Report
Scottish Intensive Care Society annual education course
Stirling Royal
Infirmary August 25th – 26th 2005
Introduction
Fifty five delegates of all medical and nursing grades descended
onto the conference centre at Stirling for this course, which like
a decent
wine, is improving with age. The number of applicants was up on last
year again with only the lucky early birds getting a chance to experience
two days of very mixed and well-received lectures / debates and workshops.
The organisation led to all of the 55 delegates getting hands on experience
at all the workshops; transthoracic echo, non-invasive ventilation, care
of tracheostomies & cardiac output monitoring. There was also ample
time for small group discussions in the areas of ethics & consent,
paediatric transfers and the treatment of status asthmaticus. The rest
of the days were taken up with two debates, several formal lectures and
a chance to ‘perform’ at the national clinical simulator.
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Workshops
Approachable experts in their field staffed all the workshops. This
made the learning experience very worthwhile.
There was time to see various different cardiac output monitors and
hear that it probably makes very little difference which monitor you
use as long as you use it wisely. Two different NIV machines were available
to try out via a variety of interfaces – if only we had managed
to lock some people into the ‘hood’ life might have been
quieter! The Echo workshop was deemed a great success, thanks must go
to our two cardiology colleagues who made the process of obtaining pictures
look exceedingly easy – mind you, having three skinny co-operative
volunteer models is not quite what we are used to in ICU!
Thanks especially to Steve Stott, Dave Rowney, Bryce Randalls and Kristine
Kruszeski for leading the workshops.
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Small group discussions
Tricky questions as diverse as ‘how to ventilate the unventilatable
asthmatic’ and ‘can I ethically treat this elderly incompetent
patient’ were given credence in the perfect setting of the small
groups where every one needed little encouragement to get involved and
explore various aspects. The setting up of a paediatric transfer talk
was particularly well appreciated by all. Getting called to the emergency
department for paediatric cases always causes a certain amount of stress – this
should allow us to be slightly less stressed in the future.
Thanks especially to Malcolm Booth, Martin Hughes, Jillian McFadean,
Chris Cairns, Ian Grant and Scott Davidson for their part.
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Lectures
We were very fortunate to have a selection of excellent speakers for
the more formal lectures given to all the delegates, Dr Dave Rowney from
Edinburgh started the ball rolling giving a prelude to his paediatric
transfer discussion with some insights into inhalational injury in the
paediatric population – this was made especially relevant by using
the examples of three recent patients from his hospital showing the differing
degrees of pathology that can present. Dr Kristine Kruszeski, a cardiologist
from Aberdeen Royal introduced us to the benefits and limitations of
transthoracic echo, it was refreshing to hear such an honest account
of her work and what she really thinks about some of our patients that
we refer to her and her colleagues. This was prior to her helping out
in the echo workshop – the contrast between the skinny subjects
on display and the typically ventilated, supine obese patient on maximal
inotropic therapy was noted by all and sundry!
On the second day Dr Sam Rowlinson kicked us off with an update on the
use of activated Factor seven with some useful guidelines from Israel.
Ian Grant then regaled us with some possibilities for the patient that
just refuses to wean from the ventilator despite our usual interventions.
Martin Hughes from Glasgow Royal laid out a systematic method for diagnosing
and assessing acute renal failure. Dr Peter Andrews gave the last afternoon’s
lecture. He gave us some insight into his previous research into intracranial
pressure monitoring and allowed us to think which patients would possibly
benefit from such a monitor.
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Simulator
One of the coups of the course was the ‘trialing’ of a new
scenario at the simulator – huge thanks has to go to the 16 brave
participants who put themselves up for video analysis and subsequent ‘expert’ discussion
about their performance. The situation got a good deal of debate going
regarding both clinical acumen and the fabled non technical skills needed
for coping with the acute presentation of a septic patient in the emergency
department. The fact that we all got a chance to see, hear and participate
in the conclusive analysis meant that the learning experience was maximised.
We must thank Graham Nimmo & Ben Shippey for leading the scenario
as well as Chris Carins & Steve Stott for sitting as the ‘Expert
panel’. However our biggest thanks must be reserved for the 16
delegates who made it all worthwhile – we hope they weren’t
too disheartened by the experience!
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Debate
Thursday finished with a debate on the use of Dopamine in ICU. Dr Chic
Lee from Inverness managed to convince us that dopamine should be left
in the cupboard, despite a good argument from Graham Nimmo that dopamine
(ok, so it doesn’t save kidneys!) still can be of some use as either
a first aid inotrope or as a diuretic. The winning margin indicates that
we will be seeing even less of this drug in the future. Friday was completed
by an entertaining debate between two of Glasgow Royals finest – Dr
Martin Hughes against Dr John Kinsella. The fight was under the banner
of ‘sepsis bundles are not appropriate to implement in my hospital’.
Even though Martin kept his early lead he, like Gordon Strachan, must
be concerned about the significant swing of support away from their side
to the opposition. The house still believes in implementing sepsis bundles
but with a reduced majority (from 30 against & 2 for pre debate to
24:8 after presentation). Dr Kinsella took this as a well fought for
moral victory.
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Entertainment
There was numerous socialising ongoing through out the days with new
friends made and old ones caught up with. There was a meal out in Stirling
on the Thursday night which, although not particularly well attended,
was one of the best meals I’ve had for ages.
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Final word
The variety and positive feedback is very encouraging to the
organisers of this course, a sign of the smoothness of it all with a
huge thanks
to primerio Mike MacMillan of Aberdeen and his side kick Paul Holder.
Dr Steve Stott for supervising the above two must also take some of the
platitudes. Thanks also to all the other advanced trainees who chaired
the sessions and generally made the course work, Marcia MacDougal & Ben
Shippey from Edinburgh, Jim Ruddy & Ewan Jack from Glasgow and Roxanne
Bloomfield from Aberdeen.
Our final words of thanks are directed to the sponsors and the delegates – without
such enthusiasm the course would not work.
The Group of Intensivists in Training in Scotland (GITS) have now well
and truly joined the digital age and have set up our own website for
rapid distribution of messages about forthcoming courses etc. Yahoo has
forced us to change our accorymn to GICTS and you can sign up to the
secure website at GICTS@yahoo.com
All trainees interested in a possible career which may involve some
work in ICU are encouraged to join up and hear the news.
We will be organising a similar course again next year with possibly
a change of venue – all suggestions will be gratefully received.
The annual GICTS meeting for medical trainees only will be held early
in the new year through in Edinburgh. Details will hopefully appear on
the SICS website closer to the date.
Ewan Jack
SpR ICM Glasgow
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