Sara Gray

Bio

Dr. Sara Gray is cross-trained in Emergency Medicine and Critical Care. She works in both areas at St. Michael’s Hospital and is an Associate Professor at the University of Toronto. She is also the Medical Director for Emergency Preparedness at St Mike’s. Her academic interests include patient safety and knowledge translation; specifically how to optimize the care of critically ill patients in the ED. Her most important achievements are her kids, who don’t care what she does at work all day, but who enjoy confounding her with obscure trivia questions and beating her at soccer.


Resuscitative Hysterotomy 101

Scared about doing a perimortem section? Unsure what resuscitative hysterotomy means? Come learn the latest evidence and techniques, all in 20 minutes.
This session will review the latest evidence for resuscitative hysterotomy (aka perimortem cesearean section), in light of the latest ACLS guidelines. Is there really evidence for the 4 minute rule? How fast do we need to do this? Terrified of this risky procedure? Come learn some practical tips for getting through this as effectively as possible. No time for the whole podcast? Check out these quick links and references: • http://emupdates.com/2013/10/22/perimortem-cesarean-section-in-the-emergency-department/ This one has many details of the procedure itself. • http://stemlynsblog.org/peri-mortem-c-section-at-st-emlyns/ Great review of the procedure, nice FOAM resources at the end • http://emcrit.org/wee/peri-mortem-c-section/ Includes links to the videos below. • Prefer a review article? This is a great review of the science on maternal cardiac arrest and PMCD (PMID 24797653) • An excellent review of published cases is here (PMID 22613275), describing the details of timing of PMCD as it relates to maternal and neonatal survival

Disaster Triage: Who gets what?

What happens in a mass casualty disaster when you run out of beds? Out of ventilators? Out of blood? Come discuss how (or whether) we should triage scarce resources during disasters.

Most hospitals develop a disaster plan, but few jurisdictions develop a plan for triaging or rationing scarce resources when the existing supply is overwhelmed. Rather than leaving individual health care workers to make these decisions, we should work together as a community of experts to develop ethical, practical and appropriate policies for triaging scarce resources during a disaster. Come and learn what the literature suggests, and join the global debate about this controversial topic.

Prefer a paper to a podcast?

Find solid overviews here:

1. Devereaux A V. Definitive care for the critically ill during a disaster: a framework for allocation of scarce resources in mass critical care. Task Force for Mass Critical Care summit meeting, January 26-27, 2007, Chicago, IL. Chest. 2008;133(5 Suppl):51S – 66S.
2. Christian M et al. Chapter 7. Critical care triage. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster. Intensive Care Med. 2010;36 Suppl 1:S55-S64. doi:10.1007/s00134-010-1765-0.

And nice reviews of the ethics here:

1. Upshur R SP. Stand on guard for thee: ethical considerations in preparedness planning for pandemic influenza: a report of the University of Toronto Joint Centre for Bioethics Pandemic Influenza Working Group. Univ Toronto Jt Cent Bioeth. 2005;(November).
2. Gostin LO, Powers M. What does social justice require for the public’s health? Public health ethics and policy imperatives. Health Aff (Millwood). 2006;25:1053-1060. doi:10.1377/hlthaff.25.4.1053.


DNR Should be the Default - CON

Should DNR be the default? Which side are you on? A SMACC-down debate for the ages.

Most hospitals develop a disaster plan, but few jurisdictions develop a plan for triaging or rationing scarce resources when the existing supply is overwhelmed. Rather than leaving individual health care workers to make these decisions, we should work together as a community of experts to develop ethical, practical and appropriate policies for triaging scarce resources during a disaster. Come and learn what the literature suggests, and join the global debate about this controversial topic.

Prefer a paper to a podcast?

Find solid overviews here:

1. Devereaux A V. Definitive care for the critically ill during a disaster: a framework for allocation of scarce resources in mass critical care. Task Force for Mass Critical Care summit meeting, January 26-27, 2007, Chicago, IL. Chest. 2008;133(5 Suppl):51S – 66S.
2. Christian M et al. Chapter 7. Critical care triage. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster. Intensive Care Med. 2010;36 Suppl 1:S55-S64. doi:10.1007/s00134-010-1765-0.

And nice reviews of the ethics here:

1. Upshur R SP. Stand on guard for thee: ethical considerations in preparedness planning for pandemic influenza: a report of the University of Toronto Joint Centre for Bioethics Pandemic Influenza Working Group. Univ Toronto Jt Cent Bioeth. 2005;(November).
2. Gostin LO, Powers M. What does social justice require for the public’s health? Public health ethics and policy imperatives. Health Aff (Millwood). 2006;25:1053-1060. doi:10.1377/hlthaff.25.4.1053.



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