Intensive Care: Lessons from the future

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Will Angus, ST6 Anaesthesia and Intensive Care Medicine, runner up in the Pecha Kucha session at State of the Art 2017, gave the following presentation where he looked back from 100 years hence.

Reflecting on the past century working within the speciality of Intensive Care, from the vantage point of the year 2117, and with only fifty years left before I reach retirement age, I wanted to share some pearls from the future via the medium of t-t-e-mail (time travel electronic mail).

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State of the Art 2017 in Liverpool: “Surprise, Surprise”.

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Professor Peter Brindley looks back at this year’s meeting and concludes; “The Conference is Dead, Long Live the Conference”.

To the seemingly endless list of unique wonderful things to have come out of Liverpool,2 we can assuredly add 2017’s Intensive Care Society State of the Art conference (SOA). In the sage words of local-girl-done-good Cilla Black: “Surprise surprise…the unexpected hits you between the eyes”. Regardless, I knew I was somewhere special when I asked for a hotel wake-up call and was told: “Certainly Sir, climate change is real”.3 I am delighted to report that the conference was similarly provocative, unexpected, and refreshing.

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State of the Art Day 3 Roundup

Day 3 at the ‘State of the Art’ proved a fitting finale to a meeting packed with lively talks, discussion  and engagement.

The morning started with a call to action with respect to organ donation. Dr Paul Murphy discussed the Government’s consultation on whether to move from an opt in to an opt out system in England following the example set in Wales.  He felt that ‘the time is right’ for such a move. The talk coincided with the launch of an on-line survey aimed at gaining an insight into the views of the critical care community on presumed consent. You can find it here.  Don’t hold back & share you’re views.  The answers will help form the response to the consultation from the Society and Faculty.

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Organ Donation, opt-in, opt-out?

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On October 3rd the Prime Minister announced plans to introduce an opt-out system of consent for organ donation into England (1), indicating that a consultation on the proposal would be launched before the end of the year.   Dr Paul Murphy, National Clinical Lead for Organ Donation, explains why the time for such a system is right.

Opt-out systems of consent are generally associated with higher donor numbers, although demonstrating a causal link remains elusive.  A consultation on a ‘soft opt out’ system in Scotland earlier in the year showed considerable support for it (2), whilst a system of so-called deemed consent already operates in Wales.  The Welsh system was enacted in December 2015 following an intense period of public education and professional preparation.  Whilst there have been encouraging signs in consent rates, as yet none have reached statistical significance and neither has there been any demonstrable increase in donor numbers.

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A consultation on a ‘soft opt out’ system in Scotland earlier in the year showed considerable support for it

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State of the Art – Open to Everyone.

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Dr Jeremy Groves shares his excitement for the upcoming annual State of the Art conference on 04/12/17. 

I’m excited.

I’m excited because, despite the long evenings, some very British rain while cycling home and the prospect of a weekend on-call, I have the State of the Art to look forward to next week.

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FICE Accreditation – past, present and future

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Marcus Peck (@ICUltrasonica), Consultant Intensivist, Frimley Park Hospital, & FICE Chair, discusses the history and growth of FICE and what exciting developments will be coming in the future.  

The first time I saw a heart move I was captivated, and I knew immediately that echocardiography and ultrasound would make a huge impact on intensive care medicine.

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#FiftyScansInFiftyDays – My journey through FICE Accreditation

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 Dr Nitin Arora (@aroradrn), Consultant Intensivist at Heart of England NHS Trust, discusses his journey in attempting to complete #fiftyscansinfifty days and offers advice to those undertaking the FICE accreditation.

Over the last few years, FICE has become the de-facto standard bedside focused echo accreditation for UK intensive care. Having tried and failed to complete my FEEL logbook as a registrar in 2012, I decided I’d try again as a consultant. After 2 years, a business case and having trialled various machines, our 2 new machines finally arrived in April 2017, and I immediately set about finding a FICE course.

Day 1 (FICE Course)

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The Beginning of the End?

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Dr Gary Masterson, President of the Society, reflects on how changes in the way critical care is commissioned may impact on critical care bed provision.

There have always been (and always will be) bed pressures in critical care. I don’t know about you, but I find this the most stressful aspect of my job. However, over the last 20 years of my working life as a consultant, when I have had the misfortune of stumping around my hospital’s general wards, I am always extremely glad to return home to my critical care unit. The general wards struggle: they’re jam-packed with elderly and frail patients with nowhere else to go, grossly understaffed, chaotic and little in the way of continuity of care. You know what I mean. In critical care, we don’t suffer these problems to the same extent and, since the advent of critical care networks and a more regional approach to managing critical care beds, we can usually cope when bed are short.

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The press, medical information, ethics and money

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Jeremy Groves reflects on some of the wider issues arising from the tragic case of Charlie Gard.

I have already written about something the adult critical care community can take away from the tragic case of Charlie Gard; however, I think there are several other issues that we can mull over.  Charlie and his parents’ plight captured the public’s attention and everyone had a view, as I discussed before, informed or otherwise.  To me it was striking how much of the discussion, and presentation of clinical information, took place in the press.

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Life support for critical care staff

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Dr Linda Jayne Mottram, Intensive Care Consultant at Belfast HSC Hospital discusses the crucial importance of maintaining clinicians mental wellbeing in the current medical culture.

Basic life support algorithms start with the premise that clinicians check for danger before approaching the patient.  The rationale being that if you are injured by something in the environment, you will be of little practical use to a patient in extremis.   The same logic applies to scene safety in prehospital medicine. No one questions your commitment to the patient by protecting yourself first, because it makes common sense to do so.  You have to be free from injury in order to provide any meaningful assistance.

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