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Deathby PowerPoint

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Who am I to teach you this?

Hon Liang Tan

Science

9 seconds

https://advertising.microsoft.com/en/.../microsoft-attention-spans-research-report.pdf

8

Common PowerPoint Mistakes

Doing it wrong

People tend to put every word they are going to say

on the PowerPoint slide. Although this eliminates the need to memorize

your talk, ultimately this makes your slides

crowded, wordy and boring. You will lose your

audience’s attention before you reach...Credits: Don MacMillan

• Avoid• Excessive

• Bullet • Pointing.

• Only• Bullet• Key

• Points.• Too

• Many

• Bullet • Points

• And• Your• Key

• Messages • Will• Not

• Stand• Out.

• InFact• The• Term

• BulletPoint • Comes• From

• People• Firing

• Guns at• Annoying• Presenters

Credits: Don MacMillan

Many people do not run spell cheek before their presentation.BIG MISTAK!!!

Nothing makes the speaker look stupidor that spelling errers.

Credits: Don MacMillan

Clin Oral Investig. 2016 Jul 8. [Epub ahead of print]Impact of the intermediary layer on sealant retention: a randomized 24-month clinical trial.Moreira KM1, Kantovitz KR1,2, Aguiar JP1, Borges AF3, Pascon FM1, Puppin-Rontani RM4.Author information

AbstractOBJECTIVES:The aims of this study were to assess long-term impact of tooth eruption stages (ES) on sealant retention on occlusal surfaces previously coated with intermediary bonding layer and to determine caries prevention.MATERIALS AND METHODS:Sixty-five school children were selected (aged 6-10 years), with four non-carious permanent first molar in different ES (OP (operculum present), ME (marginal edge), CE (completely erupted)). Split-mouth and single-blind study design was used. The teeth (260) were randomly selected according to treatment (sealant/technique): F (Fluroshield), H (Helioseal Clear Chroma), SF (Single Bond + F), EH (Excite + H). Sealant retention, marginal integrity, discoloration, and caries prevention were assessed after 6, 12, 18, and 24 months by calibrated examiner (Spearman = 0.91) using visual inspection. Data were submitted to the Cox proportional hazard model (survival analysis) and Likelihood ratio χ 2 test (correlation), p ≤ 0.05.RESULTS:At baseline, ES was 20 % in OP, 54 % in ME, and 26 % in CE. There was no significant difference on sealant retention between the treatments (p = 0.2774). However, significant differences were found regarding the ES on sealant retention (p = 0.0041). The CE stage showed the highest retention survival rate during the 24 months. The overall sealant prevention average was found to be about 99.4 % and showed no difference between the groups.CONCLUSIONS:Eruption stages affect sealant retention irregardless of the intermediate layer and type of sealant. However, there was caries prevention on tooth occlusal surfaces after 24 months, regardless of treatment.CLINICAL RELEVANCE:Sealing is recommended to prevent occlusal caries of newly erupted teeth in high-caries-risk patients. However, its application is critical on moisture limited control surfaces independently of sealer material and technique.KEYWORDS:Adhesive system; Clinical trial; Intermediary layer; Pit and fissure sealants; Retention; Tooth eruption

Clashing color schemes and font colors lead to:

• Distraction• Confusion• Headaches

• Nausea• Vomiting

• Loss of Bladder Control

Bad Color Schemes

Credits: Don MacMillan

Phail if you saySorry for this busy slide

I am not sure if you can see this (at the back)

I hope you can see this

Hmm, the color/text is not coming through

Fail if you …Look like you suffer from torticollis

Sound like rapidly passing trains

Think you are Luke Skywalker waving a Light Saber

Some Useful Principles

Be Lateral, Not Literal

Some Useful Principles

Tell a story

Humor

Engage the Audience

Change something

Change anything

Use alternative media

My Approach

Audience Content/information

Think about it a bit

My Approach

My ApproachThink lateral Think punchlines

Have a story board

My Approach

Work

Disclosure

My Approach

Work Think Laugh

Make slides

Shuffle slides

Make many slides

My Approach

Hello Hello Hello

Hello Hello Hello

Avoid too many words

Airway/ATLS

Size

Extent

Immediate Assessment

AirwayInhalation Injury

PrimarySecondary

ExtentBurns Classification

Fluid Resuscitation

Why it is important in the first 24 hours

Modified Parkland’s4 ml/kg/TBSA

Collis N, Smith G, Fenton OM: Accuracy of burn size estimation and subsequent fluid resuscitation prior to arrival at the Yorkshire Regional Burns Unit. A three year retrospective study. Burns 1999, 25:345-351.Holm C: Resuscitation in shock associated with burns. Tradition or evidence based medicine? Resuscitation 2000, 44:157-164.Csontos C, Foldi V, Fischer T, Bogar L: Factors affecting fluid requirement onthe first day after severe burn trauma. ANZ J Surg 2007, 77:745-748.

Modified Brooke’s2 ml/kg/TBSA

More than

Crystalloids - HartmanColloid - 5% Albumin

Hemodynamic Goals

Adequate Perfusion

Goldilocks Principle

Lactate

Base Deficit0.5 - 1.0 ml / kg

Kamolz LP, Andel H, Schramm W, Meissel G, Herndon DN, Frey M: Lactate an early predictor of morbidity and mortality in patients with severe burns. Burns 2005, 31:986-990.Jeng JC, Lee K, Jablonski K, Jordan MH: Serum lactate and base deficit suggest inadequate resuscitation of patients with burns injuries: application of point-of-care laboratory instrument. J Burn Care Rehabil 1997, 18:402-405.

Lines

Early Surgery

Cardiogenic

Burn Shock

Distributive

Hypovolemic

Blood ProductsHb Threshold?

ABA trial

Palmieri TL, Lee T, O’Mara MS, Greenhalgh DG: effects of a restrictive blood transfusion on outcomes in children with burn injury. J Burn Care Res 2007, 28:65-70.Kwan P, Gomez M, Cartotto R: Safe and successful restriction of transfusion in burn patients. J Burn Care Res 2006, 27:826-834.7-8 vs10-11 g/dL Transfusion Trigger: https://clinicaltrials.gov/ct2/show/NCT01079247Palmieri TL, Caruso DM, Foster KN, et al: E ect of blood transfusion on outcome after major burn injury: a multi-centre study. Crit Care Med 2006, 34:1602-1607.Hardy JF, De Moerloose P, Samama M: Massive transfusion and coagulopathy: pathophysiology and implications for clinical management. Can J Anaesth 2004; 51:293-310.

Hct >30?

Back in the ICU

Eye

Bartley AC, Edgar DW, Wood FM: Pharmaco-management of inhalation injuries for burn survivors. Drug Des Devel Ther 2008, 2:9-16.Miller AC, Rivero A, Ziad S, Smith DJ, Elamin EM: Influence of nebulised unfractionated heparin and N-acetylcystine in acute lung injury after smoke inhalation injury. J Burn Care Res 2009, 30:249-256. Kashefi NS, Nathan JI, Dissanaike S. Does a Nebulized Heparin/N-acetylcysteine Protocol Improve Outcomes in Adult Smoke Inhalation? Plastic and Reconstructive Surgery Global Open. 2014;2(6):e165. doi:10.1097/GOX.0000000000000121.

5-10K U Q4H?+

NAC?+

Salbutamol?

Medications

AnalgesiaSedation

Gastric Protection

Antibiotics?

Cefazolin

Difficult ++

ProcalcitoninCRP

De La Cal MA, Cerda E, Garcia-Hierro P, van Saene HKF, Gomez-Santos D,Negro E, Lorente JA: Survival bene t in critically ill burned patients receiving selective decontamination of the digestive tract: a randomised placebo-controlled, double blind trial. Ann Surg 2005, 23:424-430.Silvestri L, de la Cal MA, Taylor N, van Saene HKF, Parodi PC: Selective decontamination of the digestive tract in burn patients: an evidence based manoeuvre that reduces mortality. J Burn Care Res 2010, 31:372-373.

Prophylaxis?Selective decontamination

of the digestive tract?

Vitamin C?66 mg/kg/hr x 24hr

Tanaka H, Matsuda T, Miyagantani Y, Yukioka T, Matsuda H, Shimazaki S: Reduction of resuscitation fluid volumes in severely burned patients using ascorbic acid administration: a randomised, prospective study. Arch Surg 2000, 135:326-331.

Calories / Insulin?Protein

Trace elementsGlutamine?

Kurmis R, Parker A, Greenwood J: The use of immunonutrition in burn injury care: where are we? J Burn Care Res 2010, 31:677-691.

Propanalol?20 % of Max HR

(5 days post)

Herndon DN, Hart DW, Wolf SE, Chinkes DL, Wolfe RR: Reversal of catabolism by beta-blockade after severe burns. N Engl J Med 2001, 345:1223-1229.Pereira CT, Jeschke MG, Herndon DN: Beta-blockade in burns. Novartis Found Symp 2007, 280:238-248.

Oxandrolone?10 mg BD x 1 year

(5 days post)

Demling RH: Comparison of the anabolic e ects and complications of human growth hormone and the testosterone analogue, oxandrolone, after severe burn injury. Burns 1999, 25:215-221. Wolf SE, Edelman LS, Kemalyan N, Donison L, et al.: Effects of oxandrolone on outcome measures in the severely burned: a multicentre prospective randomised double blind trial. J Burn Care Res 2006, 27:131-139.

Acute Kidney Injury

Ventilator Associated Pneumonia

Catheter Associated Bloodstream Infection

Multi resistant OrganismsDelirium

Critical Care Associated Neuropathy and Myopathy

Abdominal Compartment Syndrome

Deep Vein Thrombosis Bleeding Gastric Ulcer

Acute Respiratory Distress Syndrome

Disseminated Intravascular Coagulopathy

Rhabdomyolysis

*

* RESCUE trial: https://clinicaltrials.gov/ct2/show/NCT01213914

+

SGH BURNS ICU

SummaryTropical Holiday

Trips (to BOT)Nice weather (Normothermia)

Well hydrated (Fluid)Well nourished (Nutrition)Relaxed (Analgesia, HR)Activities (Rehabilitation)

Tropical Holiday

Fluid ResuscitationLines

(Bronchoscopy)Surgery

MedicationsNutrition

First 24 hours

ICU ComplicationsWound Care

Multi-Disciplinary Rehabilitation

The rest of the stay

Talent vs Practice

Practice Practice Practice

InformationMedia

Delivery

Audience

Summary

SummaryAvoid Common “Fails”

Work Think Laugh

Practice

@HonLiangTantanhonliang@gmail.com

tan.hon.liang@singhealth.com.sg