SMACC

Sarah Yong is an impressive person. Advocacy, Training, Representation and being a new fellow of the College of Intensive Care to boot.

Theres a lot to talk about when you sit down with Dr Sarah Yong. Let’s make it easy by focussing on three big issues;

Gender issues; Women in Intensive Care Network. www.womenintensive.org

Training issues; The Critical Care Collaborative and the Victorian Primary Examination Course for CICM. www.vpecc.com

Representation issues; New Fellows Rep on the Board of the College of Intensive Care Medicine. www.cicm.org

Where to start?

Women in Intensive Care Network www.womenintensive.org @WomenIntensive

If my sources are correct there pretty much the same number of women and men out there in the world. Further it seems that there are roughly the same number of women and men presenting to intensive care units. This pattern does not repeat itself in terms of the Intensive Care doctors.

Let’s talk about this. Let’s listen to the people that are raising awareness about this. The Women in Intensive Care are talking about it and publishing about it too. You may have heard about the Medical Journal of Australia article; “Female representation at Australasian specialty conferences”.

Rapid Sequence Airway (RSA) involves the same preparation and pharmacology as RSI with the immediate planned placement of an extraglottic device (EGD) instead of intubation. Like DSI, RSA is an alternative airway management strategy that may be ideal for preoxygenation of hypoxemic patients as well for prehospital and in-flight use. Depending on the chosen EGD, RSA can facilitate gastric decompression, positive pressure ventilation with PEEP delivered by a ventilator and endoscopic intubation. The speaker presents the evolution of this novel concept in New Mexico, reviews their clinical experience with RSA in both the prehospital and hospital settings and assesses the available literature.

Becoming competent in airway management requires good decision making and and technical skills. Ultimately what matters is how your clinical performance impacts patient outcomes. For this we need to have a clear understanding of what defines success ensuring that its more than just 'getting the tube'. Come to this talk and you'll experience a Canadian take on Guinness, adventure sports, flying a plane and how other factors including failure influence airway management outcomes.

Airway management is a fundamental responsibility and skill of all involved e.g. emergency physicians , anaesthetists and critical care physicians. We need airway algorithms because there is still severe morbidity and mortality related to airway management. (NAP 4 study, ASA Closed claims series)

The 2015 Difficult Airway Society guidelines, published in the British Journal of Anaesthesia in December 2015, provide a sequential series of plans (A to D) to be used when tracheal intubation fails. They are designed to promote patient safety by prioritising oxygenation and minimising trauma and they highlight the role of neuromuscular blockade in making airway management easier.

The guidelines recognise the difficulties in decision making during an emergency and stress importance of human factor training. The guidelines include steps to assist the anaesthetic team by providing a common stem of options (a simple algorithm) for maintaining oxygenation, limiting the number of airway intervention attempts, encouraging declaration of failure by placing a Supraglottic Airway Device and overtly recommending a time for stopping and thinking. They emphasise the importance of considering discontinuing anaesthesia and waking the patient up (if appropriate) when tracheal intubation has failed.

Videolaryngoscopy and second generation Supraglottic Airway Devices are recommended and all anaesthetists, intensivists and emergency medicine physicians, should be trained to use them. There is however limited evidence available relating to the management of the can’t intubate can’t oxygenate situation (CICO) PLAN D. However it is strongly recommended that all anaesthetists must be trained to perform a surgical cricothyroidotomy and a standard operating procedure for Front of Neck Access to the airway is described using a “scalpel bougie tube” technique.


Learning Objectives
• Importance of optimal preoxygenation.
• Best technique at laryngoscopy.
• Maximum of 3 attempts at laryngoscopy / intubation.
• Maximum of 3 attempts at placing a Supraglottic Airway Device.
• When tracheal intubation fails, waking the patient up is almost always the safest option.
• All practitioners involved in airway management need to learn the “scalpel bougie tube” method of cricothyroidotomy.

In the past two decades, airway management has been revolutionized by the development of video laryngoscopy, hyperangulated blade geometry, optical stylets, laryngeal masks, and a host of advances in airway pharmacology and technique. The core skill of airway management, however, remains laryngoscopy, whether or not the operator uses a blade with a camera at the end. In this presentation, we break down laryngoscopy into its discrete components and describe best practice technique at each step. We will start by describing common mistakes made in patient positioning; proposing a set of parameters the provider can use to guide positioning that is optimal for laryngoscopy, including the configuration of the patient in the bed, the bed height and head elevation, as well as provider stance. We then move into the effect of laryngoscope grip on operator catecholamine management and describe the optimal laryngoscope grip for emergency airway management. We next confront one of the core principles of RSI, the delay between medication administration and commencement of laryngoscopy, and propose an alternative approach that emphasizes early laryngoscopy with deliberate slowness. We turn our attention to the value of the jaw thrust–as performed by an assistant–during airway management, and then move into a step by step analysis of laryngoscopy as the blade moves into the mouth, down the tongue and ultimately to the glottis. We espouse suction as an underutilized device by emergency providers, and describe the two most important intra-laryngoscopy optimization maneuvers: optimization of the position of the head, and optimization of the position of the larynx. We discuss the value of using the gum elastic bougie for both difficult and routine intubations and describe pitfalls encountered when using the bougie (and how to manage them). We conclude by describing the 3-finger tracheal palpation method of endotracheal tube depth confirmation.

Delivering a presentation is a skill like any other yet few folk are actually develop this skill they merely copy those they observe and reach the same level of mediocrity. There is more to a presentation than your slides. The p cubed concept gives an understanding of presentation design that will change your presentations forever.

Musical genius Suman Biswas (@amateursuman) gave one of the most popular talks at SMACCDUB: A Prick with a Needle. The Anaesthetist from London, probably more famous for his satirical songwriting career, gives a poignant talk about communication.

Punctuated with some classic songs and delivered with his stand-up comic timing and panache, this is what SMACC is all about: an important message that could change your practice, delivered in a unique and unforgettable way.

Language warning.

We accept that knowledge translation is critical to the practice of emergency medicine, yet when it comes to the practice of BEING an emergency physician, we do always practice evidence-based medicine. We realized that the experiences of many female emergency physicians were similar but not shared, so we created an open access resource to address that. FemInEM was born out of the real but unfortunate truth that the gender pay gap is alive and well, and promotion of women through the academic pipeline is slow and women still experience unconscious bias at all levels of development. Malignant behavior runs rampant within medical training, and women are disproportionately affected by this reality. In addition, balancing work life and home life can pose extra challenges, especially for women. Numerous studies have shown even when working full time, women often carry more of the “care based” workload for home and family, compounding the “work-life conflict” felt by physicians regardless of gender.

We will share the journey of how FemInEM began as a blog but evolved quickly into a centralized resource for women needing advocates and champions. We will tell stories of how we are helping to change the conversation related to gender and equity in EM by highlighting the successful practices and programs in an open access format. By using the principles of FOAM and the power of social media, we are trying to move the needle on gender and medicine in a way that hasn’t been done before.

More than a hundred years ago Osler moved medical education to the bedside. Somehow today, most medical education still takes place in the lecture hall far away from patients.

Medical education is often thought of as a top to bottom process where experienced professors and clinicians provide information and feedback to novice learners, with the goal of increasing knowledge and adjusting behavior.

This approach to medical education can be effective, but may also only provide situational learning making what is learned in school today, outdated tomorrow.
Creating an environment where students can learn reflective practice that can evolve with them as they move from novices to experts may prevent situational experts and facilitate expert performance.

The continuous changing nature of modern healthcare also demands that students from an early educational age are provided with the skills needed to learn, work and adapt within a continuously evolving environment. These skills aren’t traditionally taught in medical school as learning in context is limited.

Therefore, the future of medical education should focus on helping students develop the skills needed to become their own learning choreographers who take responsibility for their own education, not only as students but also as lifelong learners as part of their continuous medical education.

The purpose of the talk is to answer some of the question that may arise when you allow medical students to choreograph their own education. How this process can be started with you as the educator, and can be done without compromising patient safety and maybe even improve patient outcome.

Caring for the critically unwell is an important and difficult task. So preparing our people to meet this challenge should be all about excellence.

Too often, the structures and pressures that define medical training focus on competence rather than excellence. Competence is measurable. It can logged, assessed, and can be applied to across big organisations. But aspiring only to competence limits us - our patients need more. So can we learn from how other high-performance organisations train?

For Olympic teams, aiming for competence just isn’t good enough. These organisations develop their athletes over many years - equipping them, ready to deliver an excellent performance under pressure.

Successful coaching relationships operate on an individual level. They are long-term. They are flexible. And they are measured not by exams or assessments, but by whether the person being coached can perform in the real world.

Should you be thinking about being a coach rather than a trainer? And how can we move our focus from competence to excellence?

This talk will explore three aspects of high-performance coaching which have relevance for clinical educators:
⁃ Goal setting and commitment
⁃ The value and limitations of marginal gains theory
⁃ Self-compassion as a tool for achieving excellence.