Reflections on the ACEM Winter Symposium 2013

Now in the West the slender moon lies low,
And now Orion glimmers through the trees,
Clearing the earth with even pace and slow,
And now the stately-moving Pleiades,
In that soft infinite darkness overhead
Hang jewel-wise upon a silver thread.

And all the lonelier stars that have their place,
Calm lamps within the distant southern sky,
And planet-dust upon the edge of space,
Look down upon the fretful world, and I
Look up to outer vastness unafraid
And see the stars which sang when earth was made.

Poem by Marjorie Pickthall, Canadian poet 1883-1922

The ACEM Winter Symposium in Broome was always going to be a little different. We never expected it to be so, well, celestial.

  • Of course, we had our exploding Supernova, David Newman, all the way from Mt Sinai (light years away from our little place, on the less fashionable edge of the planet). He gave 3 stellar talks, and we all felt like we were living our own version of the SmartEM podcast. That, or an episode of Seinfeld.

1. The stroke thrombolysis debate.
He wowed us all with a comparison between the science used to interpret the data and astrology, and encouraged us all to look at the fathers of scientific theory (including the 20th century philosopher and economist, Karl Popper) to understand why we should be incredibly cynical at the interpretive methods used.

2. Diagnostics.
The mathematics of likelihood ratios, revisiting his amazing tenets of understanding the utility and limitations of the tests we do. a) All tests are imperfect b) context trumps results c) all tests have a threshold. A man that can explain statistical analysis to somebody as mathematically disabled as I is truly talented.

3. Adrenaline.
We all know it doesn’t work. But has anybody before challenged us so painfully as to why we, as individuals, continue to use it? Plus, the gob smacking truth behind the death of George Washington! Scandal! Does even the NSA know about this???

  • Trevor Jackson, our Australian Keynote, gave us an overview of the progress of education in today’s emergency medicine world. He looked at the constellation of tools now expected in the education of today’s trainees. He also came up with a cracking quiz, and hosted a Graham Norton like chat show to finish up, uncovering a few heretofore unknown truths, such as David Newman’s flashlight fetish.
  • Daniel Fatovich gave an awesome Prezi, on Reversal Of Thinking, challenging us to think about what we might be getting wrong today, based on how we see the incomprehensible dogma of the past, plus the power of groupthink.
  • Steve Lewis, neurosurgeon to the stars, gave us an incredibly interesting talk on concussion, the differing grades, the long term sequelae (and how this differs from what’s seen in TBI – think tau, and ApoE4 as opposed to amyloid) and how the highest incidence in females in the US is from cheerleading. Oh yes.
  • The Ultrasound Superheroes, led by Sonogirl Leanne Hartnett, with Robin, Alfred and Q did not disappoint with their phenomenal oversized ocular props, taking us through orbital ultrasound and reminded us that the measurements of orbital nerve sheath for ICP assessment haven’t yet passed the rigor of scientific testing.
  • Andy Buck and Amit Maini showcased their new short course integrated trauma education, which is looking to eclipse any of the pale old bodies currently on the market. Major kudos to them.
  • The luminescent Di Egerton-Warburton took us on a poignant and reflective journey on how she morphed from Dr Do-Everything to Dr Do-Nothing. She also demonstrated that IV lines can kill (think before you prick) and that Medical Administration have absolutely no sense of humour.
  • The utterly meteoric Nick Jenkins from Slough, yes, let me repeat that, Slough, gave us a masterful presentation on what it is to be a clinical leader. He delighted us with several videos, all of which are worth a watch:

And yes, if anybody wants a job in the UK….. @DrNickJenkins wants to hear from YOU

  •  James Rippey (the man with the brain the size of a planet) was as energetic as ever, reminding us of the amazing basics of ultrasound use, including the simple stuff like how to use a needle with ultrasound.
  • The lovely Colin Parker took us on a nautical journey (would like to add astro- to that, in keeping with the them of this post, but it wouldn’t do justice to Colin’s talk), and challenged us to think about the perils of navigating the diagnostic seas, reminding us of the errors that we make, every time we see a patient.
  • The one and only Casey Parker (@broomedocs) showcased a galaxy of talent, getting his bright stars of the future, his JMOs, to present a case of sepsis, Kimberley style. We learnt that lactate clearance might be a false god (is lactate a compensatory process, and actually good?) and the ultrasound/echo algorithm for assessment of fluid status, plus there was an ethical debate about the unique issues with autonomy in the indigenous patient.
  • Jenny Medcalf and Steve Langford gave talks on the incredible and unique RFDS, incomparable to any other retrieval system on the planet.
  •  We were so incredibly fortunate to listen to the young Australian of the Year Akram Azimi, a man of uncommon sense and internal beauty, who told us about the anthropological roots of empathy, and how we can translate this to the modern day.
  • Anand Senthi. The Big Bang. What else can I say. An absolute force, insisting that we question our pallid approach to the diagnosis and treatment of pulmonary embolus. This man ought to be on tour.
  • Similarly Yusuf Nagree on high sensitivity troponins. Run a mile. Run a very long mile. Be prepared for what they tell you. You have been warned.
  • Anthony Delaney told us about the current Black Hole of sepsis management, where we have accepted the gospel of EGDT, but need to claw our way out to the light of evidence, hence he has implored us all to continue to recruit to the ARISE study, in order to answer some pretty important questions.
  • David McCoubrie scared the bejesus out of us telling us about emerging synthetic drugs of abuse (bless you internet)
  • Fantastic free papers by Michelle Withers & Alyssa Vass showcasing what we’re going to see from the College with regard to education in Indigenous issues, Jennifer Williams looking at the evidence behind cervical spine guidelines, Marian Lee dissecting the communication failures that occur at handover and Vikas Thacker doing his 4:10 on antibiotic sensitivities in urine cultures

And, lastly, our unbelievable star man, who took us through the night sky, on an icicle clear evening, on the magical lawn of the Cable Beach Club, who reminded us that it was us that was spinning, not the sun setting, and demonstrated the raw magic of the stars, and showed us, with whoops of delight, Saturn’s rings in his telescope. Yes, my friends, they really are real.

Thank you to all who partook, it was a truly stellar few days.

And, finally, here is me, completely starstruck.

The author with David Newman

The author with David Newman

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  1. […] Last weekend I had the opportunity to present at the Australasian College for Emergency Medicine’s Winter Symposium in Broome, Western Australia.  The theme of the conference was ‘Not the Usual Suspects’, and it turned out to be a fantastic weekend: hard-edged science blended with art and humanity. […]