SMACC Day 2

So day 1 was pretty phenomenal and day 2 certainly has a lot to live up to, again it was impossible to catch all of the great talks due to so many superb concurrents but here is a taster of some of the sessions…..

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‘When to stop resuscitation’ from Roger Harris and followed on from Cliff Reid’s talk from last year on ‘when not to stop resuscitation’. Roger talked about the difficulty of deciding when to stop resuscitation and the debatable injustice of this extraordinary care we give some patients when that money could be better spent on a greater number of patients for the greater good.

He gave 3 take home points

  • Its much easier to start ECMO than it is to stop it
  • Human life is incredibly precious and time helps us make decisions and show us a way forward
  • Keep your passion for resuscitating patients but also channel that passion into stopping resuscitation with dignity

Sarah Gray ‘Optimising Critical Care in the Emergency Department’ and bringing upstairs care downstairs.

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Sarah spoke about ‘geography being destiny’ and that we need to challenge this with regards to the care patients get in ED as compared with ITU. She spoke about how this maybe due to time, equipment or skill set/experience. She set about giving us some superb ideas and goals for how to achieve upstairs care downstairs, this was her top 10

  1. Spend 10 more minutes than you normally would at the bedside of your sickest patients – this time will matter and will make a difference. TIME WELL SPENT
  2. Create a algorithm/checklist for people who are not yet experts
  3. Make an ITU friend
  4. Have joint ED-ITU team meetings
  5. Train as team
  6. Track your quality data and feed it back to your team as an ongoing basis-watch your quality of care increase as your EM staff compete to drive for the best care
  7. Hire an ED intensivist and bring them into your departmental evolution and patient care
  8. Make a resuscitation fellowship
  9. Have MET teams help us with our patients in ED, use their experience
  10. Build an ED ITU that have staff dedicated to ITU care only in ED-put it in your 5 year plan

Mike Winters ‘Don’t Forget A & B‘.

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He spoke about focussing on excellent post resuscitation care and gave the following advice about how to make a significant difference in our post ROSC cases on longterm outcomes.

  • Avoid death by hyperventilation- target normoncapnia

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  • Optimise ventilation and ensure hypoxia

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Sarah Webb, ‘Room Service Resuscitation‘.

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Sarah spoke about rapid response team to critically ill inpatients and that only 9% of the patients they attended ended up with escalation of care to a high dependancy area.

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She spoke about the knock on effects of having a critical care outreach team and concerns that it leads to less involvement on non-critical care staff managing them, in effect deskilling.  Sarah was unable to ascertain is the implementation of critical care outreach improved outcomes but it definitely improved experience, the 5 star treatment!

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The afternoon had the cage matches. First up….

Ian Beardsell vs Brent Thomas debating the value of a social media impact factor

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Brents top 3 points

  • Learners need s way to find them on their own whilst blogs and podcasts are increasing exponentially
  • Authors need an impact factor to award
  • Help researchers identify study population

Ian’s top 3 points

  • Based on a flawed Alexa ranking
  • Based on twitter and followers and social media followers can be bought/irrelevant
  • Popularity does not equal quality

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  • SMI goes against the philosophy of FOAMed

The match was declared a draw by one of Brent’s colleagues  (even though Ian should have won……….)

Danielle Heart vs Chris Hicks ‘Simulation is the greatest thing in education‘.

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Danielle was talking on the pro sides and her main points

  • Practice before seeing real patients and make mistakes their
  • Foacus on areas of weakness
  • EBM starting to appear for positive outcomes following SIM

Chris replied with

  • The EBM covering SIM is low level soft evidence
  • We don’t understand fidelity well
  • Instructors need to step up and increase their quality of instructing before this is the best form of education

Chris was deemed the winner

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Next up was Rob Cooney vs Jonathon Sherwin ‘Assessment in a barrier to learning’.

Rob had interesting method of silencing his opponent….

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He admitted that assessment was important but that assessments in themselves become the goal. Jonathan said that learners need goals in order to know what to aim for, otherwise they wouldn’t get anywhere. He also stated that self directed learning suffered from the unknown unknowns. Finally he stated that society does and should expect clinicians to have been assessed on invasive procedures prior to being set free in the community.

Despite the gaffa tape Jonathan won the match!

The day finished with a superb display of ultrasonography interpretation and practical skills in ‘Sono-Wars‘.

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But without doubt the biggest news from today is the announcement of SMACC’s location for 2016 which will be…………Dublin!! See you all there!

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