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Intro to COVID19 Airway

April 4, 2020

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Nitrous Sedation procedure

August 27, 2019

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Troubleshooting the ventilator

August 27, 2019

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Choosing Wisely campaign

February 6, 2019

Review 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


February 6, 2019

Thanks 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, 2018

we 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, 2018

There 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, 2018

There 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, 2018

  This 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, 2018

Thanks 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, 2018

Thanks 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): Knee Dislocation (John Loy): Rice Bezoar (Gary Ayton): Only 1 publication:… Read more

Footscray ED Orientation manual

August 2, 2018

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CALLING FOR HELP – Responsibilities of the On-Call FACEM

July 19, 2018


Trauma day 2018

April 17, 2018

Thanks 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, 2018

As 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, 2017

Compartment 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, 2017

REFERRAL 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

Cancer diagnosis process map

May 11, 2017

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Rib and sternal fractures

February 21, 2017

All 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, 2017

Thanks 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, 2016

Please consider DVT/PE prophylaxis in admitted and select outpatient cases. Read more

How to: talk the talk

September 23, 2016

Presenting 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, 2016

Here 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, 2016

Those 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, 2016

Review 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, 2016

Review 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, 2016

Scott 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, 2016

Review 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

Methadone and suboxone prescribing

April 9, 2016

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Trauma Victoria

March 23, 2016

  The 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, 2016

A 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, 2016

How 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, 2016

How 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, 2016

Performing 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, 2016

ANZCOR 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