all modules
Choosing Wisely campaign
February 6, 2019Review the 6 radiology related pathways from the Choosing Wisely campaign, which will be implemented soon. Most of these are well known to ED clinicians and should already form the backbone of your clinical practice. If you are unaware of these feel free to review them and discuss with a… Read more
NEW TROPONIN – OLD TIMI
February 6, 2019Thanks to Prof Anne-Maree Kelly for her update on the new troponin assay. She has provided a flowchart and FAQ below for you to review. Please also see the TIMI scoring worksheet, for those unfamiliar with the TIMI score. Read more
walking through the central line
November 13, 2018we discovered at registrar training last week that many of our team had not placed a central line so here is a walk through the process…. PREPARATION Patient: Why does the patient need CVC – access, multiple lumens, centrally active medications, monitoring Where should the CVC go – IJ, subclavian,… Read more
Sepsis pathway
November 6, 2018There is a new sepsis pathway which will rollout 5th November at Western Health. The pathway contains two important and useful components: a bundle of actions to execute within the first 60 minutes of suspicion of sepsis empiric antibiotics, grouped by suspected source There is an opt-out… Read more
Anaphylaxis notifications
November 6, 2018There are new MANDATORY anaphylaxis notifications that have been issued by the Department of Health that are IN EFFECT as of 1st November 2018. You can read the entire document below but the most important parts have been extracted below: What to notify? ALL cases of anaphylaxis that present… Read more
Fractures poster
October 15, 2018This poster was created by Simon Green, a nurse practitioner, and modified for use at Western Health by Ian Law and Neil Long Read more
SMS: Thinking about paediatrics
October 13, 2018Thanks to A/Prof Dr David Krieser for his presentation at Senior Medical Staff teaching in October 2018. His talk has been broken into 3 parts: Don’t Forget the Bubbles recap 2. Paediatric cases and paediatric deaths in ED 3. ED redevelopment and other shortcuts in paeds ED… Read more
Coffee and cases – Consultant teaching 22 June 2018
August 2, 2018Thanks for attending consultant teaching yesterday. With my educator’s hat on, staged repetition is the best way to remember, so here are some links to some of the topics we discussed: Propranolol OD (Justin Curran): https://lifeinthefastlane.com/toxicology-conundrum-044/ http://www.emdocs.net/wp-content/uploads/2015/08/HighDoseInsulinCCB-Yuan-.pdf Knee Dislocation (John Loy): https://emergencymedicinecases.com/occult-knee-injuries/ Rice Bezoar (Gary Ayton): Only 1 publication:… Read more
CALLING FOR HELP – Responsibilities of the On-Call FACEM
July 19, 2018RESPONSIBLITES OF THE ON-CALL FACEM Read more
Trauma day 2018
April 17, 2018Thanks to ED physicians Dr Karen Winter, Dr Ruth Hew, Dr Stacy Turner, Dr Raj Patel, Dr Terence Yuen and radiology fellow Dr Aaron Ow for co-ordinating the 2018 trauma session. Review the following posts relevant to the workshop stations: Pelvic Binder Femoral splint – CT6 and Donway… Read more
PAEDS: the 180 degree manouevre
April 5, 2018As part of his great introductory sessions on the sick child, paediatric emergency physician Dr David Krieser routinely demonstrates the 180 degree manouevre – a slick method to assess tone in infants, which can be modified to add other parts of the routine examination for a smooth, systematic performance. Review… Read more
Compartment pressures
December 6, 2017Compartment syndrome will be commonly encountered by emergency physicians in cases of trauma or infection of the distal limbs. It should be considered in any significant mechanism injury as well as in cases of pain out of proportion to the injury. The 6P’s of vascular compromise (pain, pallor, perishing cold,… Read more
Headspace referrals
June 28, 2017REFERRAL TO HEADSPACE SUNSHINE: (12-25yo, presenting with mild-moderate mental health difficulties) Business Hours: Fax ED assessment/notes to headspace Access Team, followed up with phone call to confirm receipt of the assessment (if possible, patient can speak with Access Team to ‘fast-track’ intake process) Afterhours presentations: fax assessment, leave a voicemail… Read more
Rib and sternal fractures
February 21, 2017All staff please note a recent highlight on the rib and sternal fracture policy: Key points: Surgical teams (eg. Thoracics at Footscray and General surgery at Sunshine) are required referrals in addition to Acute Pain Management Service and Allied Health however: From the policy: “The ED physician shall decide which admitting unit… Read more
Hospital in the home (HITH)
February 14, 2017Thanks to HITH registrar Dr Pamela Anjara and ID physician Dr Cristina Mateevici for providing their presentation about HITH services at the end of last year. Key points: HITH registrar is on extension 56309 – 24 hrs a day Admission conditions include IV antibiotics – cellulitis, multi-drug resistant TB,… Read more
DVT/VTE prophylaxis
November 23, 2016Please consider DVT/PE prophylaxis in admitted and select outpatient cases. Read more
How to: talk the talk
September 23, 2016Presenting in front of our peer group is usually about as fun as pulling teeth, but it is a valuable experience – both for the speaker – in the act and practice of information transfer, and for the audience – a chance to receive new information and new ways of… Read more
Central venous catheterisation (CVC)
August 31, 2016Here are some resources that I’ve found useful. How to scrub. This is often done badly in ED – there’s no excuse for this. Please make sure that the insertion site, the patient and the bed are all covered by drapes. Blind insertion. This is not recommended. There is a ton of… Read more
The ideal crystalloid
July 1, 2016Those interested in acid-base balance should have a read of this post by Josh Farkas on the Emcrit website. It follows on nicely from my acid-base talk, and I’ve added it to the notes there too. Another nail in the coffin for (ab)normal saline? Read more
Aged Care Liaison Service: Palliation
June 23, 2016Review the discharge process for residential care facility patients requiring palliation via the Aged Care Liaison Service: Read more
Aged Care Liaison Service: Antibiotics
June 23, 2016Review the discharge process for care facility patients requiring antibiotics via the Aged Care Liaison Service: Read more
RSI: Pre-Ox and Ap-Ox for RSI
May 5, 2016Scott Weingart from EMCrit on pre-ox and ap-ox for the emergency RSI. Fits in well with the talks on safe RSI and hypoxic RSI by me. Summary: Non-hypoxic patient: Pre-ox and Ap-Ox: Non rebreather mask (NRBM) and Nasal cannula (NC), both @ 15L/min or any of the options below Hypoxic… Read more
Nicotine replacement
April 9, 2016Review the full Nicotine Replacement Therapy Guidelines for those patients in ED requiring NRT (ie. psychiatric admissions). The most pertinent sections are appendix 3 and appendix 1, reproduced below: Read more
Trauma Victoria
March 23, 2016The Trauma Education initiative is a multi-centre collaborative project lead by Adult Retrieval Victoria and the Department of Health on behalf of the Victorian State Trauma System to deliver a trauma-focussed sustainable state-wide educational system for clinical staff (doctors, nurses, paramedics) across Victoria. It contains a series of easily consumed modules covering a comprehensive range… Read more
Pre-Oxygenation Update
March 15, 2016A great discussion on pre-oxygenation in the ED and pre-hospital environments, from the PHARM podcast. Check out the show notes and references here. Key Points: A BVM (with PEEP valve) will provide better pre-oxygenation than a NRBM (non-rebreather) AS LONG AS THERE IS A GOOD SEAL. Adding nasal cannulae may… Read more
RSI: The Hypoxic RSI
March 11, 2016How not to kill your hypoxic patient. Key Points: Pre-Oxygenate with CPAP/BVM+PEEP Sit up Use Ap-Ox Roc rocks 1st pass success is critical Ventilate during apnoea Show Notes: Pre-oxygenation Preoxygenation, Reoxygenation and Deoxygenation – EMCrit Covers Pre-oxygenation with CPAP in the hypoxic patient – watch the 2 videos Preoxygenation… Read more
RSI: RSI in the shocked patient
March 11, 2016How not to kill your shocked patient. Key Points: Pre-treat to get the BP up Dose Induction drugs low, Paralytics high Ventilate Gently Show Notes: Only a couple this week: Scott Weingart from EMCrit on how to safely intubate the shocked patient and some additional references if you’re… Read more
RSI: Safe RSI in the ED
February 18, 2016Performing Rapid Sequence Intubation safely in the ED. Key points: RSI in the ED is a dangerous undertaking. Focus on these 4 areas to improve safety: Patient Team Plans Equipment Show Notes: ED vs Anaesthesia Higher complication rate in ED, with higher case fatality rate when complications develop. Incidence… Read more
New ANZCOR resus guidelines
January 18, 2016ANZCOR have updated their guidelines. The main changes – as summarised by Dr Stacy Turner: ALS Defibrillation – can increase 2nd shock energy to maximum available on defib, if first shock unsuccessful. Cooling anywhere between 32-36 degrees. Post-ROSC PCI – immediate in STEMI, new LBBBB and selected patients if coronary… Read more