Cognition and Decision Making Under Stress

MichaelLauriaDon’t train and prepare until you get it right. Train and prepare until you can’t get it wrong.”

Sydney HEMS is proud to be given permission to share Michael Lauria‘s talk on Cognition and Decision Making Under Stress. Training in medicine and working as a flight paramedic with the Dartmouth-Hitchcock Advanced Response Team, Michael has extensive military combat experience with special forces and is ideally placed to share thoughts and experience on how to prepare for and execute challenging missions.

His five take home points are:

  1. Take a load off
  2. Rally up
  3. Build power
  4. Inoculate for stress
  5. Stay flexible


 

You can download the audio file by right-clicking here

 

If you’d like to see the accompanying slides the talk can be viewed on YouTube

Audio made available thanks to our mate EMCrit

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Extreme Medicine: Everest ER

One of our own Sydney HEMS physicians is an extreme environment and mountain medicine expert – Dr Yashvi Wilamasena. Yash, as he is known to his mates, plans to reach the summit of Everest in the near future. In preparation for this he was there earlier this year. It was, of course, a fateful climbing season when an avalanche claimed the lives of 16 and severely injured 9. Whilst working in the Everest Basecamp ER, Yash, along with Sydney HEMS colleague Dr Jan Trojanowski recorded a series of videocasts that take us through the significant challenges of emergency medicine at 5,000 metres. Here’s the first:

Check out the inspiring Adventure Medic site for more sharp-end-of-the-sharp-end-of-medicine stuff, and where you’ll be able to view the remainder of the Extreme Medicine episodes as they’re published

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Escharotomy Model Mk II

Inspired by Roger Harris and Craig Hore’s escharotomy training video, we have created our own escharotomy model for HEMS physician training.

Our model is based on Roger Harris’ original design with a few minor modifications. With the exception of the arterial line pressure bag, all items were sourced from Bunnings hardware store and the local supermarket. The whole thing takes about five minutes to assemble.

Ingredients:

  • Bone: 4-inch diameter PVC pipe, cut with a hacksaw blade into 50 cm lengths.
  • Muscle: A very cheap cut of steak or chicken breast.
  • Deep fascia: Gladwrap reinforced with a layer of silver duct tape.
  • Subcutaneous fat: 6-8 sheets of thin packing foam (the sort of thing your new TV comes wrapped in).
  • Skin / eschar: White Gaffer tape.
  • An arterial line pressure bag is used to simulate tense, oedematous soft tissues.

Fig 1 – Arterial line pressure bag and PVC pipe

Step 1

Fig 2 – Glad-wrapped piece of meat to simulate muscle

Fig 2

 

Step 1

Wrap the arterial line pressure bag around the length of PVC pipe.

Fig 3

Step 2

Wrap a layer of Glad Wrap around the pipe. This will protect it from being contaminated by the overlying meat layer.

fig 4

Step 3

Using Glad Wrap, bind the “muscle” onto the pipe, ensuring that it lies directly on top of the pressure bag.

fig 5

Step 4

Secure the meat with circumferential straps of silver duct tape.

fig 6

Step 5

Add a longitudinal layer of silver duct tape to simulate the deep fascia.

fig 7

Step 6

Fold the foam packing material around 6-8 sheets thick and apply on top of the deep fascia layer to simulate subcutaneous fat.

fig 8

Step 7 

Secure the foam using the white Gaffer tape, which doubles up as the skin / eschar layer.

fig 9

In this case, a hollowed-out glove box has been used as a base for the model. For greater realism, the limb could be attached to a mannequin.

Step 8

Pump up the pressure bag. This simulates tense oedematous soft tissues and will cause the skin layer to spring apart with a “pop” when incised.

Step 9 

Cut the skin!

fig 10

Step 10

Skin layer can be repaired for re-use by applying additional layers of white Gaffer tape.

 

If anybody has any bright ideas on how to replace the meat layer with something less organic, please comment below!

Escharotomy model MK II designed by Ed Burns, Craig Hore and Cliff Reid based on original design by Roger Harris. 

Links

Chris Nickson’s guide to escharotomy from LITFL

Craig Hore explains escharotomy

 

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CGD 16th July 2014. Everything Sim.

Written by Phil Webster. Posted by Kariem.

EverythingSIMA decade ago simulation was a small part of the learning sphere but in the modern day of medical education it is now becoming commonplace and a somewhat essential part of training. With its embrace, particularly in the field of critical care, comes the evolution of the equipment, science and methodology.

We had the good fortune of having the SiLECT team from Westmead starring Andrew Coggins and Mahesh together with GSA-HEMS’ own sim guru Clare Richmond, providing us with some pearls in how to run simulation and most importantly how to use the de-brief to learn and enquire. Continue reading

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Clinical Governance Day 16th July 2014

Here is the program for 16th July 2014, when we’ll have simulation experts Andrew Coggins and Clare Richmond – both emergency and retrieval physicians with extensive simulation experience – taking us through our paces on how to sim.

CGD Flyer (4)

See here for directions

The following articles are recommended for pre-reading:

Back to the Basics in Medical Simulation: 11 Programmatic Factors from Academic Life in EM

Writing a Medical Simulation Case also from Academic Life in EM

Medical Education – Advocacy and Enquiry In a Nutshell from EmergencyPedia

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VVS is Dead. Long Live Horizon.

See one, do one, teach one: the traditional medical training paradigm. Although we have now evolved to deliver safer patient care than this, the emphasis on visual-methods for learning has been present from days yonder. SEE one.

With the advent of pocketable teaching tools accessible anytime, anywhere, there runs the risk of delivering substandard visual material.

Phone in your hand, educational opportunity in front of you, hold up your phone vertically, press record, share the video, enhance the world of medical education.

To the undiscerning reader, the key flaw to this workflow may be missed. If you shoot your videos holding your smartphone vertically (also known as portrait mode), the video may occupy the entire smartphone screen and be more comfortable to hold the phone, true, but when that video is shared to those who wish to learn from the video, a slim, tall video with black bars either side will completely distract and potentially miss out on the crucial aspects of video footage that you wish to share. And it is annoying. Very. And what happens when you decide to turn your phone mid-filming to actually capture everything that deserves to be captured? Viewers will need to turn their computer screens/laptops/heads sideways to view the footage i.e. the video is unusable.

This is known as Vertical Video Syndrome (VVS) and has plagued the world for years now, despite a concerted campaign to end it.

Enter Horizon. This iOS-only app should be the new standard way of filming our medical education material. Using the iPhone gyroscope, Horizon will ensure that your videos are always shot in horizontal (landscape) whilst recording, even if you rotate your phone to vertical or anywhere in between. It is a clever use of software and hardware that really should be a standard feature of all smartphones. Until it is, we would encourage all users to film their medical educational material using this app. Or film horizontally. And allow your viewers to actually SEE one before they do one.

Sydney HEMS says ‘No’ to VVS.

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Spot Diagnosis!

Have a look at these three short videos…  Taken on a recent Sydney HEMS mission.

Can you guess the diagnosis??

NB. Art line trace is in yellow, SaO2 in blue. 

Post your answers below. First correct answer wins a crate of beer (maybe)!

 

 

Posted in Uncategorized | 9 Comments