Jellybean 77 Paul Middleton chats with RollCageMedic

LITFL • Life in the Fast Lane Medical Blog
LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog

In Australia alone thousands of people have an out of hospital cardiac arrest each year. Only 10% survive. It’s a very scary and dangerous rollercoaster. No better place to talk about that than under a real roller-coaster under the Sydney Harbour Bridge with Paul Middleton.

Matt went to Luna Park in Sydney a few weeks back. Not to ride the roller coaster nor knock coconuts off their stands for a teddy bear, but to attend the Resus@ThePark conference. He took a few minutes to sit down outside in the sunshine with Paul Middleton the conference convenor. Of course there was hammering and drilling as some adjustments were made to the Vivid Sydney Festival set up. Which was quite fitting as Paul Middleton (@Scientosis) is building something too. A future in which anyone who has a cardiac arrest in Australia is likely to get effective bystander CPR and defibrillation.

We know this stuff is important. We know that early CPR and defib makes a difference. As a former Australian Resuscitation Council (New South Wales) Chair Paul understands that this is a team sport. A big team. So now he is trying to drive change in the greater community through the charity Take Heart Australia. This means getting almost everyone in the country to realise that cardiac arrest affects everyone and that everyone has a role in helping. Everyone is a responder.

We also know that even as nurses, doctors and paramedics it’s just not that easy to ‘shock’ someone, especially the first time you do it. So whats the first thing Paul needs to do to get 24 million Australians over the fear of stepping in, the fear of electrocuting people? Ask for help of course!

It is no small thing trying to bring about change on a huge scale. This is a public health initiative with parallels with what Mark Wilson is trying to do with the GoodSam App. (See Jellybean 55 with Mark Wilson from SMACCdub) Mark spoke ‘via satellite’ to the audience at Luna Park. Such imaginative approaches are to be encouraged. Or would you rather sit back and wait for a government funded public health campaign to sort it all out? Nothing wrong with a grass roots movement.

Resus@ThePark will be back next year. Check it out.

All Jellybeans are available on iTunes, Stitcher and SoundCloud. Check out the links below.

Big thank you to David Gedge and the Wedding Present with their 1990 version the Cockney Rebel Classic “Make Me Smile” from their Corduroy EP

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Last update: Sep 19, 2017 @ 8:44 am

Jellybean 77 Paul Middleton chats with RollCageMedic
Doug Lynch

Mastering Intensive Care 016 with Charles Gomersall

LITFL • Life in the Fast Lane Medical Blog
LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog

Charles Gomersall – Training junior doctors in the BASIC practice of intensive care

How did you feel the first day you worked in ICU? Was it like walking on the moon? So foreign, because you didn’t understand much about the machines, the techniques, or even the words that were being used. That’s what it felt like for me, all those years ago. Thanks to one of my consultants who really “held my hand” on that first day, I was OK, but I wish I could have completed a BASIC course like most resident doctors in Australia (and many other countries) do today when they start their term in intensive care.

The BASIC course that those resident doctors now complete is mostly due to the efforts of Charles Gomersall. Over a decade ago, he realised the difficulties these junior doctors had in understanding what the Intensive Care consultants were both talking about and doing, so with a bunch of friends he set up BASIC (The Basic Assessment & Support in Intensive Care) course with the aim to teach participants, over 2 days, to rapidly assess seriously ill patients and provide initial treatment and organ support. Topics like airway management, acute respiratory failure, mechanical ventilation, haemodynamic monitoring, management of shock, interpretation of arterial blood gases, transport of critically ill patients, severe trauma, neurological emergencies, oliguria & acute renal failure, cardiopulmonary resuscitation, arrhythmias, nutrition, sedation and analgesia, etc.

This week my guest is Charles who is Professor in the Department of Anaesthesia & Intensive Care at The Chinese University of Hong Kong. In his words, his minor claims to fame are persuading some friends to write the BASIC course and denying a British prime minister entry to a London Intensive Care Unit, and his remaining ambition is to become a professional chef. That’s all he wanted me to say about his background but let me say that having resident doctors rapidly brought up to speed on basic intensive care skills and practice, mostly so that they can feel comfortable at the ICU bedside in their first few weeks, is something I think is hugely valuable, not only to them, but also to me as a consultant and especially our patients. So that makes Charles a hero in my eyes. Of course, BASIC has gone on to now consist of many other courses, which now help up-skill nurses, medical students, advanced trainees, consultants (by providing refresher courses) in many countries, including in the developing world.

So I think Charles is a legendary educator, an inspiring leader and an outstanding clinician. He is softly spoken, humble, unassuming but incredibly well considered. He powerfully helps the patients in his own ICU and dramatically helps patients all around the world by providing BASIC. What a master.

In this week’s episode you will hear all about the BASIC course, how it came to be, and where it is right now in amongst the other work of the BASIC Collaborative. You’ll also hear Charles speak about:

  • How he became both a doctor and an intensivist by accident
  • How difficult it is to objectively judge the value of education
  • The prime importance of putting the patient first in clinical, academic and educational practice
  • Understanding the good and bad that surrounds us in our Intensive Care department culture
  • How ICU specialists are like the hotel concierge of the hospital
  • How paying back the support we received as trainees to our upcoming trainees is vital to the system of ICU education
  • His views on sleep, cycling to work and listening to music
  • The story of being on duty in a London hospital after a train crash people
  • The benefits of communicating humanely to our patient’s families when things are not going well
  • And, how there is compulsory retirement at age 60 in Hong Kong

With this podcast, and the previous episodes, please help me in my quest to improve patient care, in ICUs all round the world, by inspiring all of us to bring our best selves to work to more masterfully interact with our patients, their families, ourselves and our fellow healthcare professionals so that we can achieve the most satisfactory outcomes for all. It would be much appreciated if you could help to spread the word by simply emailing your colleagues or posting on social media.

If you have a comment or a question, let’s engage. Whilst my primary goal is to improve patient outcomes by helping us all get better thanks to the inspiring messages of my guests, I also have the goal of building community through Mastering Intensive Care, so people can share their thoughts and their own skills. So leave a comment (on the LITFL episode page or on twitter using #masteringintensivecare), send me an email at andrewATmasteringintensivecare.com or engage in the facebook page Mastering Intensive Care.

Thanks for listening. Do the best you can for those unfortunate people in our ICUs we call patients, and strive to get better at what you do, whilst looking after yourself.

Show notes (people, organisations, resources or links mentioned in the episode):

Mastering Intensive Care 016 with Charles Gomersall
Chris Nickson

LITFL Review 298

LITFL • Life in the Fast Lane Medical Blog
LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog

LITFL review

Welcome to the 298th LITFL Review! Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chunk of FOAM.

The Most Fair Dinkum Ripper Beauts of the Week

Nick CumminsThe UK Intensive Care Society recently had a meeting focusing on burnout. All the podcasts have been made #foamed- start with this one by LJ Mottram on the evidence for workplace stress in ICU, and read her accompanying blog post. [SO] 

The first podcast from The Don’t forget the bubbles conference is up- listen to Mary Freer talk about compassionate healthcare. [SO]

 The Best of #FOAMed Emergency Medicine

 The Best of #FOAMcc Critical Care

The Best of #FOAMres Resuscitation

  • The Resus Room podcasts explores recent literature on the role of bicarb in cardiac arrest. [MG]
  • This blog on the simple topic of cannula extension sets is thought provoking.  Marginal gains in the resus room can mean the big difference to outcome.  [CC]

The Best of #FOAMtox Toxicology

  • EM:RAP has a FOAM segment this month, exploring dextromethorphan overdose. [MG]
  • Josh Farkas talks us through a case of ketamine tolerance and looks through the evidence behind it.  I’m yet to experience it in my practice.  Are you? [CC]

The Best of #FOAMus Ultrasound

  • What’s the evidence for the 60/60 sign in acute PE? David Slessor discusses the original 2002 paper for The Bottom Line. [SO]

The Best of Medical Education and Social Media

News from the Fast Lane

Reference Sources and Reading List

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Last update: Sep 18, 2017 @ 4:51 am

LITFL Review 298
Marjorie Lazoff, MD