ED & TRAUMA CARE: PREPARING FOR THE UNEXPECTEDA Collaboration of the Emergency Department & Trauma Continuum Conferences

Thank you to our Premier Sponsor:

Thank you to our Sponsors:

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Conference Planning Committee:

Lee Barratt

Sonya Canzian

Ines De Campos

Mary Dimeo

Karen Gaunt

Carolyn Hamill

Sharon Kim

Amanda McFarlan

Jessica Nanni

Anne Sorvari

Conference Program: December 9, 201107:30 Continental Breakfast & Registration08:00 Welcome & Opening Remarks

Doug Sinclair, Executive Vice President Programs & Chief Medical Officer, St. Michael’s HospitalPlenary Session

(Allan Waters Family Auditorium in the Keenan Research Centre)

08:15 Having Difficult Conversations: “Dodging the Silver Bullet & Reducing Conflict” Judy Clarkson, LLB09:15 Advanced Trauma Life Support Guidelines: Is There Any Science to Guide Us? Laurie Morrison, MD

09:55 Break10:10 Hemorrhage in Trauma: Taking the Occult Out of Shock. Tanya Liv Zakrison, MD10:50 Toxic Exposure: Unexpected Presentations. Margaret Thompson, MD11:30 Lunch

Concurrent SessionsPatients & Families

(Room: 216)

Health Care Professionals / Peers

(Room: 211)

Technology & Research

(Room: 136)12:10 Rhabdomyolysis, Tanning &

Laundry: A Case Review.

Shannon Doucette, RN

Methadone Maintenance and it’s Implications.

Dale Ryan, MD

Rib Fractures: What’s Old is New Again.

Michael McKee, MD

12:45 Families in Crisis: A Father’s Perspective.

Blair Carter

Death Rounds: A Multidisciplinary Debriefing Tool.

Gordon Rubenfeld, MDKlara Siber, MDiv

Brain Function: Are You Fit to Drive?

Tom Schweizer, PhD

13:20 Error, Re-Visits & Groupthink: An ED Case Review.

Lee Barratt, RN

The FACTs about PACT: Coordinating Treatment with a Post Arrest Consult Team.

Karen Wannamaker, RNOrla Smith, RN

A Sim Starter: Learning in Action.

Jennifer Riley, MD

13:55 Break The Great DebatePlenary Session

(Allan Waters Family Auditorium in the Keenan Research Centre)

14:10 Managing the Bariatric Trauma Patient. Avery Nathens, MD14:50 Coroner’s Cases in the ED: Learning from Tragedy. Dan Cass, MD15:30 Closing Remarks / Evaluations15:30 - 16:30 Complimentary Wine and Cheese Reception

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Avery B. Nathens, MD PhD FACS Dr. Nathens is currently the Division Head in General Surgery and Director of Trauma at St. Michael’s Hospital in Toronto, Canada and a Professor of Surgery at the University of Toronto. He is a practicing trauma surgeon and epidemiologist with a focus on trauma system design. He is an active member of the Provincial Trauma Network, and the National Trauma Registry Advisory Committee and holds a Canada Research Chair in Systems of Trauma Care. Internationally, he chairs the National Trauma Databank Sub-Committee and the committee overseeing the Trauma Quality Improvement Program. Dr. Nathens has had extensive experience evaluating trauma system effectiveness and patient flow within a system and has published many landmark peer-reviewed papers in the Lancet, NEJM and JAMA focusing on trauma system design and implementation.

Jennifer Riley, MD Dr. Jennifer Riley is an Emergency Physician St. Michael’s Hospital and Hospital for Sick Children (HSC) in Toronto. She is an Assistant Professor at The University of Toronto, Department of Medicine and Pediatrics. Dr. Riley has been involved in Simulation education and training for almost 10 years at SMH and previously at HSC for trainees of all levels. She has also have been involved in the organization of large scale disaster simulations for residents and health care professionals.

Dale Ryan , B.Sc, BA, B.Ed, MD, FRCPC Dr. Dale Ryan is an Emergency Physician at St. Michael’s Hospital in the Department of Emergency Medicine. He is a Methadone Provider at the AMS clinic in Toronto. Dr. Ryan is also the Medical Director of the Clinesthetics MedSpa.

Gordon D. Rubenfeld, MD, MSc Dr. Gordon Rubenfeld is Professor of Medicine in the Interdepartmental Division of Critical Care Medicine at the University of Toronto and Chief of the Program in Trauma, Emergency, and Critical Care at Sunnybrook Health Science Center. He received his undergraduate education in philosophy and literature at Johns Hopkins University and medical training at Jefferson Medical College, Duke University, University of California San Francisco and the University of Washington. He received training in health services research as a Robert Wood Johnson Clinical Scholar and has a Masters in Epidemiology from the University of Washington.

Dr. Rubenfeld has published over 100 peer reviewed articles related to organization and structure of critical care, epidemiology of acute lung injury, and improving end of life care in the ICU. He is the co-editor, with Randy Curtis of Managing Death in the ICU published by Oxford University Press. Dr. Rubenfeld has served on numerous consensus panels, guideline bodies, and journal editorial boards including Critical Care Medicine, Intensive Care Medicine, Critical Care and the American Journal of Respiratory and Critical Care Medicine.

CONCURRENT SESSIONS: SESSION OBJECTIVES

Session 1: 1210 - 1245

1a. Rhabdomyolysis, Tanning and Laundry: A Case Review Shannon Doucette, RN

Learning Objectives:1. Outline, through a case presentation, the etiology, manifestations, pathophysiology and management of rhabdomyolysis.2. Review key clinical considerations and potential complications from initial presentation through to resolution of rhabdomyolysis.

1b. Methadone Maintenance and it’s Implications Dale Ryan, MD

Learning Objectives:1. Review methadone and it’s uses.2. Review the Methadone Maintenance Program in Ontario.3. Review some common methadone-related presentations in the ED.

1c. Rib Fractures: What’s Old is New Again Michael McKee, MD

Learning Objectives:1. Review general approaches to the evaluation and management of rib fractures.2. Discuss approaches to rib fracture repair including plating, wiring and intramedullary techniques.

Session 2: 1245 - 1320

2a. Families in Crisis: A Father’s Persective Blair Carter, Founding Director and CFO, Safe and Sober Canada

2b. Death Rounds: A Multidisciplinary Debriefing Tool Gordon Rubenfeld, MD & Klara Siber, MDiv

Learning Objectives: 1. Understand how to run interdisciplinary rounds to debrief on moral distress around death in the ICU.2. Learn about lessons learned from these rounds at Sunnybrook.

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Shannon Doucette, RN, BScN, MN Shannon Doucette has been a staff nurse at St. Michael’s Hospital since completing her BscN at Laurentian University in 2002. She completed her critical care certificate at George Brown College in 2003 and is currently working in the Trauma and Neurosurgery ICU. Most recently, she has completed her Masters of Nursing at University of Toronto.

Michael David McKee, MD, FRCS(C) Dr. McKee is a Toronto native who obtained his MD from the University of Toronto in 1986, and graduated from the Orthopaedic Training programme at that institution in 1992 and obtaining his specialty certification that year. He then completed a fellowship in Orthopaedic Traumatology at the Massachusetts General Hospital in 1993 under the supervision of Dr. Jesse Jupiter. He then returned to Toronto and accepted a staff position at St. Michael’s Hospital, University of Toronto in the Division of Orthopaedic Surgery. His clinical practice includes polytrauma, complex fractures, revision fracture care and post-traumatic reconstruction. His research interests include randomized clinical trials in fracture care and prospective trials in post-traumatic reconstruction and bone graft substitutes.Dr. McKee was an ABC Traveling Fellow in 2001, and won the Edwin G. Bovill Award in 2002, 2003, 2005 and 2006 (Outstanding Scientific Paper at the annual meeting of the Orthopaedic Trauma Association - OTA). He was a finalist for the Neer Award from the American Shoulder and Elbow Surgeons in 2002 and 2005, and won the award in 2006. Dr. McKee has also been recognized for teaching (Robert Salter Award for Teaching Excellence, University of Toronto 2002, William Horsey Postgraduate Teaching Award, St. Michael’s Hospital 2005) and has been an examiner in orthopaedics for the Royal College of Physicians and Surgeons of Canada. Dr. McKee is a member of the OTA’s Orthobiologics Committee, is currently involved in a number of funded prospective clinical studies in osteoconductive and osteoinductive bone substitutes and has published extensively in the orthopaedic trauma field.

Laurie Morrison, MD Dr. Morrison is the Robert & Dorothy Pitts Research Chair in Acute Care & Emergency Medicine, Professor and Clinician Scientist in the Division of Emergency Medicine, Department of Medicine at the University of Toronto and Li Ka Shing Knowledge Institute at St Michael’s Hospital. She is the Director of Rescu, a resuscitation research program focusing on the evaluation and implementation of prehospital and transport medicine time sensitive interventions in acute emergencies (www.rescu.ca). She conducts systematic reviews and meta-analyses in topics pertaining to Acute Coronary Syndrome and Resuscitation and has established a collaborative network to conduct randomized controlled trials and outcome validation studies in prehospital resuscitation research. She is a US National Institute of Health, Canadian Institute of Health Research and Heart and Stroke Canada funded investigator within the Resuscitation Outcomes Consortium. She is a past Chair and current member of the Advanced Cardiac Life Support committee of the American Heart Association and on the Editorial Board of the 2010 guidelines in Resuscitation as the Co-Chair of the International Liaison Committee of Resuscitation Advance Life Support Taskforce in 2010. She is the current chair of the Research and Policy Planning Advisory Committee for Heart and Stroke Canada. She was born and educated in Peterborough Ontario, completed her undergraduate at Queens and her medical degree at McMaster. She completed postgraduate training in Emergency Medicine at McGill prior to completing her fellowship at U of T and returning to McMaster in 2000 to obtain a graduate degree in health research design. She has received the Canadian Medical Association award in mentorship; the May Cohen award and was recently celebrated for excellence in mentorship at U of T with the Department of Medicine Bob Hyland award.

CONCURRENT SESSIONS: SESSION OBJECTIVES

Session 2 (con’t): 1245 - 1320

2c. Brain Function: Are You Fit to Drive? Tom Schweizer, PhD

Learning Objectives:1. Review issues behind fitness to drive assessment post acquired brain injury.2. Present new research combining fMRI and driving simulation.

Session 3: 1320 - 1355

3a. Error, Re-Visits & Groupthink: An ED Case Review Lee Barratt, RN

Learning Objectives:1. Understand the influence that working in a busy team environment can have in leading to errors.2. Examine an example of care in the ED where the diagnosis was missed and/or patient complaints were dismissed: To identify where/how a team can make mistakes. To plan and prevent similar situations from occurring.

3b. The FACTS About PACT: Coordinating Treatment with a Post Arrest Consult Team Karen Wannamaker, RN & Orla Smith, RN

Learning Objectives:1. Define Post Cardiac Arrest Syndrome.2. Identify best practices for the treatment of post cardiac arrest syndrome.3. Introduce the PACT as an interdisciplinary team to optimize post cardiac arrest care at St. Michael’s Hospital and review some recent cases assessed by the team.

3c. A Sim Starter: Learning in Action Jennifer Riley, MD

Learning Objectives:1. Discuss the benefits and limitations of simulation-based education.2. Describe the process and reasons for debriefing a simulation session.

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AFTERNOON PLENARY SESSION: SESSION OBJECTIVES

1410 - 1530

Managing the Bariatric Trauma PatientAvery Nathens, MD

Learning Objectives:1. Understand the altered physiology and anatomy of the bariatric patient. 2. Review the literature with respect to outcomes of the bariatric patient. 3. Provide some tips on how to reduce the risk of adverse outcomes in this patient population.

Coroner’s Cases in the ED: Learning from TragedyDan Cass, MD

Learning Objectives:1. Understand the purpose of the coroner’s investigation.2. Understand when to involve a coroner.3. Review some coroner’s cases with relevance to the ED setting.

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SPEAKER BIOGRAPHIES: Lee Barratt, RN Lee Barratt is currently the clinical nurse educator for the emergency department at St. Michael’s. She has been nursing in the ED setting for 12 years. She is also a sexual assault nurse examiner for the Scarborough team. She has had various positions in nursing including instructing nursing both BScN and RPN, flight nursing, and pediatrics.

Blair Carter, Founding Director and CFO, Safe and Sober Canada Blair Carter is an independent Manufacturers Representative, residing in Courtice, ON. He is a founding member of Safe and Sober Canada (http://www.safeandsobercanada.com), an organization started after his daughter’s death in a car crash in 2007. Mr. Carter is a regular speaker and advocate of safer driving practices and pro-active approaches to reducing impaired driving crashes.

Dan Cass, MD Dr. Dan Cass is the Regional Supervising Coroner for Toronto West, and has been a Coroner since 2007. Prior to this, Dr. Cass was a staff emergency physician at St. Michael’s Hospital, and was Chief of the ED for 10 of those years. His current role involves overseeing the more than 1200 death investigations carried out annually in west Toronto. He is also the chair of the Patient Safety Review Committee for the Office of the Chief Coroner, which reviews cases of potentially preventable deaths in the hospital setting and makes recommendations aimed at preventing similar deaths in future.

Judith Clarkson BA, LLB, Cert. Ombudsman Judith Clarkson is an owner of Mediated Solutions. She practices dispute resolution and is a trained, experienced mediator, facilitator, arbitrator and fact finder. Ms. Clarkson is an expert in dealing with dysfunctional /poisoned work environments. Ms. Clarkson was a Registered Nurse and is a Lawyer and a Human Resource expert. Ms. Clarkson taught basic and strategic negotiation courses, and Resolving Conflict in the Workplace at the University of Toronto, in the Dispute Resolution Faculty. Ms. Clarkson is the recipient of the University of Toronto’s Excellence in Teaching Award, adult learning. Ms. Clarkson teaches and coaches in the IR faculty at Queens University. She has published numerous articles on legal and conflict resolution subjects and is a frequent Speaker at Conferences. Ms. Clarkson has been a Director of Human Resources in a teaching hospital practiced labour law and conducted extensive labour negotiations across Canada in the Health Care Sector (long term and acute care settings) and was In House Counsel for a Major Utility Company. Ms. Clarkson provides coaching and executive coaching. Her clients include Health Care facilities, Long Term and Acute settings, Regulated Health Care Professional Colleges, Para Legals, Executives in private and public sector positions.

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AFTERNOON PLENARY SESSION: SESSION OBJECTIVES

1410 - 1530

Managing the Bariatric Trauma PatientAvery Nathens, MD

Learning Objectives:1. Understand the altered physiology and anatomy of the bariatric patient. 2. Review the literature with respect to outcomes of the bariatric patient. 3. Provide some tips on how to reduce the risk of adverse outcomes in this patient population.

Coroner’s Cases in the ED: Learning from TragedyDan Cass, MD

Learning Objectives:1. Understand the purpose of the coroner’s investigation.2. Understand when to involve a coroner.3. Review some coroner’s cases with relevance to the ED setting.

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SPEAKER BIOGRAPHIES: Lee Barratt, RN Lee Barratt is currently the clinical nurse educator for the emergency department at St. Michael’s. She has been nursing in the ED setting for 12 years. She is also a sexual assault nurse examiner for the Scarborough team. She has had various positions in nursing including instructing nursing both BScN and RPN, flight nursing, and pediatrics.

Blair Carter, Founding Director and CFO, Safe and Sober Canada Blair Carter is an independent Manufacturers Representative, residing in Courtice, ON. He is a founding member of Safe and Sober Canada (http://www.safeandsobercanada.com), an organization started after his daughter’s death in a car crash in 2007. Mr. Carter is a regular speaker and advocate of safer driving practices and pro-active approaches to reducing impaired driving crashes.

Dan Cass, MD Dr. Dan Cass is the Regional Supervising Coroner for Toronto West, and has been a Coroner since 2007. Prior to this, Dr. Cass was a staff emergency physician at St. Michael’s Hospital, and was Chief of the ED for 10 of those years. His current role involves overseeing the more than 1200 death investigations carried out annually in west Toronto. He is also the chair of the Patient Safety Review Committee for the Office of the Chief Coroner, which reviews cases of potentially preventable deaths in the hospital setting and makes recommendations aimed at preventing similar deaths in future.

Judith Clarkson BA, LLB, Cert. Ombudsman Judith Clarkson is an owner of Mediated Solutions. She practices dispute resolution and is a trained, experienced mediator, facilitator, arbitrator and fact finder. Ms. Clarkson is an expert in dealing with dysfunctional /poisoned work environments. Ms. Clarkson was a Registered Nurse and is a Lawyer and a Human Resource expert. Ms. Clarkson taught basic and strategic negotiation courses, and Resolving Conflict in the Workplace at the University of Toronto, in the Dispute Resolution Faculty. Ms. Clarkson is the recipient of the University of Toronto’s Excellence in Teaching Award, adult learning. Ms. Clarkson teaches and coaches in the IR faculty at Queens University. She has published numerous articles on legal and conflict resolution subjects and is a frequent Speaker at Conferences. Ms. Clarkson has been a Director of Human Resources in a teaching hospital practiced labour law and conducted extensive labour negotiations across Canada in the Health Care Sector (long term and acute care settings) and was In House Counsel for a Major Utility Company. Ms. Clarkson provides coaching and executive coaching. Her clients include Health Care facilities, Long Term and Acute settings, Regulated Health Care Professional Colleges, Para Legals, Executives in private and public sector positions.

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Shannon Doucette, RN, BScN, MN Shannon Doucette has been a staff nurse at St. Michael’s Hospital since completing her BscN at Laurentian University in 2002. She completed her critical care certificate at George Brown College in 2003 and is currently working in the Trauma and Neurosurgery ICU. Most recently, she has completed her Masters of Nursing at University of Toronto.

Michael David McKee, MD, FRCS(C) Dr. McKee is a Toronto native who obtained his MD from the University of Toronto in 1986, and graduated from the Orthopaedic Training programme at that institution in 1992 and obtaining his specialty certification that year. He then completed a fellowship in Orthopaedic Traumatology at the Massachusetts General Hospital in 1993 under the supervision of Dr. Jesse Jupiter. He then returned to Toronto and accepted a staff position at St. Michael’s Hospital, University of Toronto in the Division of Orthopaedic Surgery. His clinical practice includes polytrauma, complex fractures, revision fracture care and post-traumatic reconstruction. His research interests include randomized clinical trials in fracture care and prospective trials in post-traumatic reconstruction and bone graft substitutes.Dr. McKee was an ABC Traveling Fellow in 2001, and won the Edwin G. Bovill Award in 2002, 2003, 2005 and 2006 (Outstanding Scientific Paper at the annual meeting of the Orthopaedic Trauma Association - OTA). He was a finalist for the Neer Award from the American Shoulder and Elbow Surgeons in 2002 and 2005, and won the award in 2006. Dr. McKee has also been recognized for teaching (Robert Salter Award for Teaching Excellence, University of Toronto 2002, William Horsey Postgraduate Teaching Award, St. Michael’s Hospital 2005) and has been an examiner in orthopaedics for the Royal College of Physicians and Surgeons of Canada. Dr. McKee is a member of the OTA’s Orthobiologics Committee, is currently involved in a number of funded prospective clinical studies in osteoconductive and osteoinductive bone substitutes and has published extensively in the orthopaedic trauma field.

Laurie Morrison, MD Dr. Morrison is the Robert & Dorothy Pitts Research Chair in Acute Care & Emergency Medicine, Professor and Clinician Scientist in the Division of Emergency Medicine, Department of Medicine at the University of Toronto and Li Ka Shing Knowledge Institute at St Michael’s Hospital. She is the Director of Rescu, a resuscitation research program focusing on the evaluation and implementation of prehospital and transport medicine time sensitive interventions in acute emergencies (www.rescu.ca). She conducts systematic reviews and meta-analyses in topics pertaining to Acute Coronary Syndrome and Resuscitation and has established a collaborative network to conduct randomized controlled trials and outcome validation studies in prehospital resuscitation research. She is a US National Institute of Health, Canadian Institute of Health Research and Heart and Stroke Canada funded investigator within the Resuscitation Outcomes Consortium. She is a past Chair and current member of the Advanced Cardiac Life Support committee of the American Heart Association and on the Editorial Board of the 2010 guidelines in Resuscitation as the Co-Chair of the International Liaison Committee of Resuscitation Advance Life Support Taskforce in 2010. She is the current chair of the Research and Policy Planning Advisory Committee for Heart and Stroke Canada. She was born and educated in Peterborough Ontario, completed her undergraduate at Queens and her medical degree at McMaster. She completed postgraduate training in Emergency Medicine at McGill prior to completing her fellowship at U of T and returning to McMaster in 2000 to obtain a graduate degree in health research design. She has received the Canadian Medical Association award in mentorship; the May Cohen award and was recently celebrated for excellence in mentorship at U of T with the Department of Medicine Bob Hyland award.

CONCURRENT SESSIONS: SESSION OBJECTIVES

Session 2 (con’t): 1245 - 1320

2c. Brain Function: Are You Fit to Drive? Tom Schweizer, PhD

Learning Objectives:1. Review issues behind fitness to drive assessment post acquired brain injury.2. Present new research combining fMRI and driving simulation.

Session 3: 1320 - 1355

3a. Error, Re-Visits & Groupthink: An ED Case Review Lee Barratt, RN

Learning Objectives:1. Understand the influence that working in a strong team environment can have on an individual.2. Examine examples of care in the ED where the diagnosis was missed and/or patient complaints were dismissed: To identify where/how the team went wrong. To plan and prevent similar situations from occurring.

3b. The FACTS About PACT: Coordinating Treatment with a Post Arrest Consult Team Karen Wannamaker, RN & Orla Smith, RN

Learning Objectives:1. Define Post Cardiac Arrest Syndrome.2. Identify best practices for the treatment of post cardiac arrest syndrome.3. Introduce the PACT as an interdisciplinary team to optimize post cardiac arrest care at St. Michael’s Hospital and review some recent cases assessed by the team.

3c. A Sim Starter: Learning in Action Jennifer Riley, MD

Learning Objectives:1. Discuss the benefits and limitations of simulation-based education.2. Describe the process and reasons for debriefing a simulation session.

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Avery B. Nathens, MD PhD FACS Dr. Nathens is currently the Division Head in General Surgery and Director of Trauma at St. Michael’s Hospital in Toronto, Canada and a Professor of Surgery at the University of Toronto. He is a practicing trauma surgeon and epidemiologist with a focus on trauma system design. He is an active member of the Provincial Trauma Network, and the National Trauma Registry Advisory Committee and holds a Canada Research Chair in Systems of Trauma Care. Internationally, he chairs the National Trauma Databank Sub-Committee and the committee overseeing the Trauma Quality Improvement Program. Dr. Nathens has had extensive experience evaluating trauma system effectiveness and patient flow within a system and has published many landmark peer-reviewed papers in the Lancet, NEJM and JAMA focusing on trauma system design and implementation.

Jennifer Riley, MD Dr. Jennifer Riley is an Emergency Physician St. Michael’s Hospital and Hospital for Sick Children (HSC) in Toronto. She is an Assistant Professor at The University of Toronto, Department of Medicine and Pediatrics. Dr. Riley has been involved in Simulation education and training for almost 10 years at SMH and previously at HSC for trainees of all levels. She has also have been involved in the organization of large scale disaster simulations for residents and health care professionals.

Dale Ryan , B.Sc, BA, B.Ed, MD, FRCPC Dr. Dale Ryan is an Emergency Physician at St. Michael’s Hospital in the Department of Emergency Medicine. He is a Methadone Provider at the AMS clinic in Toronto. Dr. Ryan is also the Medical Director of the Clinesthetics MedSpa.

Gordon D. Rubenfeld, MD, MSc Dr. Gordon Rubenfeld is Professor of Medicine in the Interdepartmental Division of Critical Care Medicine at the University of Toronto and Chief of the Program in Trauma, Emergency, and Critical Care at Sunnybrook Health Science Center. He received his undergraduate education in philosophy and literature at Johns Hopkins University and medical training at Jefferson Medical College, Duke University, University of California San Francisco and the University of Washington. He received training in health services research as a Robert Wood Johnson Clinical Scholar and has a Masters in Epidemiology from the University of Washington.

Dr. Rubenfeld has published over 100 peer reviewed articles related to organization and structure of critical care, epidemiology of acute lung injury, and improving end of life care in the ICU. He is the co-editor, with Randy Curtis of Managing Death in the ICU published by Oxford University Press. Dr. Rubenfeld has served on numerous consensus panels, guideline bodies, and journal editorial boards including Critical Care Medicine, Intensive Care Medicine, Critical Care and the American Journal of Respiratory and Critical Care Medicine.

CONCURRENT SESSIONS: SESSION OBJECTIVES

Session 1: 1210 - 1245

1a. Rhabdomyolysis, Tanning and Laundry: A Case Review Shannon Doucette, RN

Learning Objectives:1. Outline, through a case presentation, the etiology, manifestations, pathophysiology and management of rhabdomyolysis.2. Review key clinical considerations and potential complications from initial presentation through to resolution of rhabdomyolysis.

1b. Methadone Maintenance and it’s Implications Dale Ryan, MD

Learning Objectives:1. Review methadone and it’s uses.2. Review the Methadone Maintenance Program in Ontario.3. Review some common methadone-related presentations in the ED.

1c. Rib Fractures: What’s Old is New Again Michael McKee, MD

Learning Objectives:1. Review general approaches to the evaluation and management of rib fractures.2. Discuss approaches to rib fracture repair including plating, wiring and intramedullary techniques.

Session 2: 1245 - 1320

2a. Families in Crisis: A Father’s Persective Blair Carter, Founding Director and CFO, Safe and Sober Canada

2b. Death Rounds: A Multidisciplinary Debriefing Tool Gordon Rubenfeld, MD & Klara Siber, MDiv

Learning Objectives: 1. Understand how to run interdisciplinary rounds to debrief on moral distress around death in the ICU.2. Learn about lessons learned from these rounds at Sunnybrook.

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Klara Siber, MDiv; MHSc (Bioethics)Klara Siber is a certified spiritual care professional who has been working at Sunnybrook Health Sciences since 2003. She holds a Bachelor of Religious Studies degree and a Master of Divinity, Counselling degree from Tyndale University College and Seminary. Her interest in end-of-life and critical care has led her complete a Master of Health Sciences in Bioethics at the University of Toronto. She co-chairs the Critical Care Ethics advisory group and co-facilitates monthly Last Rights (Death) Round. In addition to her responsibilities to provide spiritual care in a multicultural context, Klara is involved in research, teaching and mentoring of Clinical Pastoral Education Students as well as other healthcare providers.

Orla Smith, RN, MN, CNCC(C) Orla Smith manages research activities in the Critical Care Department at St. Michael’s Hospital. She is also an instructor in nursing at Ryerson University. Orla has over 10 years of experience in critical care nursing and research. Orla’s research interests include: treatment and research decision-making in the ICU; patient safety and quality improvement in critical care including the delivery of optimal post-arrest care; organizational culture and patient safety; and building individual and organizational capacity for nursing research. Orla is currently working on her PhD at the University of Toronto.

Tom Schweizer PhDTom Schweizer is a Scientist at the Keenan Research Centre of the Li Ka Shing Knowledge Institute at St. Michael’s Hospital. Dr. Schweizer has a PhD in behavioural Neuroscience and competed postdoc at the Rotman Research Institute at Baycrest. Current positions: Scientist, Keenan Research Centre of the Li Ka Shing Knowledge Institute at St. Michael’s Hospital; Assistant Professor, Division of Neurosurgery, Faculty of Medicine, University of Toronto; and Assistant Professor, Institute of Biomaterials and Biomedical Engineering, University of Toronto.

Margaret Thompson, MDDr. Margaret Thompson is an Emergency Physician at St. Michael’s Hospital and the Medical Director of the Ontario Poison Centre at the Hospital for Sick Children. She is double certified in Emergency Medicine by the Royal College of Physicians and Surgeons of Canada and the American Board of Emergency Medicine. She is also a Fellow of the American College of Medical Toxicology.

Karen Wannamaker, RN, BSc., CNCC(C)Interim Nurse Specialist - Education. Medical Surgical Intensive Care Unit (MSICU), St Michael’s Hospital. Karen has over 20 years of experience in Critical Care Nursing. She was the Resource Nurse in MSICU from 2006-2010, and a George Brown Clinical Educator from 2008-2009. She is co-chair of the Cardiac Arrest Committee and a member of the Post Arrest Consult Team (PACT).

Tanya Liv Zakrison, MHSc, MD, FRCSC, MPH(c) Tanya Zakrison is currently working as a Clinical Associate at St. Michael’s Hospital in the Division of General Surgery. She has completed fellowship training in Critical Care Medicine at Sunnybrook Health Sciences Centre and Trauma & Acute Care Surgery at University of Miami’s Ryder Trauma Center. In addition to her clinical work, she is currently pursuing an MPH with the Johns Hopkins Bloomberg School of Public Health. Her current interests include identifying hospital-based quality improvement issues in the field of trauma and acute care surgery using a mixed-methods approach, with heavy emphasis on qualitative research.

MORNING PLENARY: SESSION OBJECTIVES

Having Difficult Conversations: “Dodging the Silver Bullet and Reducing Conflict” Judith Clarkson, BA, LLB, Cert. Ombudsman

Learning Objectives: 1. Planning for difficult conversations. 2. Responding to bullying in the workplace. 3. How to use negotiation and mediation skills in relevant workplace situations. 4. Trends and developments in managing workplace conflict and poisoned work environment.

Advanced Life Support Guidelines: Is There Any Science to Guide Us? Laurie Morrison, MD

Learning Objectives: 1. Feel comfortable with the new changes in the ACLS guidelines. 2. Understand what aspects of care have any scientific validity. 3. Learn what practices should continue and what should be dropped from our treatment algorithms.

Hemorrhage in Trauma: Taking the Occult Out of Shock Tanya Liv Zakrison, MD

Learning Objectives: 1. Define occult shock. 2. Understand the pathophysiology of the shock state in the trauma patient. 3. Learn how to identify occult shock. 4. Learn how patient outcomes are affected by occult shock.

Toxic Exposure: Unexpected Presentations Margaret Thompson, MD

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ED & TRAUMA CARE:

PREPARING FOR THE UNEXPECTEDA Collaboration of the Emergency Department & Trauma Continuum Conferences

Thank you to our Premier Sponsor:

Thank you to our Sponsors: