Intensive Care Network Podcasts

In this podcast, Mr Larbalestier shares his experiences with cardiac transplantation and guides us through some his POV footage of the first heart transplantation at the new Fiona Stanley Hospital.

Ciaran McKenna and Andy Buck have a pow-wow with Matthew Mac Partlin on 3D Printing - Where it's up to, where it might go and how they are using it.

Dr Steve McGloughlin is an intensivist at the Alfred Hospital. He has a special interest in education particularly the use of simulation and crisis resource management skills in critical care. He is also an infectious diseases specialist and maintains both clinical and research interests in infections in critically ill patients. Here he discusses the ongoing primacy of antibiotics in intensive care and our continuing battle with antibiotic resistance

Professor Cornely is Professor of Internal Medicine and Director for Clinical Trials at University Hospital, Cologne, Germany. His research interests include invasive fungal diseases in haematology/oncology and in the ICU setting. Here he discusses the epidemiology, diagnostic challenges, appropriate prophylaxis and treatment of fungal infections in the ICU with a focus on haematology patients.

Irma Bilgrami gives an insightful and engaging talk on mentorship, the mentor and mentee roles and how to ensure everyone has equal access to these important relationships. This was recorded at the May 2016 Women in Intensive Care Network (WIN) meeting in Victoria.

Professor Theodore "Jack" Iwashyna presents an entertaining and informative talk on randomised controlled trials, how we could be getting more useful and better data, and strategies for getting the most out of RCT data in the future. This was recorded at the December 2015 ICN Victoria educational meeting.

Basic Science Clinic by Steve Morgan & Sophie Connolly An expert is a person who has made all the mistakes that can be made in a very narrow field. Niels Bohr   Welcome to Basic Science Clinic Raw Science 8. Convective gas flow through the tracheobronchial tree is the end-point of pulmonary mechanics but the fundamental purpose of the lung is gas exchange, comprised of three interlinked physiological processes: ventilation, diffusion and perfusion. Today we examine the incredible structural adaptation of the human lung down to the alveolus as the centrepoint of gas exchange, a process itself best conceptualized via the elegant physiological model of the alveolar gas equation.   The unraveling of the procession of pulmonary blood flow from right ventricle to lung to facilitate the mingling of blood and air involved protagonists that spanned epochs from Hippocrates to Galen and eventually in 1661 to Marcello Malpighi. He was the first person to view the pulmonary capillaries and alveoli through the augmente

Basic Science Clinic by Steve Morgan & Sophie Connolly What we know is not much. What we do not know is immense. Pierre-Simon Laplace Welcome to Basic Science Clinic Raw Science 7. As a prelude to deconstructing gas exchange we have been examining how humans, as tidal ventilators, replenish the composition of the gas in the functional residual capacity to provide a plentiful oxygen repository to buffer fluctuations in the oxygen content of blood leaving the lung with every beat of the heart. Convective, pressure gradient driven, bulk gas volume displacement can only occur if the displacing force is greater than the forces that oppose gas flow. These oppositional forces are the physiological targets of pathological processes that affect the lung, that alter pulmonary mechanics, increase work of breathing eventually critically compromising respiratory function and indicating the need for respiratory support measures. To effectively manage organ system dysfunction it is vital to develop an intimate understan

Burns Microbiology by Janin Infection is a major cause of morbidity & mortality in burns. Pierre goes through the common bugs responsible and how to manage them.

Jon Gatward goes through everything you need to know about approaching the airway of a patient with burns.

Basic Science Clinic by Steve Morgan & Sophie Connolly Although this may seem a paradox, all exact science is dominated by the idea of approximation. Bertrand Russell  Welcome to Basic Science Clinic.  This is Crit Think episode 6, the final podcast in our mathematics series in which we will discuss the mathematics behind clinical measurement. The use of ever advancing technologies is an inherent and necessary component of critical care, encompassing the most basic of measurement devices (the sphygmomanometer, the stethoscope) to the most complex methods of organ support. Such devices enable continuous monitoring and measurement of physiological variables, informing decision-making processes and underpinning management choices. Unfortunately, the fallibilities of the clinical process extend far beyond that of human error, and increasingly so, as technological developments entail greater reliance on medical devices. Along with this, comes the tendency to overplay the perceived accuracy and precision of suc

This talk covers burns assessment and initial wound management, including the types of dressings available. Very easy to get wrong, with serious ramifications if you do!

Burns Resuscitation. Lewis Macken takes us through the initial 24 hours of managing a patient with significant burns. Lewis tackles the tricky questions of how much and what kind of fluid to give, and explains the history behind burns resuscitation.

Basic Science Clinic by Steve Morgan & Sophie Connolly If you can’t explain it simply, you do not understand it well enough. Albert Einstein Welcome to Basic Science Clinic Raw Science episode 6. The next step on the oxygen cascade relates to the composition of alveolar gas, how and why it differs from that in the upper respiratory tract and conducting airways. This composition is determined by the components of the alveolar gas equation. We will examine the AGE in more detail in the next podcast, but for now we can take it to be PAO2 = PiO2 – PaCO2/RQ. In this conceptual model the PiO2 describes the gas entering the alveolus and the second half, the minus PaCO2/RQ, is the net gas leaving the alveolus as oxygen is exchanged with CO2 across the alveolar capillary membrane. The PAO2 is therefore the net alveolar oxygen partial pressure reflecting the interaction of these two processes. The composition of PiO2 we ascertained in the last podcast where humidification and warming of inspiratory gas at 1 atm lea

Effective patient management requires a combination of timely diagnosis, appropriate medical management and application of human factors. Human factors is the study and application of human interaction with the systems around them. It combines engineering and psychology, and a recognition that humans are not machines and subsequently make mistakes. In order for a system to be robust, it needs to take these factors into account.    In other industries, the role of human factors in developing a robust safety culture is well-established. Human factors and non-technical skills are increasingly recognised as a cornerstone of effective management in high stress situations where critical decisions are being made. Nowhere is this more applicable than within critical care.   Closely allied to human factors are non-technical skills. These comprise Communication, Teamwork, Leadership and Situational Awareness - of which Communication is generally regarded as the most vital. These four aspects are vital for effective pat

Basic Science Clinic by Steve Morgan & Sophie Connolly So mathematical truth prefers simple words since the language of truth is itself simple. Tycho Brahe Welcome to Basic Science Clinic, this is Crit think episode 5. Today our exploration of the mathematical architecture of our most inexact of sciences brings us upon the edifice of logarithms and exponentials. Daunting as it may sound, we will try to tease out their utility and relevance to critical care medicine and even attempt to penetrate the secrets of the mysterious number e. Logarithmic transformations permeate pharmacokinetic, biological and physiological modelling.  Exponentials are the inverse function of the logarithm, and the special properties of explosive exponential change in quantities has implications for ventilation, pharmacotherapy and beyond.  Euler’s number, e, represents the idea that all continually growing systems are scaled versions of a common rate. Describing e as a constant approximating 2.718 is like calling pi an irrational

Dr Andrew Davies, Intensivist at Frankston Hospital in Melbourne discusses how Intensive Care Specialists can better care for themselves, including avoiding burnout, eating well, exercising, escaping work, and meditation. This talk was recorded at the ICN Victoria meeting in December 2015.

Basic Science Clinic by Steve Morgan & Sophie Connolly  “…water is the driving force of all nature….without it, nothing retains its form.” Leonardo Da Vinci Welcome to Basic Science Clinic Raw Science episode 5. Let’s get down to business and accompany oxygen on its relentless tumble from nasopharynx to mitochondria down the partial pressure staircase that explains how 160 mmHg of inspired oxygen partial pressure becomes 20 mmHg in the inner mitochondrial matrix. In this pod we will examine step one of this cascade and the science of the humidification of dry, inspired atmospheric gas, whilst paying deference to dihydrogen oxide. Water is pretty amazing stuff. It is the solvent of life characterized by anomalous idiosyncrasies without which biology wouldn’t even be a thing.  It is the only substance found concurrently in 3 phases on Earth’s surface and is a byproduct of the outpouring of stellar gas and dust produced when a star is born. NASA recently discovered a water vapour cloud surrounding a quasar 1

Basic Science Clinic by Steve Morgan & Sophie Connolly “Isaac Newton was not the first of the age of reason. He was the last of the magicians.” John Maynard Keynes Welcome to Basic Science Clinic, Crit Think episode 4, in which we will discuss The Calculus.  One of the crowning intellectual achievements of humanity, Calculus is the foundational mathematical concept of modern science.  Almost usurped by a publication entitled the Complete History of Fishes released only months earlier, through his development of the fundamental theorem, Newton (or was it Leibniz?) has provided us with the tools to successfully land a rover on the surface of Mars. Calculus delineates the dynamic system.  It is the lens through which we may focus our perception of bedside numbers and observations to comprehend the beat to beat physiology of the critically unwell. In this pod we’ll cover: - Newton and Leibniz and the development of the fundamental theorem of calculus - Differentiation and pressure-volume relationships - Integ

Basic Science Clinic by Steve Morgan & Sophie Connolly We live in a society exquisitely dependent on science and technology, in which hardly anyone knows anything about science and technology. Carl Sagan Welcome to Basic Science Clinic Raw Science episode 4. We are close to embarking on the descent down the oxygen cascade, en route we will examine the key contributors to these stepwise decrements in oxygen partial pressure that coax the gas down to the level of the mitochondria. To grasp the concepts essential to the physiology of this pathway you need to understand the fundamentals of gas behaviour, enter the gas laws.   In this pod we will cover: Boyle’s, Charles’, Guy-lussac’s laws Avogadro’s number Dalton’s and Henry’s laws Saturated vapour pressure & boiling point The concept of in vivo partial pressures    Raw Science Factoids Increasing ambient pressure from 1 to 2 atm will decrease the volume of 1L water by 400 mmHg and FiO2 1.0 gives PiO2 > 2000 mmHg, resulting in tissue hyperoxia. Opening