Sunday, May 26, 2019 • 13:00 - 14:30
Track 4 - Critical Care
Track Chair: Dr. Laurel Murphy
Room: 201

The Physiologically Difficult Airway - Intubating a Sick Person Without Making Them Sicker - Dr. Osama Loubani

Description: When we intubate, we often focus on getting a good view of the airway and making sure the tube gets in the trachea. But if we don’t pay attention to the patient’s physiology – BP, CO2, pH and thoracic pressure – we might make a bad situation even worse.

Learning Objectives

At the end of this presentation, participants will be able to:

  1. Recognize physiologic changes that occur during intubation and how they can exacerbate critical illness.
  2. Describe interventions to mitigate physiologic changes that might precipitate worsening in the patient’s status during intubation.

Pearls

  1. However bad things are before you start, you can make them worse if you jump in too quickly. Take your time, have a plan for managing BP, pH and CO2 for intubation.
  2. Start pressors before you intubate critically ill patients. Whatever you give them, their pressure will drop – be prepared.
  3. If the patient has a low pH before intubation, it will get worse during and after intubation. Try to normalize pH as best as you can before starting.

I am an Emergency Physician with a fellowship in ICU. I split my time between the emergency department and intensive care in Halifax.

Organ Donation in the ED - When You Can't Save One, Save 8 - Dr. Jennifer Hancock

Description: Organ donation is a tremendous gift that provides life saving opportunities for thousands of Canadians each year. Timely identification and referral is the first step in the process, yet many front line clinicians are uncertain as to who is a potential donor and how to refer once identified.

Learning Objectives

At the end of this presentation, participants will be able to:

  1. Understand the importance of Emergency Physicians in the donation process.
  2. Identify potential organ donors.
  3. Describe the Emergency Physician’s role in supporting the potential donor and their family until referred to an ODO.

Pearls

  1. Emergency Physicians are often the first point of contact with potential donors and their families, and as such are integral players in the donation process.
  2. There are many things that can be done in the Emergency Department to help with the success of the process.
  3. Your Provincial Organ Donation Organization is a skilled resource available to provide support at all times.

Associate professor, Department of Critical Care Dalhousie University. Area of interest: Organ Donation, medical education and team resiliency.

Approach to Refractory Shock - Dr. Ehab Eshtaya

Description: You filled the tank and started pressors but your patient is still hypotensive. Now what? An overview of how to navigate through patients with refractory shock.

Learning Objectives

At the end of this presentation, participants will be able to:

  1. Understand the main variables that contribute to refractory shock.
  2. Outline an approach to navigate through causes of refractory shock.
  3. Identify management strategies for patients in refractory shock.

Pearls

  1. Bedside echo is a fundamental tool to the approach to refractory shock.
  2. If filling the right heart with fluids does not translate to filling the left heart then more fluids is not the answer.
  3. Consider antidotes to potential toxicological poisoning in undifferentiated refractory shock.

Haligonian living out west! Studies medical school at Dalhousie University. Completed residency in Emergency Medicine and Critical care at the University of Alberta.

The Psychology of Resuscitation - Dr. Sara Gray

Description: We will discuss how simple psychological skills and training can help us take our resuscitation performance to the next level.

Learning Objectives
At the end of this presentation, participants will be able to:

  1. Review basic techniques for modulating stress.
  2. Discuss how to incorporate these techniques in your busy shift.

Pearls

  1. These simple skills can help you with any challenging situation, including a resus, a difficult conversation, or a high-risk procedure.

Dr. Gray is cross trained in Emergency Medicine and Critical Care, she practices in both areas at St Michael’s Hospital in Toronto. She is the St Mike’s co-director for ED wellness, and the Vice Chair of the CAEP Wellness Committee.

Old Salty Is Not Your Friend: The Case Against Normal Saline - Dr. Rob Green

Description: Is there anything worse than another lecture on “crystalloids vs. colloids”? Forget that, colloids suck; end of story. But what about that drug that EVERY sick patient receives: NORMAL SALINE. Is Salty our friend? We say NO.

Learning Objectives

At the end of this presentation, participants will be able to:

  1. Review why normal saline has (until now) been the standard resuscitation fluid for EM.
  2. Discuss alternatives (and rational) for the use of other intravenous fluids in critically ill EM patients.
  3. Outline the “new normal” intravenous fluid resuscitation paradigm.

Pearls

  1. Over-resuscitation with crystalloids is a real thing.
  2. Acidity (and how much chlorine) matters in patients that require fluid resuscitation.
  3. In sick, hypotensive patients, fluids and vasopressors are best friends.

Managing TBIs with Confidence - Dr. Laurel Murphy

Description: Traumatic brain injuries are one of our sickest and scariest patient populations. Our management in the Emergency Department can impact the long-term outcome of these patients.

Learning Objectives

At the end of this presentation, participants will be able to:

  1. Recognize the importance of maintaining normal physiologic parameters.
  2. Describe an approach to the blood pressure management of these patients.

Pearls

  1. Consider the TBI airway to be physiologically difficult.
  2. Reverse anticoagulation.
  3. Time is of the essence.

Laurel Murphy is an assistant professor of Emergency Medicine and Critical Care medicine at Dalhousie University. She is involved in medical education at the undergraduate and postgraduate levels, and her clinical interest is in neurocritical care.