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Art of Resuscitation

Wednesday June 16

Track Chairs

Sara Gray

MD FRCPC

Chris Hicks

MD FRCPC

Dr Gray practices Emergency Medicine and Critical Care at St. Mike’s in Toronto. She loves resuscitation and hates COVID.

Dr Christopher Hicks is an emergency physician and trauma team leader at St. Michael’s Hospital in Toronto. Chris is co-creator and co-chair of resusTO, an inter-professional simulation-based resuscitation conference in Toronto with international acclaim. In 2020, he co-founded Advanced Performance Healthcare Design, consulting with hospitals and industry using simulation to inform the design of systems, spaces and teams.

Description

Resuscitation is an art and a science. Scalpel meets skin, person meets machine, heart races, hand shakes. This session will equip you with the knowledge and skill to manage some of the most pressing crises in emergency medicine, by way of content knowledge and psychological skill. Then we look forward, to building ECMO programs and the future horizon of critical care in the ED.

Learning Objectives

How are you? Mental practice and communication that will keep you grounded in a crisis

What are you doing? Penetrating neck trauma and the art and science of the bougie-assisted cricothyroidotomy

Person meets machine: Ventilation and ECMO in the Emergency Department

Speakers

Soft is the new hardcore: why relationships in resuscitation matter

Together we will apply some theory from organizational behaviour and anthropology to understand why relationships in resuscitation matter. We will learn about some key ways to build relationships, fast, when it matters most.

Learning Objectives

Reflect on why relationships in resuscitation matter…but actually.

Identify a framework to think about what strong relationships look like…moving well beyond communication and collegiality.

Get soft to be hardcore. Deliberately apply simple tools to create strong relationships with any team.

Pearls

Explicitly identify shared goals, shared knowledge about roles, and demonstrate mutual respect using a prebriefing on your next shift.

Keeping your head screwed on: Cut throat cases in the ED

This talk will review ED management of penetrating neck trauma with an emphasis on nuanced pearls and tips and tricks for emergency physicians

Learning Objectives

To review general approach to penetrating neck trauma
To increase comfort with nuanced management of cut throat cases

Pearls

Early airway control
Keep a foley catheter in your back pocket

Resuscitating the TCA Poisoned Patient

Learning Objectives

Review the presentation and management of tricyclic antidepressant poisoning
Describe the indications and limitations for the use of sodium bicarbonate in a sodium-channel blocker poisoned patient.
Discuss resuscitative strategies in the tricyclic antidepressant poisoned patient.

From dream to reality: mental rehearsal for bougie cric

We will discuss how mental rehearsal can help us improve our performance when we are called upon to perform high-acuity low-opportunity procedures such as the bougie assisted cricothyrotomy.

Speakers

ED Mechanical Ventilation 101: Physiological Principles & Basic Troubleshooting

Just intubated a patient in the ED and the respiratory therapist and Intensivist aren’t available? Learn how to manage a mechanically ventilated patient in the ED by developing an approach to initial ventilator settings and basic troubleshooting.

Learning Objectives

Describe the physiological basis of key ventilator settings and waveforms (i.e. Tidal Volume, Minute Ventilation, PEEP)
Summarize an approach to initial ventilator settings in the ED
Develop approach to troubleshooting Hypoxia and Hypercarbia in ventilated ED patients

Pearls

If oxygenation is an issue, assess the PEEP, Tidal Volume, FiO2
If ventilation is an issue, examine the respiratory rate and tidal volume
Remember to order post-intubation sedation on your patients

ED ECMO: State-of-the-art EM or a fool’s errand?

This lecture will describe the planning and logistical framework required for ED-based ECMO initiation for different indications, and will explore the components required at a location to initiate ECMO emergently. We will review team composition, training requirements, and integration of roles within an ED-initiated ECMO program.

Learning Objectives

Gain an understanding of the planning and logistical framework required for ED-based ECMO initiation for different indications
Explore the components required at a location to initiate ECMO emergently
Explore team composition, training requirements, and integration of roles within an ED-initiated ECMO program

STEP UP: The Zero Point Survey

In an organized resuscitation the primary survey is preceded by a series of steps to optimize self, team and environment: the Zero Point Survey

Learning Objectives

Self: Apply specific techniques to achieve a state of psychological wellness, focusing on I’M SAFE
Team: Towards implicit coordination, short and scripted pre-briefings to establish accurate and flexible shared mental models
Environment: Shake off learned helplessness — sighlines, horizontal work surfaces, crowd control and priority patient access can all be facilitated with deliberate resuscitation environment engineering