FOAM Eye-Catchers 7: SMACC GOLD Highlights

Having recently returned from the FOAM-ite mecca, SMACC GOLD, in this edition I take a look at just a few of the many highlights.  Given there were frequently 3 speakers on at the same time, there were many talks that I missed so this is not an all inclusive list by any means.

This was an all day workshop that was held the day before the conference. It was most enlightening partly due to the high calibre of speakers but also because the attendees were generally great educators so the ideas from crowd sourcing were fantastic. Several other workshops were held simultaneously which I therefore could not attend but I heard the Airway, Ultrasounds and ECG workshops were top notch.


Richard Levitan delivered big time, with tips and tricks from his wealth of airway research and experience. Levitan was the pioneer/promoter of increasingly well known airway terms and technologies such as apnoeic oxygenation (NO DESAT), bimanual laryngoscopy and he defined the “sniffing position” as “ear-to-sternal notch, face parallel to the ceiling”. He’s been running a top class cadaveric airway training course out of Baltimore for years and thankfully brought it to Sydney last year as an annual (or ?biannual) event. I was fortunate enough to attend this just before SMACC and it was truly extraordinary [disclaimer: I have no financial or other association with this course]. The course optimises almost every aspect of airway management with the ability to practice techniques repeatedly on numerous cadavers. Levitan provided a very condensed version of these teachings in the SMACC Airway Workshop and his SMACC talks … just without the dead people.

In addition the talk by Keith Greenland, an Australian Anaesthetist from Queensland, known for his airway research, was most innovative. Further, since it was essentially the same material as his youtube video called Understanding Airways regarding the “2 curve theory” and the “3 columns” approach to intubation preparation and troubleshooting, you can check it out now instead of waiting for the SMACC talks to be released.


This world renowned ECG guru built on many of the themes from his blog to deliver some really useful ECG tips regarding “Subtle Signs of Ischaemia on ECG”. During this talk he provided several examples of the use of the formula he published that has relatively high accuracy in differentiating subtle STEMIs from benign early repolarisation. There is an embedded spreadsheet where you can input figures and use the formula in the right hand column of his blog. A key message was that the ECG is proportional so you should interpret changes such as ST elevation/depression and T waves taking into account their relative size compared to the QRS.

He also delivered an ECG Workshop along with Emergucate’s own John Larkin, author of ECG of the Week.


The famous UK trauma surgeon and expert on coagulation, presented several talks, all of which were eye opening and insightful. An excellent speaker with a wealth of knowledge in the area. He controversially lead with the message that most of what we are doing now in trauma will likely be proven to be wrong in 10 years … but qualified this with reassurance that we’re a lot closer to the right path than were were 10 years ago.


Whether it was in the Education workshop or her talks during the conference, she is the master educator and speaker and all her insights and techniques were a pleasure to observe.


Louise Cullen: Why Most Published Research is Wrong?

  • Built on the theme of the landmark Ioannidis article, Why Most Published Research Findings Are False, the various mechanisms that undermine truth in research were explored. You left this talk with a very healthy scepticism regarding the evaluation of new research.

Simon Carley: Do Risk Factors Really Matter?

  • Great discussion, reviewing the evidence that suggests we put far too much weight on chronic epidemiological risk factors when assessing patients with acute symptomatic complaints such as (but not limited to) chest pain.


Interesting discussion from this ICU clinician and researcher who stole the show at SMACC 2013 with his brilliant talks on catecholamines and fluids in sepsis. Suggested that it may actually be some effect that beta blockers have on inflammation rather than heart rate that accounts for the possibility of a beneficial effect in the right group of sepsis patients at the right stage of compensation/decompensation. However at present we simply are not there yet at identifying exactly who those patients are and this remains a “watch this space” area of interest.


The FOAMed pioneer and author of LITFL and the RAGE podcast, produced a well thought out discussion of how we need to move away from the old school ICU teachings of striving to make all the numbers normal (“Euboxia) and instead target what is likely to be optimal for the patient given their clinical condition and various stages of compensation and adaption.


Fascinating discussion about the emerging evidence regarding the possible harms of too much fluids in sepsis care and revealed what we know about the elusive endothelial glycocalyx and what role it may play in explaining all this.


The author of Resus Me, rolled through myth after myth from the resus world dispelling them with the eagerness of a man on a mission. Additionally he armed you with serious and humorous responses for the next time you were confronted with a doctor or nurse practicing in the dark ages and unsurprisingly the comedic retorts were far more appealing. There were too many myths to cover here but for just a taste:

  • “You shouldn’t use ketamine in head injured patients”
  • “Vasoactive infusions must go through a central line”
  • “If you intubate a COPD patient you’ll never get them off a ventilator”



In his usual entertaining and persuasive style he gave several talks including:

  • A peek into the future with “Cutting Edge Intra-Arrest Care”
  • A report on the success and findings of the sepsis collaboration in New York: the first 15,000 patients. It seems if you organise your hospital systems and management to get on board with sepsis care, pay close attention to your patients, send off lots of lactates with quick turn around of results so you can identify septic shock early and institute management in a timely fashion (eg early antibiotics) you can make a big dent in your mortality figures. Admittedly I’m simplifying this a tad but that appeared to be the general theme.
  • “Awake Intubation the emcrit way” – full of practical tips to get the job done



All in all, the SMACC team delivered once again with a truly sensational conference, of which I’ve only mentioned a fraction. Next year it shall depart our shores, being held in Chicago in May 2015!

Oh … and finally, the opening ceremony of SMACC GOLD was a blast – built around the theme of “uniting the tribes” of critical care.



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