Neuro Resus – Details, episodes & analysis

This podcast episode features a conversation between Dr Oli Flower and his AI co-host, Simon (ChatGPT 4o), focusing on vasospasm and delayed cerebral ischemia (DCI) in aneurysmal subarachnoid haemorrhage (aSAH). The discussion covers:

• The distinction between radiological vasospasm (imaging finding) and DCI (clinical syndrome).
• The evolution of understanding DCI’s multifactorial causes, beyond just vasospasm.
• Evidence and controversies around ICU management, including blood pressure targets, nimodipine use, and the role of other interventions.
• Screening and monitoring strategies: transcranial Doppler, CTA, CTP, and the limitations of each.
• Post-management assessment, therapeutic hypertension, and the emerging role of milrinone.
• The importance of multimodal monitoring and the future potential of AI and global data sharing.
• The episode closes with a lighthearted off-topic discussion about casting for the new Naked Gun movie.

The conversation is rich in clinical nuance, highlights current evidence gaps, and emphasises the need for individualised patient care and ongoing research.

Catherine Bell takes us through how to troubleshoot problems commonly encountered when looking after patients who have an external ventricular drain (EVD) in situ. Issues with using brain tissue oxygen monitors are also discussed. A highly practical session aimed at bedside clinicians.

This presentation was delivered by Catherine Bell at CODA2022. Want more content about EVD? Visit neuroresus.com or subscribe to be notified of new podcast releases via email.

To express your interest in attending the 2024 Neuroresus live course, click here. 

Stuart Browne is a Neuro Rehab specialist from Sydney. He discusses what "severe disability" really means. 

Severe disability is more common than many realise - about 6% of the Australian population.

Stuart discusses how health is more than simply physical recovery and how it is a multidimensional construct. He covers how permanent disability doesn't necessarily equate to a poor quality of life. He also discusses the long timespan of recovery, which is often much longer than appreciated.

He specifically discusses "Locked-in Syndrome" and how the survivors have surprisingly positive self-reported health-related quality of life and well-being.

Stuart also covers how severely disabled people face various forms of discrimination.

This podcast was recorded at the Brain Symposium which took place in March 2023. For more talks and content like this, visit neuroresus.com or subscribe to be notified of new podcast releases via email.

To express your interest in attending the 2024 Neuroresus live course, click here. 

Acute liver failure for the intensivist by Dr David Anderson

The understanding around the metabolic response to the stress of critical illness has evolved rapidly over the past decade. 

This involves a neuroendocrine and an inflammatory component, which results in perturbations within the sympathetic nervous system, the hypothalamo-pituitary axis and the immune system. 

The clinical consequences are widespread and include changes in metabolic rate, altered use of macronutrients as energy sources, stress hyperglycaemia, muscle wasting and changes in body composition. Many of these manifestations are akin to the metabolic syndrome observed in ambulatory populations. Medium to long-term effects of these metabolic disturbances involve bone health, cognitive and behavioral alterations. 

Knowledge of these effects is relevant due to the potential therapeutic implications, which will be discussed. 

What the boss wants: getting a consultant job by Dr Priya Nair & Dr Ray Raper

The Australian population away from metropolitan areas has the same health care needs and deserves the same level of care (within available resources) as urban residents: we can and should provide it.

This short talk aims to explore work in a non-tertiary centre ICU as a career option and why it’s worth considering.  It will look at what life and work are really like in non-metropolitan areas and how and why working in a regional ICU can be a rewarding career.  It will try and dispel some misconceptions as well as present some of the challenges (and how to overcome them) that arise while working outside capital cities.  This is meant to be a light-hearted look at living and working in the bush or on the beach and an insight into a career path often overlooked by city-based trainees, not a hard-core recruitment drive or a critique of urban life/tertiary centre work.  Come along with an open mind and have a look: you may discover a lifestyle and workplace you didn’t realise could suit you, for the short or longer term.

To pass the Second Part Exam, your performance needs to be at the expected level for a junior consultant. You need to be able to rapidly synthesise clinical information from multiple sources to reach a differential diagnosis and appropriate management decisions. (And achieve this while feeling the equivalent of standing at the top of an Olympic downhill ski-run, simultaneously suffering from a severe bout of gastro.) 

Some general pointers include: 

Get experience running the unit and calling the shots 

Establish a good knowledge base - don’t just practice SAQs 

Write and share your own SAQs and Vivas 

Make every case you see at work a practice Hot Case 

Teach everyone else 

Consider performance coaching  

Finally, if things don’t go to plan the first time, remember it’s an exam not a statement on who you are as a person. Work out what worked and what didn’t and why to change your approach and come back stronger. 

Tips and tricks for getting through the first part: Examiner’s perspective

10% of patients admitted to ICU die and, in some societies over 80% of people die during a hospitalization that included an ICU stay.  Most deaths in ICU are predictable and the overwhelming majority of patients are comatose for the last few days of their life.  Most communication by intensivists is directed at families rather than patients.  This talk will cover some scenarios where this isn’t the case and give guidance on delivering bad news to and discussing organ donation with awake patients.