Podcast - April 2024

Podcast – April 2024 Monthly Round Up – Bougies, cardiac arrest, trauma, sepsis, race and medicine, and choosing with intention

Welcome to the St Emlyn’s Monthly Podcast, your go-to source for the latest insights, developments, and discussions in emergency medicine and critical care. Each month, Simon and Iain will bring you in-depth analysis, evidence-based practices, and practical advice to enhance your clinical practice and professional development. Whether you are a seasoned practitioner or just starting your journey in the field, our podcast aims to provide valuable knowledge and foster a community of learning and support.

In this round-up of April 2024, we talk about a wide range of issues relating to emergency medicine, including the use of bougies, cardiac arrest management, trauma, sepsis, race and medicine and choosing with intention, with content with the RCEM CPD conference and the Austrian Emergency Medicine Conference in Graz.

Thank you for joining us, please do like and subscribe wherever you get our podcasts.

Listening Time – 30:10
Introduction00:00 – 00:34
Do Bougies increase first pass success?00:34-04:28
Cardiac arrest management – dual sequence defibrillation, personalised care and drones for AEDS. 04:28-10:50
Trauma – Cardiac tamponade vs exsanguination10:50- 13:35
Sepsis – effect of the microcirculation13:35 – 15:23
A history of race and medicine16:54 – 18:36
Differential attainment18:37 – 19:27
What can we do about addressing EDI issues?19:28 – 22:20
Choosing with intention20:21 – 26:55
The ARC-H Principle 26:56 – 28:32
Closing thoughts28:33 – 30:10

Do Bougies increase first-pass success?

We discuss the use of bougies in tracheal intubation, particularly focusing on a recent meta-analysis that evaluated the efficacy of bougies in improving first-pass success rates. The analysis reviewed 18 studies encompassing 9,151 patients and found that the use of a bougie significantly increased the likelihood of successful first-attempt intubation compared to using a standard stylet. This effect was observed across various settings, including emergency intubations, and was particularly pronounced in patients with more challenging airways (Cormack-Lehane grades III or IV).

Despite the evidence being classified as low certainty, the findings suggest that bougies should be considered as a first-line tool rather than a rescue device in emergency tracheal intubations. The review highlights the importance of using a structured approach to assess and combine data from multiple studies to draw robust conclusions about clinical practices.

Conference – 11th Congress of the Arbeitsgemeinschaft für Notfallmedizin

Simon recently went ot the 11th Congress of the Arbeitsgemeinschaft für Notfallmedizin (Workgroup for Emergency Medicine) held in Vienna, Austria. This event gathered professionals and experts in emergency medicine to discuss the latest advancements and practices in the field.

Key topics included the management of major trauma, resuscitation strategies, and innovations in pre-hospital emergency care. The congress emphasized evidence-based practices and highlighted various case studies and research findings that can improve patient outcomes in emergency settings.

In the podcast we discuss some of the presentations about cardiac arrest management, particularly the DOSE VF trial, how we can target our therapies to patients rather than algorhythms and the potential use of drones for AED delivery in the future.

The conference also provided networking opportunities for attendees, fostering collaboration among international emergency medicine communities. It underscored the importance of continuous education and adaptation to new technologies and methodologies in emergency care.

Let’s talk about R-A-C-E

Dr. Rita Das provided a compelling talk on the history of race and medicine, drawing from her extensive experience and academic background in medical sociology. Here are the key points from her presentation:

  1. Race as a Social Construct: Dr. Das emphasized that race is a social construct, noting that humans are 99.9% similar in their DNA. The categorization of people by race, originating from Carl Linnaeus in the 16th century, has historically been used to justify slavery and colonization.
  2. Exploitation in History: She highlighted the exploitation of black and Indigenous bodies during the slave trade and colonization. These bodies were often exhibited as curiosities or used as living cadavers for medical experiments and anatomical learning, as in the case of Sara Bartman, known as the Hottentot Venus.
  3. Medical Exploitation: Dr. Das provided numerous examples of medical exploitation, such as Marion Sims’ gynecological experiments on enslaved women without anesthesia, and the non-consensual use of tissues and bodies for dissection and experiments.
  4. Modern-Day Disparities: Current issues include longer times to analgesia for black patients compared to white patients, and disparities in the treatment of conditions like sickle cell disease and endometriosis in non-white populations.
  5. Historical and Ongoing Experiments: She discussed the medical profession’s complicity in unethical experiments, such as the Tuskegee syphilis study and smallpox vaccine trials, highlighting a legacy of mistrust in medical systems among black and Asian populations.
  6. Health Disparities: Dr. Das pointed out several stark health disparities:
    • Race as an independent predictor of health outcomes.
    • Higher mortality rates from cardiovascular diseases in South Asian populations.
    • Increased likelihood of restraint and lower chances of receiving psychological help for black patients in mental health crises.
    • Higher maternal and infant mortality rates in black and Pakistani populations.
  7. Racism as a Social Determinant of Health: She stressed that racism is a critical social determinant of health, urging the audience to recognize and address these disparities.

Dr. Das’ talk was a call to action to understand the historical context of these disparities and to work towards equity in healthcare. Her presentation encouraged reflection on the role of medical professionals in perpetuating these inequalities and the importance of actively seeking to address them.

Dr. David Chung followed with a discussion on differential attainment (DA) in medical exams, highlighting structural inequalities faced by international medical graduates (IMGs). He emphasized the need for culturally sensitive training and support for IMGs to address these disparities.

Dr. Sivanthi Sivanadarajah concluded with a talk on practical steps to address these issues, advocating for ongoing self-education and using one’s position of privilege to support systemic change.

The ASSESS pnemonic:

  • Ask questions in a humble and safe manner
  • Seek self awareness
  • Suspend judgement
  • Express kindness and compassion
  • Support a safe and welcoming environment
  • Start where the other person is

Choosing with intention

Liz Crowe‘s blog post highlights the importance of intentional decision-making. She explains that saying “yes” or “no” should align with one’s values, goals, and priorities, rather than societal pressures or guilt. Crowe distinguishes between choices, which are momentary decisions, and intentions, which are commitments tied to a plan of action. She suggests creating a personal matrix to guide decisions and setting clear boundaries to maintain focus and wellbeing. This intentional approach helps prioritize meaningful activities and relationships.

The ARC-H principle

Anisa Jafar’s blog post on St Emlyn’s introduces the ARC-H principle, aimed at redefining global health by focusing on Access-, Resource-, and Context-limited Healthcare. The principle seeks to eliminate the directional, often colonial nature of traditional global health approaches, emphasizing the expertise of those delivering healthcare in resource-limited settings. The ARC-H framework broadens the scope of global health to include underserved populations in high-resource countries and those affected by geopolitical factors, promoting a more balanced and inclusive understanding of global health.

Cite this article as: Iain Beardsell, "Podcast – April 2024 Monthly Round Up – Bougies, cardiac arrest, trauma, sepsis, race and medicine, and choosing with intention," in St.Emlyn's, June 5, 2024, https://www.stemlynsblog.org/podcast-april-2024-monthly-round-up/.

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