dasSMACC – Day #1
Tempodrom in Berlin, Germany
Day #1: June 27th, 2017
Brian Burns started the conference off by discussing the future of prehospital trauma care:
- Trauma kills 5 million/year and predicted to be 8 million/year by 2020
- Trauma is the number one killer of people <40 years of age
- 1/4 of trauma deaths in the world are due to motor vehicle accidents
- 90% of prehospital trauma deaths are due to bleeding
- Future of prehospital trauma:
- Early warning systems – Automated response technology in vehicles
- Real-time patient data from biosensor watches and kinematic data from vehicle
- Point of care TEG – Blood products could be dispatched with drone technology to trauma scene to initiate prehospital massive transfusion protocol
- Remote site POCUS interpretation
- Avoiding communication blackout with trauma center receiving live data as medics extricate via telemedicine
Jess Mason relayed the story of one of her patients, a former EMT, that succumbed to Sickle Cell Disease:
- Medical education mixed with the human condition = narrative medicine (i.e. The patient becomes the teacher)
- If you remember the story, you will remember the medicine
- Sickle cell disease is a terminal condition, not unlike metastatic cancer
- Life expectancy for these patients is only into the mid 40s
- Give early IV analgesia
- Know how to convert different types of narcotics so you don’t under or overdose your patient
Sara Gray gave a talk giving us permission to be kind to ourselves when things don’t go as expected:
- The voices in your head are critical and judgmental
- Our culture of silence is killing us. Not talking about our fears and anxieties can lead to anxiety, depression, burnout, and ultimately suicide
- Self-compassion has positive physiologic effects
- Self-compassion is a resuscitation skill that need s to be practiced
- Have a failure friend = a go to person you can talk to when you make a mistake
- Your emotional/psychological state can influence your performance during critical events
- Calling for help is not a sign of weakness. Knowing when to ask for help is an important skill
- Great resources for this are located at www.selfcompassion.org
- Take Home Message: Listen to your inner dialogue, practice better self talk, and have empathy toward others
Alex Psirides spoke on “Doing Everything” at the end of life:
- Talking about dying does not lead to death, just as talking about sex does not lead to pregnancy
- Beware of optimism bias. We often overestimate the benefits of what we can do and deliver, but underestimate the potential harms
- Give your patients the death you would want
- Remember to provide maximal care to your patients, whether you resuscitate or you palliate
Rinaldo Bellomo dropped some fantastic points on general patient care and faulty thought processes:
- The biggest threat to understanding is the illusion of knowledge
- Doctors suffer from physiologic seduction. We always try to make everything normal, but this may actually cause more harm to patients
- Human beings are perfectible, but not perfect
- “It ain’t what you don’t know that gets you into trouble. It’s what you know for sure that just ain’t so.” Mark Twain
- In reference to the publication of bad research: The amount of energy necessary to refute bullshit is an order of magnitude bigger than to produce it
- We make the measurable important, but we don’t make the important measurable
David Carr gave a brilliant talk in an effort to make endocarditis “sexy”:
- Valve replacement (mechanical or animal) patient’s risk of endocarditis increases 1% per year.
- Other at risk populations for endocarditis: IVDU (obviously), cancer (especially adenocarcinoma), and lupus
- Fever + 1 should lead you to look for endocarditis
- + Stroke
- + Back pain
- + Heart failure
- + 1° AV block (high risk for perivalvular abscess)
- Up to 95% of endocarditis patients have fever
- Up to 90% of endocarditis patients have a murmur
- Coagulase negative Staph aureus is the 2nd leading cause of endocarditis (25%) in valve replacement patients
- Get 3 culture sets, from 3 different locations, one hour apart
- Empiric treatment for endocarditis = Vancomycin + Rocephin
Paul Young then gave a very though provoking talk on the current state of research:
- P values suck…instead we should be thinking about probability and use a Bayesian model in interpreting research
Image from HERE
- The fragility index is a useful tool to help assess usefulness of randomized trials
Marcelo Amato was the lead author on the paper introducing driving pressure in ventilated patients with ARDS:
- Size of tidal volume is not important, it is the pressure generated that leads to lung injury
- Targeting tidal volume is a “one-size-fits-all” approach. It is not right for every patient
- Driving pressure = Plateau pressure – PEEP
- Decrease in driving pressure is directly proportional to increase in survival in ARDS
- Link to New England Journal of Medicine 2015 Publication HERE
Michelle Johnston sent a backdoor shot to thrombolytics for stroke by saying we really don’t know how it works and called for more specific treatments for clot removal:
- The treatment of choice for bleeding after giving tPa is cryoprecipitate
- Other choices include platelets, fresh frozen plasma (not enough factors), and prothrombin complex concentrates
For More on This Topic Checkout:
- Simon Carley at St. Emlyn’s: #dasSMACC Day 1 With St. Emlyn’s
- Lauren Westafer & Jeremy Faust at FOAMCast: #dasSMACC – Endocarditis, Statistics, & Sickle Cell
Post Peer Reviewed By: Salim Rezaie (Twitter: @srrezaie)
The post Lessons Learned and Take Home Messages From dasSMACC – Day 1 appeared first on REBEL EM - Emergency Medicine Blog.