Letter From America #2

A small victory — I made it to 5.30 am today, which leaves me just enough time to relate some of the not so insignificant events of yesterday.

Bushy tailed and bright-eyed, I found myself a seat at the trauma review precourse at USC Essentials of emergency medicine in San Francisco. Beneath the vent of an overenthusiastic air conditioning system I soon stopped shivering as profound hypothermia took an insidious hold. Fortunately the pre-precourse warm up involved a big screen appearance of my esteemed countrymen the Flight of the Conchords and their number 23 hit “Hurt Feelings”.

Sanjay Arora MD, an Associate Professor from USC, spearheaded an elite line up of speakers covering the core aspects of trauma evaluation and resuscitation. Highlights included a high yield session on imaging and classic injuries, a succinct look at trauma in pregnancy, a guide to clinical decision making in blunt head injury in both adults and children, a series of procedure videos discussed by Sanjay and Mel as well as the state-of-art in assessing neck, chest and abdominal trauma.

A great moment was Sanjay’s telling of the ‘Egg Splosion’ incident.

I especially liked the hot topics sessions that covered tranexamic acid, massive transfusion, etomidate, ketamine, prothrombin complex concentrate and c-spine rules. Top lecture for me though was a focused evidence-based talk on pediatric trauma by Ilene Claudius MD (Assistant Professor Of Clinical Pediatrics and Assistant Professor of Emergency Medicine, Keck School of Medicine). The talk was delivered a Q and A format that would make LITFL readers feel right at home.

…Of course I was more than chuffed to finally get to say G’day in person to the likes of emergency medicine luminaries like Mel Herbert MD and Scott Weingart MD.


The pivotal moment of the day came between the 23rd and 4th floors of the hotel. As the elevator descended  a distinct grinding could be heard as it began to lurch up and down. I felt like i was inside God’s yo yo. Finally, just shy of the fourth floor, the elevator came to a definite stop. No matter which buttons I pressed the lift remained still and the doors closed. Prising the doors open revealed only the inside wall of the elevator shaft.

Yep, I was stuck between floors.

What to do? There was no emergency number to call, just an alarm buzzer to press. Being from New Zealand…and not wanting to make a fuss I half-heartedly sounded the alarm a few times. Nothing happened. 25 minutes later I was alarming the hell out of that buzzer. Voices were finally heard and the lift began it’s lurching descent again. When it reached the first floor — or not quite as there was a meter drop to the lobby floor — the lift doors began gnashing open and closed like the jaws of a rabid dog. I took this as my cue to effect an Indiana Jones-esque escape and lept to my freedom. I felt like the first escapee from Alcatraz… With tinnitus.

Fortunately, despite my unexpected urban misadventure, in my absence Egerton Y. Davis IV was still able to personally inaugurate the mercurial ZDoggMD as an honorary fellow of the UCEM. ZDoggMD is mixing rap with humor to bring medicine to the peeps and exemplifies the practice of Utopian Medicine. According to Egerton he is a bloody good guy and even bought the eDaddy (as Egerton is now calling himself)…a beer.

Today essentials proper begins, and Egerton will be looking for more fellows to inaugurate… I’ll be using the staircase whenever possible.

Further Reading

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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