5-6 December 2024, Broadway House, London







Case based discussions that cover best practice in airway management, ventilation, shock management and haemodynamic support, neuroprotection, sepsis, trauma and haemorrhage PLUS how to make it happen! For the first time Cliff is adding extensive content on leadership, communication, and human factors.



FULL PROGRAM AND REGISTRATION HERE



Note This is an IN-PERSON, TWO-DAY event. There is no option to attend virtually. Participants are expected to attend both days. No refunds will be given if only one day is attended.

After 19 years of teaching everything Dr Cliff Reid wishes someone told him when he was training in emergency medicine and intensive care in one day, he’s finally extended it to two days to allow more in depth discussion of clinical AND non-technical factors. It’s not just about what to do, but how to make things happen when the system is conspiring against you!








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Tues 24 September 2024, Broadway House, London



This is a one day run through of how I think every aspect of resuscitation and critical care in the emergency department should be done.



It combines my experience of more than twenty years as a specialist in emergency medicine, critical care, and retrieval medicine with the most up to date information from the latest literature.



The format is classroom case-based discussion, with key memorable concepts shared in a way that can make a lot of participants thing differently about the clinical stuff they see every day.



Yes, it’s impossible to cover everything in one day when the venue kicks us out at 5pm. But it is SO much fun trying. And we go to the pub after for anyone that wants to keep the conversation going.



Get tickets here








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There has been an exponential rise in COVID-19 cases. There is no doubt we’re feeling the effects of that all over the world. Many people, especially it seems, the lay public and politicians, have a hard time understanding the meaning of ‘exponential’.



The scariness of exponential growth shown here with E.coli
Image by Stewart EJ, Madden R, Paul G, Taddei F (2005) / CC BY-SA



But can exponential rise continue? If cases double every 3-4 days, then based on today’s figures from the Johns Hopkins Dashboard (1st April) by May 6 there will over 8.7 billion people infected, which is more than everyone on the planet, and clearly impossible.



This means the rise must tail off eventually. In fact, the more people there are who are infected, the harder it is to find someone to infect with the virus who hasn’t already got it. Also, spread should be limited by the social distancing and other measures (such as handwashing).



This actually gives rise to a LOGISTIC curve, rather than an EXPONENTIAL curve. This is an S-shaped curve that describes population growth (in both viruses and people) as well as other phenomena in economics and science(1).



Attribution: Qef / Public domain



Notice in the above curve the mid-point marked 0.5. This is the inflection point when the rate of increase in cases stabilises before declining. Specifically, the ‘Growth Factor’, or number of new cases in one day divided by the number of new cases the previous day, equals 1. Note at this point cases are still increasing – the virus is still spreading – but it’s not accelerating, and therefore no longer on an exponential trajectory.



Image from ‘Exponential growth and epidemics’ by 3Blue1Brown



This isn’t the only model to describe pandemics and none is perfect(2). We still can’t predict what will happen with SARS-CoV-2 and we absolutely need to continue to enforce strict containment measures. But having a basic understanding of the data gives us ways to visualise it that allow comparisons, and show which countries have ‘fallen off’ the exponential rise curve.



Logarithmic graph by Aatish Bhatia in collaboration with Minute Physics – see https://aatishb.com/covidtrends for up-to-date animated graph



Since in most places, we are still on the exponential part of the curve, it is imperative to educate as many people as we can on the benefits of strict isolation and hygiene measures:



Great infographic by @GaryWarshaw and @SignerLab




The best brief explanation of the above, which prompted me to write this brief post, is by the brilliant minutephysics



Take a few minutes to watch the video below:







Please note all the caveats at the end of the video. And one final one – I’m not an epidemiologist or mathematician. I’ve just been wrestling with what the endpoint of exponential rise would be and found these resources helpful.



References



1. https://www.nctm.org/Classroom-Resources/Illuminations/Interactives/Pandemics-How-Are-Viruses-Spread/



2. Yang W, Zhang D, Peng L, Zhuge C, arXiv LHAP, 2020. Rational evaluation of various epidemic models based on the COVID-19 data of China. arxivorg
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One of my nursing colleagues was telling a story the other day about one of the first resuscitations we did together in the ED several years ago. It demonstrates the principle of establishing control of a sub-optimally coordinated team by using some form of attention grabber. She kindly agreed to write down her recollection for me to share here:
I have finally found 2 minutes to sit down and write you the story I was telling you about the other week….
We were in the middle of a resus in the ED, it was chaotic, loud and messy.
I remember you calling out in a commanding voice for everyone to stop (can’t recall what you actually said) but when we all looked up and fell silent you lifted up one leg, let a rather loud large fart out and then very calmly proceeded to take control of the situation. Everyone was so stunned, and slightly amused that the whole situation just settled right down and we all cracked on with the resus in a much more organised fashion.
I don’t know if you know I own a first aid training company. I tell this story when I am teaching. I explain to people that an emergency situation can be chaotic and stressful and someone has to take control. Sometimes you need to take a second to get a grip of yourself and others before you can be of any help to the person in need.
By telling your story it makes people realise you can stop for a second to gather yourself, take stock of what is needed then crack on. Sometimes it takes extreme measures such as dropping a fart to get people to get back on track.
You have given me many stories over the years but the fart one has got the most traction so far.
See you at work
 
 


I accept that some people may find this offensive or consider it inappropriate or unprofessional. Please consider:



All mammals produce flatus.Holding on to flatus can be uncomfortable and can distract a resuscitation team leader, potentially adversely affecting outcome.The performance had its desired effect, helping the resuscitation.The patient was intubated and therefore not at olfactory riskC’mon jeez it was just a fart
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This video shows the mechanism for dislodgement and deformation of humeral intraosseous needles and how to avoid this.
In summary, if you need to abduct the arm (eg. for thoracostomy), keep the thumbs down (ie. have the arm internally rotated at the shoulder). Otherwise the IO catheter may bend or fall out.

References:
1. Pasley J, Miller CHT, DuBose JJ, Shackelford SA, Fang R, Boswell K, et al. Intraosseous infusion rates under high pressure. Journal of Trauma and Acute Care Surgery. 2015 Feb;78(2):295–9.
2. Paxton JH, Knuth TE, Klausner HA. Proximal Humerus Intraosseous Infusion: A Preferred Emergency Venous Access. The Journal of Trauma: Injury, Infection, and Critical Care. 2009 Sep;67(3):606–11.
3. Cho Y, You Y, Park JS, Min JH, Yoo I, Jeong W, et al. Comparison of right and left ventricular enhancement times using a microbubble contrast agent between proximal humeral intraosseous access and brachial intravenous access during cardiopulmonary resuscitation in adults. Resuscitation. 2018 Aug;129:90–3.
4. Knuth TE, Paxton JH, Myers D. Intraosseous Injection of Iodinated Computed Tomography Contrast Agent in an Adult Blunt Trauma Patient. Ann Emerg Med. 2011 Apr;57(4):382–6.
5. Mitra B, Fitzgerald MC, Olaussen A, Thaveenthiran P, Bade-Boon J, Martin K, et al. Cruciform position for trauma resuscitation. Emerg Med Australas. 2017 Apr;29(2):252–3.
6. Reid C, Healy G, Burns B, Habig K. Potential complication of the cruciform trauma  position. Emergency Medicine Australasia. 2017 Apr 27;29:252.
7. Reid C, Fogg T, Healy G. Deformation of a humeral intraosseous catheter due to positioning for thoracostomy. Clin Exp Emerg Med. 2018 Sep;5(3):208–9.
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