Das SMACC Day One
Just a few initial thoughts whilst the first day of Das SMACC is still free in my head!
Pre-Hospital Medicine: The Future is Now: Brian Burns
Trauma is a silent killer with 14,000 killed every day or 5 million a year. As a proud geek I fully approved of the demonstration of technology as a 'meerkat system' to predict severity, POCUS and point of care TEG with drones providing tailored blood products to the scene. Early day yes. Orwellian possibly. Exciting definitely.
Jonathan's Story: Jessica Mason
I'm always looking for new ways of teaching and found the approach by Jess Mason of using a patient story inspiring. She said "remember the story, remember the medicine" as she used the story of a patient of hers with sickle cell anaemia to make an important point: it is a terminal disease and should be treated as such; be kind with analgesia - opioids are the best.
Voices in my Head: Sarah Gray
Do you talk to yourself in the same way you would talk to a patient? Sarah talked about self compassion, an area of interest for me as my masters dissertation looks as mental health and resilience. This may be the subject of a future blog as she recommended the site selfcompassion.org as a window into our emotional health. Asked the audience to put their hand in the air and then lower it down if we knew someone who had died of suicide, suffered depression or self-harm. One hand out of 2500 was left in the air at the end... Don't burn out!
“Everything” at the End of Life: Alex Psirades
It's a fact that all medical students are trained in CPR but not in how to discuss DNAR. There were powerful reminders that as healthcare workers we all share the same ultimate fate of our patients: our mortality. Even with improvements in medicine the mortality rate in the 21st century remains the same as the 17th. Alex mentioned optimism bias and how as clinicians prognostication of terminally ill patients actually worsens as we know them more as people. He highlighted the HHHHHMM scale used in veterinary medicine which I think actually has some transferability to human patients.
The Problem with Physiology: Rinaldo Bellomo
"Today's medicine is tomorrow's derision" Rinaldo highlighted the problems of physiology with example discredited practices such as Early Goal Directed Therapy, replacing albumin, replacing Protein C or prophylactic craniotomy. More biases here - attribution bias & immediacy bias. That fluid bolus you gave to correct your patient's BP? In 20 minutes it will be back to baseline. Mad Physiology leads to Mad Medicine.
Four Tragic Dog Deaths: Lessons in Program Design and Development: Resa Lewiss
A good look at programme design with the four pillars I recognised from DREEAM: Clinical Excellence, Education, Research and Administration. Resa used the deaths of four of her childhood dogs as examples of how a project may die: Cancer - a slow, insidious killer such as a cultural or personnel issue, Homicide - someone outside comes along and pulls the plug, Suicide - something you do kills your project and Old Age - your project fails to adapt and grows old and gets passed by. Powerful and like all good presentations memorable.
Endocarditis will also f&*k you up: David Carr
Endocarditis. There is a 1% risk per year of endocarditis for patients with valve replacement. The risk is 1-2% in intravenous drug users. There thrombotic non-bacterial endocarditis: marantic endocarditis seen in malignancy and anti-phospholipid syndrome related endocarditis seen in lupus. 95% will have fever. 90% will have a murmur. To think of it as 'fever plus one'. Fever plus stroke in the young - usually MCA infarct - should make us think endocarditis. Fever plus back pain (osteomyelitis suggest haematalogical spread of the organisms which can also cause endocarditis). Fever plus heart failure (especially if there is no history of CCF - 'virgin' heart failure. Failure plus arrhythmia. (First degree heart block may be boring but suggests pervalvular abscess). Only 5% will have peripheral stigmata such as Janeway lesions or Osler's nodes - I'm going to have to change my teaching. Far more important is to look in their mouth, dental work in the preceding fortnight is suggestive and easier to identify than Roth's spots.
Plenty to discuss in the future. For now I hope you enjoy reading. Off to upload the podcast!
- Jamie