Neuro Resus

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**Neuro Resus**

Podcasts on topics relevant to intensive care medicine

Latest Episodes:

Raw Science 1: Why Oxygen? Dec 24, 2015

Show notes

Basic Science Clinic by Steve Morgan

Assume nothing, trust no one, give oxygen.

– Anon

Welcome to Basic Science Clinic Raw Science podcast series. In case you haven't being paying attention, science is cool. Indulge your inner geek by joining us on our pursuit of developing an integrated scientific understanding from which you can develop a clinical practice informed by deeper insights and inoculation against magical thinking.

We are going to take an unashamedly convoluted journey from atmospheric gas to the mitochondria and back again, to examine respiratory physiology and hopefully frame the information in a format that helps you on your inexorable march to examination success.

Have you ever asked yourself what is all the fuss about oxygen? In the first two podcasts we are going to address why oxygen is the foundational slab of our hierarchy of needs and how it got here in the first place. It might just give you a renewed appreciation of nature's most vital pharmaceutical.

We would love to hear feedback and we will even take requests from the floor for future subjects. Apologies for any mistakes, we are always happy to learn so corrections are most welcome.

Raw Science Factoids

2 x 1026 molecules of ATP formed daily, or ~160kg from 2500 calories.
At any one time there is 50g of ATP in the body, cells contain ~1 billion ATP molecules, utilize 2 million ATP/s, regenerating ~600 ATP/s.
On average we breath ~400 L O2/day and at rest consume ~350 L O2/day.
Oxygen is the third most abundant element in the universe, and the most abundant by mass in the Earth's biosphere.
Increased solubility is evidenced by the increased density of life in the polar oceans.

Crit Think 1: You Do The Math(s) - Maths & Humans Dec 24, 2015

Show notes

Basic Science Clinic by Steve Morgan & Sophie Connolly

All our knowledge begins with the senses, proceeds then to the understanding, and ends with reason. There is nothing higher than reason.

Immanuel Kant

Welcome to Basic Science Clinic Crit Think. Our Raw Science series is to provide content for the new programs that you are writing for your intracranial wet-wear, Crit Think is the upgrade of your operating system. The study and understanding of the process, structure and potential pitfalls of thought, ie thinking about thinking or metacognition, helps you to integrate the knowledge you are acquiring and then apply it with scientific rigor, making you a safer, skeptical, rational bedside empiricist. Create the good habits of data seeking and analytics to emulate the best consultants, with their granular, high fidelity knowledge and their near preternatural ability of pattern recognition that leads to the right intervention just in a nick of time.

This series will include mathematics, what latin is to language, maths is to science. Without maths there is no science; and go on to cover: logic, reasoning and logical fallacies; the art of clinical decision making, heuristics, cognitive biases; educational theory; introduction to ethical principles. In the informational age, with ready available knowledge on the end of a digital swipe, there is an even greater imperative that in your nascent development as a clinician you consider these key components of the structure of your most potent, yet potentially deceptive tool, for knowledge application and making critical decisions over seconds to minutes that may be life-saving.

Basic Science Clinic Podcast Intro Dec 24, 2015

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Paul Young on SPLIT, HEAT and Platform Trials Oct 19, 2015

Show notes

Paul Young is the man of the moment.

In one week has has published the SPLIT trial in JAMA, the HEAT trail in the NEJM and presented both at the ESICM conference. Platform Trials.

In this interview Paul discusses The SPLIT Trial - the first trial to substantially look at buffered crystalloids vrs saline and now really paves the way for a definitive trial in this area.

He answers some questions that have been asked such as was the volume of fluid sufficient to demonstrate an effect, why PlasmaLyte was used and what he’ll be doing following these results.

HEAT is a much anticipated trial looking at the effect of early administration of acetaminophen to treat fever due to probable infection. This intervention did not affect the number of ICU-free days. Paul captured out imagination on this topic with a talk at SMACC in 2013 and now the dialogue really begins. We discuss where to go from here on this topic that often stimulates passionate debate…

Finally we discuss Platform trials and how they will save the world. This was topic of a talk Paul gave in Chicago which will be released soon. Read this fascinating paper by Berry Connor and Lewis for a real insight into the hot topic.

Leo - Powerful Presentation Sep 13, 2015

Show notes

Grace Leo shares her cornerstones for developing a powerful presentation: passion, purpose and practice. In this workshop talk from smaccGOLD, she also provides tips and strategies to turn an average presentation into one with style. For the full post, please see www.intensivecarenetwork.com

Disaster Planning for Dummies Sep 03, 2015

Show notes

A personal story of cyclone Yasi

The beginning of 2011 was an extraordinary period for natural disasters in our part of the world. It began with the floods in South East Queensland, then Cyclone Yasi, the Christchurch earthquake and finally the Japanese tsunami.

The evacuation of the Cairns Hospital in less than 24 hours is one of the great success stories for Emergency Services in Queensland. It is even more extra-ordinary when one realizes there was no formal evacuation plan for Cairns Hospital in place. Many health professionals put aside their personal welfare and concerns for their own homes to ensure that 320 patients were evacuated without a single fatality. Special mention should be made of those that weathered the Category 5 winds (over 250 km/hr) in the stand-alone basketball stadium that served as the ‘hospital’ for 250,000 people post Cairns Hospital shutting down.

This presentation by Dr Sean McManus outlines an exhausting 96 hours. Firstly managing the evacuation of ten ventilated patients from the Cairns Intensive Care Unit, then packing up his house and bunkering down for the storm and then finally dealing with a critically unwell 5 month old with complex cardiac pathology.

“Polepole”, the Swahili motto for climbing Kilimanjaro is a consistent theme throughout the presentation. Translated as ‘steady, steady’, it means just keep taking little steps until you reach the summit and don’t let the enormity of the mountain overwhelm you.

Bloody Anticoagulants Sep 02, 2015

Show notes

Bloody Oral Anticoagulants – BCC talk 2014

The use of the New Oral Anticoagulant Drugs present unique challenges for the Intensive Care practitioner

1. The NOACs now have PBS approval for non-valvular AF, below knee DVT, DVT prophylaxis and low volume PE

2. There is no specific antidote for NOAC related bleeding but don’t despair there are some things that can help

3. Routine coagulation testing does not reflect drug levels or anticoagulation activity

Global sales of Dabigatran topped $1billion in 2012.

This talk outlines the pharmacodynamics and pharmacokinetics of the NOACs. Limitations and cautions of use are outlined with a review of the extensive literature. Clinical cases involving the NOACs are presented. The timing of stopping the agents before minor or major surgery, the approach to a patient with intracranial haemorrhage taking oral anticoagulants and the challenges faced when patients have an Acute Kidney Injury whilst taking these

Neuro-Trauma Aug 29, 2015

Show notes

Neurotrauma – How to Put Humpty together again

Humpty is a 23 year old egg, who fancied himself as a bit of a Hipster. Little did poor old Humpty know that his day was about to end in tears and he was to join the 1000 other Australians who annually have a severe head injury.

The talk focuses on Traumatic Brain Injury. There is particular emphasis on Traumatic Subarachnoid Haemorrhage and Transfusion Thresholds in Traumatic Brain Injury.

The discussion explores the incidence and patterns of vasospasm following tSAH and the role, if any, of nimodipine and other therapies usually reserved for the aneurysm SAH population

The optimal target haemoglobin concentration following TBI is unknown. The discussion looks at the literature and explores the pathophysiology of anaemia in this setting. A blood conservation strategy for patients with TBI is outlined

Penetrating Injuries to the Neck Aug 27, 2015

Show notes

Penetrating injuries to the neck is a great summary of how to assess and manage neck wounds from lacerations to the airway to gunshot wounds. The talk covers relevant anatomy, the zones of the neck and how to investigate vascular, tracheal and oesophageal injuries. A comprehensive understanding of the relevat anatomy is essential to recognising associated injury patterns. The improvements in the accuracy of helical CTA scans has meant that the delineation of the zones of the neck has become less relevant to the further investigation and management of pemetrating neck wounds. Oesphageal injuries remain difficult to detect and require a high level of clinical suspicion to identify these.

Feeding in ICU: A Trickle or a Torrent? Aug 27, 2015

Show notes

Feeding in the Intensive Care - A trickle or a torrent, is a great summary of several key critical care nutrition trials and how we can apply the evidence from these to the ICU patient. Providing adequate nutrition to patients in the intensive care is an extremely complex therapy that must be carefully titrated on a daily basis. The evidence for how to provide nutrition to critically ill patients is largely lacking and what evidence there is is often contradictory. In this presentation I will look at four feeding trials conducted in the ICU setting and published over the last 3 years. While the results are somewhat conflicting, there are lessons from each that we can apply at the bedside.

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