Summary of teaching wednesday 30/11/16 – dr karen winter (demt footscray)

 

LUMBAR PUNCTURE

Beware of the sitting duck for a vasovagal! consider balancing them against the side of the trolley to stabilise
Opening pressure must be measured in the lateral position – but only a few indications for measuring
Take your time setting up and insist on an assistant
Involve your patient – “drop your shoulders please”….”am I in the middle?”

Consider the timing of anticoagulation or antiplatelet agents –
Heparin 6 hours
Clexane 12 hours
INR < 1.3
Aspirin – OK
NOACs or Clopidgrel – NOT FOR YOU!!!
We were lucky to have a chance to practice on the LP models and have a look at US assisted LP.

PREDICTING OCCUPATIONAL VIOLENCE IN ED

Are we making this “normal” because it’s NOT!
Check the ALERTS – 3 locations on EDIS
Chart prn medications on arrival, not after the incident has occurred!
Behaviour Safety Support Plans – consider triggers and subtle signs of impending violence

MIGRAINE

Chlorpromazine (Largactil) needs to be at an appropriate rate
Chart regular analgesia
Consider sumatriptan on discharge in recurrent presenters