Category: Simulation

ETM & The Vortex – SMACC Gold Presentation

I’ve just returned from the amazing SMACC Gold Conference on the Gold Coast, and what an amazing conference it was. 3 days of powerhouse Emergency and Critical Care from the cream of the medical education crop.

We were lucky enough to be invited to speak in the education forum, and rather than dish out a boring old Powerpoint presentation, we teamed up with the guys from the Vortex, and did a live scenario, demonstrating some of the trauma resus skills you learn on the ETM Course, as well as the Vortex approach to the unanticipated difficult airway, live on stage, followed by a brief feedback session with the audience.

The scenario demonstrated the team approach to trauma resuscitation taught on the ETM Course, and how this helps manage multiple, complex, simultaneous events that are proceeding at different rates, rather than the traditional, linear A/B/C/D approach. This Resus Room Management approach is one of the key things that differentiates ETM from other trauma courses.

I’m guessing by some of the feedback we got that it was pretty well received. This is compliment from Rob Rogers, (of iTeachEM fame, and one of the most highly regarded Emergency Medicine educators on the planet), made my day!

And here’s the “Awesome Card”:

UPDATE: Here’s Rob’s synopsis of the SMACC Conference over at iTeachEM.

So thanks to everyone who came along and attended our session, and I’d very much like to thank Chris Nickson and the rest of the SMACC Team for offering us the oppourtunity to showcase the course at the conference, as well as our assistants on the day, including:

Tim Gray (@timgray61)

Noush Perera (@noushperera)

Tim Leeuwenburg (@KangarooBeach , KIDocs & Rural Doctors Net)

John Dyett (@johndyett)

Robert Simpson (@AmboFOAM & AmboFOAM blog)

There are already multiple blog posts summarising the rest of the conference, and you can check some of them out here, here, and here.

Suffice to say, this was without a doubt the best conference I’ve been to, and only promises to be bigger and better next year when SMACC launches overseas, as the 2015 conference will be held in Chicago in May. So start planning your leave now!

Posted in Simulation, Trauma Education, UncategorizedLeave a Comment

How to save a life with a 20G IV – JAMIT Video

Inspired by the recent ACRRM RMA 2013 Conference JAMIT video competition (Just A Minute Instant Tutorial), we made a little video about one of our favourite trauma procedures. Trauma patients frequently arrive in shock, peripherally shut-down, with collapsed veins. Traditional dogma states all trauma patients should have “2 large bore, 14G or 16G IV’s inserted”. Well 14G and 16G IV’s are frequently hard to get in to cold, constricted, collapsed, empty veins, and all too often I see people prang numerous attempts at large bore IV insertion, not obtaining access and ruining the veins for further IV access attempts.

In under a minute, you can insert a 20G IV (pink) into a cubital fossa, forearm, or saphenous vein, and use the Seldinger technique to feed a guidewire through it, and then insert a short, 7 or 8.5Fr (note French, not Gauge) rapid infuser catheter (RIC) into the vein. You can also use any IV that the patient arrives with to railroad the wire and upsize to a RIC using the Seldinger technique. This is a rapid, effective technique that obtains access that is superior to a standard IV.

Actual flow rates through these catheters is hard to measure, and vary depending on the connectors, infusion pressure and delivery device (here’s a nice comparison between a Level-1 system and a Haemonetics Rapid Infusion System), but RIC catheters clearly have a higher flow rate than standard IV’s.

So here you go, a JAMIT video entitled “How to save a life with a 20G IV”.

httpv://www.youtube.com/watch?v=AprH6bKEGtg

If you have trouble getting a RIC line in, here’s some tips:

Awake patient? Use local anaesthetic!
You need at least 5-7cm of straight vein. Hence the insertion sites listed above
Deeper sites like femoral or subclavian are NO GOOD for RICs – the catheter is too short. (Try a longer cordis) You could use the external jugular – but not often available in collared trauma patients.
If the wire won’t feed smoothly into the vein, it’s either hitting a valve or a sharp bend in the vein – you can try pulling it in & out gently to see if you can get it past the obstruction (the tips on the wire are very soft, you won’t pop the vein), but if you can’t – don’t insert the RIC, it will hit the same obstruction & you may pop the vein.
You need to make a small incision (3-4mm) with the small green scalpel – if you don’t the RIC or dilator will hang up on the skin and not go in. If your incision is even 0.5mm away from the wire, there will be a small tissue bridge that will catch the RIC & stop it going in
When you make the incision – blood will well up at the site and obscure your view/make a mess – have some sterile gauze folded up & ready to put some pressure/soak up the blood as soon as you make the cut.

Posted in Simulation, Trauma Procedures1 Comment

Interested in Simulation? Sign up to NHET-Sim

NHET-Sim is the National Health Education and Training in Simulation program. It is part of a federally funded program by the Australian Government that is open to all Australian health practitioners wishing to use simulation as an education tool. I’m sure many of you are finding that there is a booming interest in simulation in Emergency Medicine education. Many ED Directors are catching on to this and are putting out directives to the ED Consultants to “start doing some sim” in their weekly teaching sessions. Unfortunately many people have no training in running simulation and may not be running scenarios or giving feedback in the most educationally useful way.

NHET-Sim is a way for those who don’t have the time to do a formal degree course, or who don’t have access to a Sim-Centre to learn about the educational background to simulation, and to learn ways to run better sim sessions at your workplace.

I’ve enrolled in the Graduate Certificate in Clinical Simulation at Monash University this year, and have found it a real eye-opener into the world of simulation. I’ve incorporated a lot of what I’ve learned through this course into the general educational structure, and more specifically the scenarios in the ETM Course, and I’d encourage anyone who has the time to check out the Grad Cert via the Monash University website.

For everyone else, there’s NHET-Sim. You can do the NHET-Sim program over 3 months, either via mixed face-to-face/e-learning, or solely via e-learning. So check it out, and maybe you can boost the educational utility of your ED sim sessions!

Posted in Simulation, Trauma EducationLeave a Comment

How Can ETM Help Me Manage Trauma Better?