“My Mental Toughness Manifesto” – The Talk

I recently spoke at the fantastic AGN 2018 conference in Graz, Austria. My talk was a slightly modified version of “My Mental Toughness Manifesto” presentation.

The talk was live streamed, and a youtube video has since been uploaded (see above).

It’s been quite a journey getting to this point. The blog posts, podcasts and talks I’ve given about my experience working in Khayelitsha have become a huge part of my career, and I owe Sa’ad Lahri and his team an enormous debt. It will always be the most important professional experience of my life.

It started off with this blog post covering my initial reflections on the experience.

That led to an invite to speak at ICEM 2016, where I delivered the first iteration of the talk which has evolved into “My Mental Toughness Manifesto”. The original title was “Lessons From the Western Cape”. Professor Simon Carley was in the audience, and we recorded this podcast after I spoke that day.

That podcast led to a follow up guest blog post for St.Emlyn’s – “An Englishman in South Africa” – which I’m proud to say is one of their most popular posts to date.

Since that St.Emlyn’s post dropped things have escalated somewhat. I have now spoken on the topic of performance psychology all over the UK to a wide range of audiences including foundation and core trainees, GPs, anaesthetists, military medics, prehospital docs, Hospital Grand Rounds and senior educators at Health Education England. I’ve also spoken at international EM conferences in South Africa, Germany, Denmark and now Austria.

My proudest achievement is delivering an extended version of “My Mental Toughness Manifesto” at the International Special Training Centre in Pfullendorf, Germany, to a group of Special Operations soldiers from nations across NATO. The guys I spoke to were all training to be Combat Medics. I first went over in January 2017, and was honoured to be invited back earlier this year. That experience prompted me to write four accompanying EMJ blog posts:

“My Mental Toughness Manifesto” Part 1: Cognitive Appraisals

“My Mental Toughness Manifesto” Part 2: PRACTICE

“My Mental Toughness Manifesto” Part 3: PERFORM

“My Mental Toughness Manifesto” Part 4: PROCESS

This journey will continue. I will always be a student of performance optimisation and acute stress management in the context of delivering acute healthcare. The content of my blogging will keep mirroring those interests in the years to come.

I would like to take this opportunity to thank those who have helped me get to a point in my career where I am being invited to speak regularly on a topic I am truly passionate about. To have my session at in Graz live streamed (AND live translated in German!) was a huge bonus. In particular I’d like to thank Simon Orlobb for the invitation to speak in Graz, my mentor Simon Carley, and of course Sa’ad and the team at Khaye. I should also mention James Kingston and Jocko Willink as their incredible work is featured in the talk.

Exciting times.

Robert
@PonderingEM

Best Of: Finding Rib Fractures On Chest X-Ray

A lot of people have been viewing and requesting this post recently.

Here’s a neat trick for finding hard to see rib fractures on standard chest xrays.

First, this is not for use with CT scans. Although chest CT is the “gold standard” for finding every possible rib fracture present, it should never be used for this. Rib fractures are generally diagnosed clinically, and they are managed clinically. There is little difference in the management principles of 1 vs 7 rib fractures. Pain management and pulmonary toilet are the mainstays, and having an exact count doesn’t matter. That’s why we don’t get rib detail xrays any more. We really don’t care. Would you deny these treatments in someone with focal chest wall pain and tenderness with no fractures seen on imaging studies? No. It’s still a fracture, even if you can’t see it.

So most rib fractures are identified using plain old chest xray. Sometimes they are obvious, as in the image of a flail chest below.

But sometimes, there are only a few and they are hard to distinguish, especially if the are located laterally. Have a look at this image:

There are rib fractures on the left side side on the posterolateral aspects of the 4th and 5th ribs. Unfortunately, these can get lost with all the other ribs, scapula, lung markings, etc.

Here’s the trick. Our eyes follow arches (think McDonald’s) better than all these crazy lines and curves on the standard chest xray. So tip the xray on its side and make those curves into nice arches, then let your eyes follow them naturally:

Much more obvious! In the old days, we could just manually flip the film to either side. Now you have to use the rotate buttons to properly position the digital image.

Final exam: click here to view a large digital image of a nearly normal chest xray. There is one subtle rib fracture. See if you can pick it out with this trick. You’ll have to save it so you can manipulate it with your own jpg viewer. 

Related posts:

Source: http://thetraumapro.com/2018/04/24/best-of-finding-rib-fractures-on-chest-x-ray/

Case Report: Pregnancy and Trauma in the Game of Thrones

This is the 3rd Episode of the Game of Thrones Case Series. Be sure to also review Hypothermia and Traumatic Arrest in the Game of Thrones and Toxin-Induced Cardiac Arrest in Game of Thrones. Patient Presentation and History During the wedding of Edmure and Roslin, a young pregnant woman of unknown gestational age was found unresponsive with multiple abdominal stab wounds on the floor of the great hall at The Twins. Lord Frey allegedly planned ...

The post Case Report: Pregnancy and Trauma in the Game of Thrones appeared first on CanadiEM and was written by Will Wu.