergency Medicine Ireland: http://emergencymedicineireland.com
3. Podcasts and Vodcasts
EMCrit Blog: http://emcrit.org
A discussion of the practice of ED critical care. A mixture of podcasts, vodcasts and blog posts. An awesome EM resource.
ERCast: http://blog.ercast.org
Good resource for podcasts. “Focused discussions on the questions, quagmires and known unknowns we face everyday in the emergency department”.
EM Cases: http://www.emergencymedicinecases.com
CME audio program, check out the “best cases ever” section.
Smart EM: http://www.smartem.org
Free Emergency Medicine Talks: http://freeemergencytalks.net
More than 2000 MP3’s recorded at lectures and meetings around the world. Includes some very inspirational talks on leadership and why we practice emergency medicine.
Paeds EM: http://empem.org
Ultrasound Videos: http://vimeo.com/groups/ultrasound
Many Vimeo posts demonstrating positive FAST scans amongst many others.
4. Others:
Pre-Hospital / HEMS: PHARM: http://prehospitalmed.com Pre-Hospital and retrieval medicine blog and podcasts.
Cardiology (ECG’s): Amal Mattu’s ECG Videos: http://ekgumem.tumblr.com Dr Smith’s ECG Blog: http://hqmeded-ecg.blogspot.co.nz These two blogs on ECG’s are brilliant – usually linked with a case discussion.
http://ecg.bidmc.harvard.edu/maven/mavenmain.asp
http://www.skillstat.com/tools/ecg-simulator
Radiology: http://www.med-ed.virginia.edu/courses/rad/index.html Online radiology tutorials
http://www.imageinterpretation.co.uk
Online Norfolk Image Interpretation course – valuable site for both Part 1 Anatomy and Part 2 Fellowship exam study. Really good website.
http://www.hawaii.edu/medicine/pediatrics/pemxray/pemxray.html
Radiology cases in Paeds Emergency Medicine.
ED Ultrasound:
See the Ultrasound section of the Improving Care in ED website for other useful links.
http://sinaiem.us
Paediatrics: Paeds EM: http://empem.org Free podcasts, well worth listening to.
Paeds Radiology: http://www.hawaii.edu/medicine/pediatrics/pemxray/pemxray.html
Trauma ED Trauma and Critical Care: http://www.edtcc.com
Trauma: http://www.trauma.org
One of the best Trauma sites on the we. Also good interactive case scenarios (need to open these in firefox on ADHB computers)
http://regionstraumapro.com
Trauma blog
Toxicology
http://www.thepoisonreview.com
“A critical update and evaluation of recent scientific literature, news stories, and cultural events related to the field of medical toxicology”.
Medical Education / Simulation: Sim and Choppers: http://andrewpetrosoniak.wordpress.com
Procedural: Regional Anaesthesia: http://www.nysora.com Good resource for regional anaesthesia, anatomy, landmarks including US guided techniques.
Arthrocentesis: http://mulla.pri.ee/Kelley’s%20Textbook%20of%20Rheumatology,%208th%20ed./HTML/350.htm
Good landmark descriptions and pictures for the large joints.
Orthopaedics:
http://www.wheelessonline.com
Evidence Based Medicine: Best Bets: http://www.bestbets.org A searchable database for rapid evidence based answers to clinical questions in Emergency Medicine.
The NNT: http://www.thennt.com
Journal Watch: http://emergency-medicine.jwatch.org Summaries of key points from around 250 journals.
In an important quality initiative for AED, Dr Fen Moy (ED Specialist) has recently launched an airway registry to gather data on endotracheal intubation in the emergency department. The results will be used to improve clinical care and training:
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The Adult Emergency Department Airway Register
Reason for Establishing an Airway Register:
Currently AED does not have any records of the number of intubations done in the department. Nor is there any information about the indications, which staff are performing the intubations, difficulties encountered, and complications occurring.
Emergency Medicine Australasia published a prospective observational study of the airway register used in Royal North Shore Hospital in Sydney. It was the first descriptive study of intubations in an Australasian ED. It highlighted the lack of information of intubations done in Australasian EDs. There has been more information from North America with the establishment of an online National Emergency Airway Registry since 1996 (however it only has 25 participating hospitals).
Benefits of an Airway Register:
1. The register will provide objective data for AED & DCCM regarding numbers of intubations done in AED.
2. Collected information which can lead to quality improvement for AED and other departments. Specifically: frequency of complications; experience & success rates of intubators; need for rescue devices; need for Airway Emergency Team call-outs.
3. This can then be used for further education & training of staff.
Expectations:
It would be expected that the intubator will be responsible for filling out the form, particularly the sections highlighted #. The forms are on the side of each Resus bay’s write-up platform, and the completed forms can be placed in the adjacent plastic sleeve.
The team leaders – please remind the intubator to fill in the form.
Feedback:
Results of the register will be analysed and fedback to AED during Clinical Governance sessions, as well as to the Department of Anaesthesia and the DCCM. We are using this registry within AED currently, but may look at joining the Australasian Registry at some stage in the future for wider collaboration.
Dr Fen Moy
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Current version of AED airway registry (click to enlarge):
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Minh Le Cong from Prehospitalmed.com recently interviewed Dr Toby Fogg, the author of the airway registry study referenced above, and released it as an audio podcast. The podcast, which contains discussion around the the results of the study plus airway registries in general, RSI checklists, airway skills maintenance, video laryngoscopy, and criciod pressure is here. Minh Le Cong’s podcast page, with references, is here.
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This is Cliff Reid delivering a talk at the 2012 Essentials of Emergency Medicine Conference.
Cliff is a doctor with one or two letters after his name (FACEM FCEM FCRSEd FRCP FCCP FFICM EDIC DRTM DIMC CFEU) who spends a considerable portion of his time as a lead educator for the Greater Sydney Area HEMS.
‘Own The Resus’ is his take on how to be an effective leader in a resuscitation situation. There are some absolute pearls in here – my favourite is ‘fake it till you become it‘!
Enjoy…
A recent concept that has been widely discussed on FOAM sites, as well as at the SMACC conference, is The Vortex (pdf)
The Vortex is a simple cognitive aid that can be used in the setting of an unanticipated difficult airway. Conceived by Nicholas Chrimes (Melbourne anaesthetist) and Peter Fritz (Melbourne emergency physician), it aims to simply concepts, move away from complex algorithims, and be applicable in multiple settings.
Key to the concept is that the key goal in an unexpected difficult airway situation is alveolar oxygen delivery. Techniques to deliver oxygen (LMA, ETT, face mask) are regarded as equivalent, as any of these, if successful, will move a desaturating patient out of the Vortex into the ‘green zone’ where oxygenation is adequate for a ‘time out’ and alternative planning to occur. At the centre of the vortex is a surgical airway.
Resources regarding The Vortex:
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One of the benefits for ED doctors involved with HEMS is that is gives us a different perspective on our own speciality by observing it from the outside.
During one recent job, I delivered a moderately unwell trauma patient to a trauma centre. The patient was unwell enough to require pre-hospital radio notification and was met by a team in resus. The hospital in question deals with a lot of trauma, and deals with it well.
On this occasion however, the ED was heaving, and on arrvival I got the impression that the receiving team had been cobbled together at the last minute out of all available resources. Everyone looked busy and stressed. There was not a clearly identified team leader. On our arrival, there was a request to get the patient onto the ED bed immediately, although no immediate intervention was required.
The result?
-A flurry of activity –…
View original post 731 more words
Improving care in ED 