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Welcome to the latest edition of Emergency Education. Through this series, Dr Simon Rohde, Director of St Andrew’s Emergency Centre, shares valuable information and insights into common and not so common emergency presentations. Dr Rohde says: “Attention everyone! Let’s talk about heart failure – a serious condition that affects millions worldwide. As an emergency doctor, it’s crucial to raise awareness about this condition and its potential consequences. “Heart failure occurs when the heart muscle becomes weakened, leading to an inability to pump blood effectively. Symptoms may include shortness of breath, fatigue, swelling in the legs, and rapid weight gain. If left untreated, heart failure can result in severe complications such as kidney damage, liver damage, and even death. “Serious causes of heart failure include coronary artery disease, high blood pressure and heart valve disorders. Lifestyle factors like smoking, obesity, and a sedentary lifestyle can also contribute. “Early detection and management are key to improving outcomes. If you experience symptoms of heart failure, don’t ignore them. Seek medical attention promptly. Treatment may involve medications, lifestyle changes and, in severe cases, surgery or implantation of devices like pacemakers.” If you need us in an emergency, we're here for you 24/7 at St Andrew's Emergency Centre in Spring Hill. For more info, visit standrews.ph/ECentre

This month, we are proud to spotlight Andrew Sama, MD, FACEP. Recognized as a leader and innovator in Emergency Medicine, Dr. Sama is a board-certified emergency medicine, pediatric emergency medicine, and internal medicine physician with over 40 years of medical experience. He is the founding President of Progressive Emergency Physicians (PEP) and Executive Vice President at Emergency Care Partners (ECP). Read the full article to learn more about Dr. Sama's impressive career in emergency medicine and his other leadership roles in healthcare and education. #MedicineisLocal #EmergencyMedicine

My Reflections today as an EM Consultant. 12years ago, as a newly qualified Emergency Medicine consultant , I shared my reflections on the tumultuous world of an ER Doctor. Rediscovering those words today, their enduring resonance compels me to share this journey with myself and colleagues again. Here's a glimpse into what I wrote then : MAKE THINGS HAPPEN, SAVE LIVES, ALLEVIATE SUFFERING In the chaotic theatre of my Emergency Department, efficiency and triage mastery are prerequisites. Constantly re-triaging amidst the unpredictable chaos, I stand guard for any potential emergency. My role isn't to master all of medicine but to be a jack of all trades, addressing and diagnosing what poses an imminent threat to life. If definitive care is beyond my scope, my duty persists until the patient reaches it. To make things happen is to transform visions into reality. Acknowledging the invaluable team within my ED, the heartbeat of the department, is essential. It involves swiftly moving critical patients, minimizing delays in diagnostic procedures, and advocating for timely interventions. Making things happen is an art, a skill vital to excelling in Emergency Medicine. To save lives, I must first recognize when a life is at stake. In the undifferentiated crowd, identifying those harboring life-threatening conditions is no easy task. From the comfortable-looking patient with a hidden Type A Aortic Dissection to the chest pain case with a concealed saddle pulmonary embolus, my role is to navigate the landmines scattered throughout the Emergency Department. Resuscitation, a topic in itself, encapsulates the essence of Emergency Medicine. To fulfill my purpose, I must be an expert in resuscitation, navigating critical moments that define the fate of my patients. Ultimately, Emergency Medicine centers on the patients, who I consider family under my care. Effective communication, empathy, and a commitment to providing the best care possible guide my interactions. To succeed in this dynamic field, I offer humble advice: never cease learning, trust instincts, be decisive, manage stress, understand human factors, debrief after challenges, learn emergency ultrasound, follow up on patients, embrace the reality of bad outcomes, and above all, be kind and compassionate, leaving an indelible mark on the lives of those we serve.

The concept of the "Chain of Survival" originated in the 1980s and 1990s from the field of emergency medicine and resuscitation science as a framework to improve outcomes in cases of cardiac arrest. • Mary M. Newman, co-founder and president/CEO of the Sudden Cardiac Arrest Foundation, developed the chain of survival metaphor and first described it in an article she wrote for the Journal of Emergency Medical Services in 1989 • The concept was later adopted by the American Heart Association and other health organizations. The Chain of Survival, prominently displayed on our defibrillator cabinets, represents a sequence of four essential steps, emphasizing the critical and interconnected nature of each link in rescuing sudden cardiac arrest (SCA) victims. Following each step diligently is crucial, as neglecting the initial actions can risk the chances of saving a life. 💞 💠 𝐂𝐡𝐚𝐢𝐧 𝐨𝐟 𝐒𝐮𝐫𝐯𝐢𝐯𝐚𝐥 💠 🔸 𝟏. 𝐑𝐞𝐜𝐨𝐠𝐧𝐢𝐭𝐢𝐨𝐧 𝐨𝐟 𝐂𝐚𝐫𝐝𝐢𝐚𝐜 𝐀𝐫𝐫𝐞𝐬𝐭 𝐚𝐧𝐝 𝐂𝐚𝐥𝐥 𝟗𝟗𝟗 When calling 999, you'll be asked two questions: • "Is the patient conscious?" • "Are they breathing normally?" If the answer is no to both, it suggests the patient is in cardiac arrest with no blood reaching the brain. They ask about "normal" breathing to distinguish it from agonal breathing. Agonal breathing is gasping that occurs when the brain lacks oxygen, often mistaken for normal breathing. Recognizing agonal breathing helps avoid delays in starting CPR, crucial for maintaining blood flow and improving survival chances during cardiac arrest. • Send someone to retrieve the nearest AED 🔸 𝟐. 𝐒𝐭𝐚𝐫𝐭 𝐂𝐏𝐑  Decreasing the time between cardiac arrest onset and the first chest compression is critical to survival.  • Push hard and fast in the centre of the chest at the rate of 100-120 pumps per minute. • For a detailed read - https://bit.ly/4cj0xGf If a defibrillator cannot be found, continue performing CPR until help arrives. This continuous CPR effort can help maintain blood circulation and support the person until advanced medical help arrives. 🔸 𝟑.𝐑𝐚𝐩𝐢𝐝 𝐃𝐞𝐟𝐢𝐛𝐫𝐢𝐥𝐥𝐚𝐭𝐢𝐨𝐧 If an AED is available-  • Position the AED next to the patient as soon as it's available. • Power on the AED and follow the visual and voice prompts for guidance. • Apply the electrode pads to the victim's bare chest, following the diagram on the pads. • Ensure no one is touching the victim when the AED advises a shock. • Press the shock button as instructed by the AED. (If a Semi-automatic defibrillator) • 𝐀𝐧𝐝 𝐜𝐨𝐧𝐭𝐢𝐧𝐮𝐞 𝐬𝐭𝐞𝐩𝐬 𝟐 𝐚𝐧𝐝 𝟑 𝐮𝐧𝐭𝐢𝐥 𝐡𝐞𝐥𝐩 𝐚𝐫𝐫𝐢𝐯𝐞𝐬. 🔸 𝟒. 𝐄𝐦𝐞𝐫𝐠𝐞𝐧𝐜𝐲 𝐑𝐞𝐬𝐩𝐨𝐧𝐝𝐞𝐫𝐬 The remaining link in the Chain of Survival refers to actions that should be taken by professional responders. They include advanced life support and integrated post-cardiac arrest care. #Defibsaveslives #Emergencyresponse #Defibstore #ChainofSurvival

Congrats to Dr. Ali Baker on the Southcoast Health and Boston Children's Hospital pediatrics/EM team for the terrific article in Annals of Emergency Medicine describing the 4S’s disaster management framework in action during the #tripledemic. Could the 4S disaster framework help your teams focus in #spaceplanning, #staffing, #supplychain and #structure? ‘Most children in the United States present to community hospitals for emergency department (ED) care. Those who are acutely ill and require critical care are stabilized and transferred to a tertiary pediatric hospital with intensive care capabilities. During the fall of 2022 “tripledemic,” with a marked increase in viral burden, there was a nationwide surge in pediatric ED patient volume. This caused ED crowding and decreased availability of pediatric hospital intensive care beds across the United States…. To combat these challenges, the pediatric ED leadership applied a disaster management framework based on the 4 S’s of space, staff, stuff, and structure. ‘ https://lnkd.in/eB7hv3dr For more info contact: alexandra.baker@childrens.harvard.edu

while my participation in open heart missions for congenital heart diseases with the itallian team of San Donato as post open heart pediatric icu specialist

TRIGGER WARNING - CCTV Footage of a cardiac arrest and successful resuscitation efforts. Please know though, this story has a positive ending. If you watch anything today, make it this video. This is Claire’s story. In 2016, she was just 17 and seemingly fit and healthy. Claire had been having stuttering symptoms (left shoulder pain) which was a sign of something more sinister occurring, but due to her age these symptoms were not thought to be cardiac related. Unfortunately, despite seeking medical advice that day, Claire went into cardiac arrest while at Volleyball, with her parents sitting front row. It is important to note that some people have absolutely no warning signs of their impending cardiac arrest. Thanks to the Project SAVE by Children's Healthcare of Atlanta, her school had an AED that they frequently practiced using in scenarios just like Claire’s. In the full footage (posted in comments), you can hear people yelling to call 911. Thankfully, the bystanders jump into action, using those precious minutes waiting for the Paramedics to save Claire’s life before the ambulance even arrives. Claire was in Ventricular Fibrillation (V Fib/ VF), a shockable rhythm, and the AED advised the heroic bystanders to provide a shock, saving Claire’s life. Since it was so soon after Claire’s cardiac arrest, and effective CPR had been started quickly, she still had reasonable perfusion to her brain and actually regained consciousness. For every minute that CPR and defibrillation are delayed, the patient’s chance of survival decreases by 10%. Minutes absolutely matter. On average, less than 10% of people survive a cardiac arrest, with approximately >25 000 cardiac arrests occurring per year, Australia wide. CPR buys time by attempting to provide some perfusion to the brain and other organs, while an AED can revert the fatal arrhythmia - they are both equally important! Any attempt is better than no attempt. Watching this footage as a Critical Care Paramedic was quite moving. This is something we train for and attend so often, but these are people simple going about their day, enjoying school sport without any idea what was ahead. They were incredibly brave, handled this emergency so effectively (likely due to previous training) and stepped up when they were needed most. Knowing the patient would be additionally traumatic and I hope everyone involved was offered psychological support. Because of those bystanders, Claire returned to a completely normal function. Every link in the chain of survival was there that day. This is why public access AEDs are so essential in allowing brave bystanders to save lives. I will continue to raise funds for more AEDs through my side project One Little Heart, to ensure that if this happens, the bystanders have what they need to safe a life.

these skills are so invaluable! This is how two hours of your life in a classroom can save a life ! let everyone step up and be counted. Be proud to save a life, complete a basic life support session, they're not expensive and could make YOU a future life saver.

As you know, the Grey Book from the American College of Surgeons includes a brand-new requirement:   All trauma centers must assess the pediatric readiness of their Emergency Department and develop a plan for addressing identified gaps.   The requirement is straightforward, but the obstacles are many:   …hospital administrators who do not see the urgency of this new requirement.   …the belief that improving pediatric readiness will be difficult and costly.   …the gap between an ED’s self-assessed readiness score and its “real life” readiness to treat children.   If you are concerned about your own hospital’s readiness to treat pediatric patients, I invite you to join us on March 27 for a new trauma leadership webinar:   Pediatric Readiness: Streamlined Implementation Strategies for Trauma Center and Emergency Department Leaders   (To sign up, visit: https://lnkd.in/gHZTEPpf )   During this live event, emergency nursing expert Karen Webb, DNP, RN, NEA-BC, NHDP-BC will dispel the misconceptions surrounding pediatric readiness — and explain how trauma and ED leaders can leverage existing resources to create a manageable path to better care for sick and injured children.   Karen will…   …explain how to secure pediatric equipment, supplies and medications without significant extra costs.   …spotlight the small improvements that can add up to significant gains in pediatric readiness.   …share doable strategies for immediately improving pediatric readiness in team processes and staff education.   I hope you can join us!

The importance of early intervention. BLS should be part of the national curriculum.