September 25, 2020

Cayman Islands Critical Illness Symposium SEPT 12-13, 2014 WESTIN RESORT, GRAND CAYMAN

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Screen Shot 2014-09-12 at 7.31.06 AMTenet Healthcare, Florida Region

As one of the largest healthcare networks in Florida, Tenet’s reputation for exceptional medical care makes our hospitals the preferred provider for International patients seeking care in the United States. Tenet Florida Hospitals are a family of ten comprehensive, acute care hospitals operated by compassionate and highly trained healthcare professionals. We offer world-class healthcare and specialized centers of excellence. With 5,000 of the area’s most respected physicians and more than 250 awards, we are committed to providing the highest quality care and service to every patient and family.

Schedule

FRIDAY, SEPTEMBER 12

8:00 AM         Registration and Breakfast

9:00 AM         Welcome and Opening

 

1 – CHAIR: DR. LEE

9:15 AM         Fluid Management: Dead Easy?

Professor Monty Mythen,

10:05 AM       Managing the Acutely Unstable Cardiovascular System

Dr. Ali Shahriari, Tenet Healthcare – Florida Region

10:55 AM       Difficulty in Breathing

Workshop: Dr. Anthony Williams, Health Services Authority

12:15 PM       LUNCH

Screen Shot 2014-09-12 at 7.49.04 AM

SESSION 2 – CHAIR: DR. DULLUM

1:30 PM         How Will a Critically Ill Child Present?

Dr. James Robertson, Cayman Islands

2:20 PM         Acute Stroke Management

Dr. Arun Talkad, Tenet Healthcare – Florida Region

3:10 PM         TEA

3:30 PM         “I Want to Die” – Suicide Risk Assessment & Crisis Intervention

Professor Brian Mishara, University of Quebec

4:30 PM         DRINKS RECEPTION ON THE BEACH (until 7pm)

 

SATURDAY, SEPTEMBER 13

8:00 AM         Registration and Breakfast

 

SESSION 3 – CHAIR: DR. LEE

8:30 AM         Responding to the Deteriorating Patient – A Team Based Approach

Workshop: Dr. Karen Flannery, Tenet Healthcare – Florida Region

9:50 AM         How Does the Body Cope With Extremes?

Professor Monty Mythen, University College London

10:40 AM       CLOSE

Fluid Management: Dead Easy?

Professor Michael (Monty) G. Mythen, MB, BS, MD, FRCA, FFICM, FCAI (Hon)

Biography

Monty is the Smiths Medical Professor of Anesthesia and Critical Care, University College London. He is also director of the UCL / Smiths Medical Discovery Lab at the Institute of Sport Exercise and Health, and a national clinical advisor to the UK Department of Health on enhanced recovery after surgery.

Monty is an elected council member of the Royal College of Anesthetists.   He is chair of the board and council member of the National Institute of Academic Anesthesia. Monty works as editor-in-chief of Perioperative Medicine, is an editorial board member of the British Journal of Anesthesia and Critical Care, and co-chair of Evidence Based Peri-operative Medicine (EBPOM).

Summary

Intravenous fluid (IV) therapy is a ubiquitous intervention in the critically ill patient.   Poor IV fluid management costs lives. IV fluids need to be treated with respect. Like any drug the effects and side effects need to be clearly understood. Prescribing must be thoughtful and regularly reviewed. The choice of IV fluid (the ‘what?’) is important but overwhelmed by the issues of ‘why?’ ‘how?’ ‘how much?’ and in the post-resuscitation period ‘if at all?’ There is a tradition to describe fluid balance in terms of water load. There is increasing attention being given to the more important issue of salt load. Each litre of Saline contains 9g of NaCl. That is a day-and-a-half of a high salt diet!

In treating the Critically ill patient context is critical. What stage is the patient at on the pathway to recovery? Salvage (save a life), Optimisation (save the organs), Stabilistation (minimize harm), De-escalation (facilitate recovery). In true resuscitation – the salvage phase, volume therapy to treat life-threatening hypovolemia is highly effective but hours and days into critical illness the effectiveness of further volume therapy is difficult to demonstrate and may cause significant harm.

References

  1. NICE clinical guideline 174. http://www.nice.org.uk/guidance/cg174
  2. Pearse RM et al. Effect of a perioperative, cardiac output-guided hemodynamic therapy algorithm on outcomes following major gastrointestinal surgery: a randomized clinical trial and systematic review. JAMA. 2014 Jun 4;311(21):2181-90
  3. Mythen MG et al. Perioperative fluid management: Consensus statement from the enhanced recovery partnership. Perioperative

Medicine. 2012 Jun 27;1:2

  1. Myburgh JA, Mythen MG. Resuscitation Fluids. N Engl J Med. 2013 Sep 26; 369(13):1243-51.

Managing the Acutely Unstable Cardiovascular System

Ali Shahriari, MD

Medical Director of the Aortic Disease Institute, Florida Medical Center

 

Biography

is board certified in cardiovascular and thoracic surgery. His areas of interest include aortic aneurysm, endovascular surgery, vascular surgery, complex valve surgery, Marfan’s syndrome and thoracoabdominal / suprarenal aneurysm. He attended medical school at the University of Gothenburg, School of Medicine in Gothenburg, Sweden. He completed his residency in general surgery at Indiana University Medical Center in Indianapolis, IN and his residency in vascular surgery at Sahlgren’s University Hospital, Department of Cardiovascular Surgery in Gothenburg, Sweden. He completed his fellowship in interventional vascular and endovascular therapies at Endovascular Therapies Fellowship Training (ETFT) Program in Peoria, IL and his fellowship in cardiovascular surgery and aortic diseases at Yale University in New Haven, CT. He also completed his fellowship in diagnostic and therapeutic upper gastrointestinal endoscopy and oesophageal stent placement for benign and malignant conditions at Sahlgren’s University Hospital. Dr Shahriari is the Medical Director of the Aortic Disease Institute at Florida Medical Center in Fort Lauderdale.

Summary

There are many causes of an acutely unstable cardiovascular system, the most common   being acute coronary syndrome (ACS). Aortic dissection involving the ascending aorta can be mistaken for ACS and can be a cause of ACS. Regardless of aetiology, rapid assessment with determination of cause with prompt appropriate management of the disease state is critical to ensure optimal outcomes. This presentation will cover recognizing and managing the acutely unstable cardiovascular system with focus on the natural progression of aortic diseases, signs / symptoms, pre-operative management (fluids, transport, etc.), novel surgical interventions and postoperative complications.

Objectives:

  1. Recognize a patient with an acutely unstable cardiovascular system
  2. Understand the progression of acute cardiovascular disease
  3. Discuss the management of patients with acute cardiovascular disease
  4. Be aware of novel interventions for acute cardiovascular disease

Aortic aneurysms (TAA and AAA together) are the 13th leading   cause of mortality in Western countries and are probably responsible for 15,000 to

30,000 deaths per year in the United States. TAAs are classified into four general anatomic categories: ascending (60%), arch   (10%), descending (40%), and thoracoabdominal aneurysms (10%). The fact that AAs can be life threatening and may not produce symptoms makes it all the more important for clinicians to be vigilant in their evaluation of patients at risk. Aneurysms are often first detected on an imaging study ordered for other indications, so any suggestion of an enlarged aorta should prompt follow-up with an appropriate dedicated imaging study. Modern imaging techniques (especially CT and MRI) have now made the sizing and surveillance of aneurysms relatively easy.

References

  1. Braunwald G, et al. ACC/AHA Guidelines for the Management of Patients With Unstable Angina and Non− ST-Segment Elevation Myocardial Infarction: Circulation. 2000;102:1193-1209. http://circ.ahajournals.org/content/102/10/1193
  2. Marino P, Marino’s The ICU Book. 2013. LWW ISBN-10: 1451121180
  3. Shahriari A, Farkas E.A. Treatment of ruptured aortic aneurysms. Chapter 13 in

Elefteriades J.A. (Ed.): Acute Aortic Disease: Informa, 2007, 205-228

  1. Danyi P, Elefteriades J, Jovin I: Medical Therapy of Thoracic Aortic Aneurysms: Are We There Yet? Circulation. 2011;124:1469-76. http://circ.ahajournals.org/content/124/13/1469
  2. Isselbacher E. Thoracic   and   Abdominal Aortic Aneurysms:   Circulation. 2005;

111:816-828. http://circ.ahajournals.org/content/111/6/816

Difficulty in Breathing (workshop)

Dr. Anthony Williams, MBBS, DM

 

Biography

is a consultant in anaesthesia and intensive care employed by the Cayman Islands HSA. He obtained his medical training at both undergraduate and postgraduate levels at the University of the West Indies. He has worked in anaesthesia and intensive care for over 20 years. His professional interests are obstetric and regional anaesthesia and analgesia.

Summary

Dr. Williams and team will be conducting a workshop entitled ‘I Can’t Breathe’ – Acute Respiratory Distress. Difficulty breathing is a common presenting complaint, competing with pain as the primary cause for visits to the emergency department. Patients who develop this symptom may be seen in the outpatient primary care setting, the emergency department, or as an inpatient. Nurses, emergency medical technicians, primary care physicians or emergency care physicians may be the initial contact with these patients and must therefore be equipped to initiate the necessary measures to bring about a successful resolution of the underlying problem. There are numerous pathological processes which are associated with shortness of breath, and making a correct diagnosis can be challenging. Prompt, accurate assessment leading to commencement of appropriate therapy lends itself to reduced anxiety for the patient and family, and a good outcome in these patients. We will review the approach to the management of the patient presenting with acute respiratory distress.

 

References

  1. Shiver J, Santana J. Dyspnea. The Medical Clinics of North America 90 (2006); 453 – 479
  2. Lighezan D, Lighezan R, et al. Acute Dyspnoea: From Pathophysiology, Evaluation to Diagnosis. Timisoara Medical Journal

2006, Vol. 56, No 2-3; 235 – 242

  1. McEvoy M. How to Assess and Treat Acute Respiratory Distress. Journal of Emergency Medical Services. August 2013
  2. Thomas P. ‘I Can’t Breathe’ – Assessment and Emergency Management of Acute Dyspnea. Australian Family Physician 2005 Jul;

34(7):523-9

How Will a Critically Ill Child Present?

Dr. James Robertson, MB, ChB, MRCP, PGCE

Biography

Dr James Robertson graduated from Leeds University in 1989 and completed his training in the northwest of the UK. He is trained   in paediatrics, care   of neonates and cardiology, and has worked in paediatrics for most of his career. He jointly ran a neonatal unit on the Wirral in the North West of the UK for 13 years. He has been on Cayman for over five years.

Summary

Dr Robertson’s presentation will look at how children present with serious illness, but more importantly, look at ways we can try and identify a sick child before they become perilously ill. He will consider training and discuss the merits of scoring charts and their role in the care of children.

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