Category: News

International Womens Day – March 8, 2018

Tomorrow (March 8) is International Women’s Day.


Please take a moment to consider gender equality for your colleagues, your patients and your community.


Some of the issues we encounter every day:

  • Effects of drugs and treatments specific to women – side effects, pharmacokinetics
  • Patient privacy – during conversations, examinations and procedures
  • Domestic Violence
  • Communication with other staff members



Rib and sternal fractures

All staff please note a recent highlight on the rib and sternal fracture policy:

rib and sternal fractures

Key points:

  1. 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:
  2. From the policy: “The ED physician shall decide which admitting unit is the most appropriate  to admit the patient under:
    • Medical, general surgical or thoracic surgical as appropriate”

Simulation Olympics 2016

UPDATED 9/3/17 – See Dr Neil Long’s additional notes regarding the stations below

On the 14th December ED Consultant Dr David Alexander and simulation registrar Dr Neil Long staged the annual simulation olympics with this year’s event  – “the Pentathlon” – featuring resuscitation stations such as “the swimmer”, “the runner”, “the fencer”, “the shooter” and “the rider”.

Congratulations to registrars Gordon Carter and Mark Daley representing “the Republic of Ireland” who stormed home for the gold medal.


Thanks to all the registrars who came and participated.

[L-R: Sze-Chi + Jess, Son + Kiri, Sheri + Jamie, Rob + Annie, Emily + Maddy, Heather + Ben]

Thanks to Dr Luigi Marino, Dr Raj Patel, Dr Sam Robertson and the simulation centre staff for their help running the morning.




Wolff-Parkinson-White Syndrome with Atrial Fibrillation

• Very rapid irregularly irregular tachycardia (rates may approach 300 beats/min) with wide QRS complexes that vary in morphology
• Often misdiagnosed as SVT, VT or atrial fibrillation with BBB
• Misdiagnosis and treatment with AVN blockers can be deadly!
• Treat with procainamide, flecainide (?), or preferably electrical cardioversion
• Key Point: Avoid all AV Nodal blockers
• Adenosine
• Beta-blockers
• Calcium channel blockers
• Digoxin
• Amiodarone
Pitfall: Treatment with Amiodarone results in patient decompensation (see references)
Take Home Points:
WPW + Atrial Fibrillation
• Irregularly irregular tachycardia
• Complexes vary in shape and width
• May approach 250-300 bpm or higher
• Avoid all AV nodal blockers…including Amiodarone!
• Use Procainamide, Flecainide (?),or electrical cardioversion

Traumatic Cardiac Arrest Algorithm from the European Resuscitation Council

Main changes:
  1. don’t do CPR
  2. control catastrophic haemorrhage
  3. control the airway
  4. bilateral chest decompressions
  5. relieve cardiac tamponade
  6. consider prox aortic compression
  7. MTP
  8. CPR can commence once the chest procedures have been completed but in the context of trauma and hemorrhagic loss your CPR will be useless if you don’t correct the underlying cause.

Heat Stroke

Heat Stroke


Shoulder dystocia

Video coming soon



Dr Keith Nallaratnam has graciously extended the use of his CD collection of EM:RAP podcasts to all staff.

For those unfamiliar with EM:RAP, it is a monthly American podcast hosted by Mel Herbert. Each episode usually covers about 3 topics with edited audio lectures from different prominent speakers and with Mel’s animated but useful commentary throughout. Here’s an excerpt from their associated YouTube channel:




Keith’s CDs will be kept in Narelle Farrugia’s office. Please borrow responsibly so we do not have to bring these back:




Updated National Inpatient Medication Chart

All practitioners please note that an updated inpatient medication chart will be rolled out imminently.

Key changes:

  1. dedicated insulin prescribing section and glucose monitoring
  2. dedicated venous thromboembolism prophylaxis checkpoint (see below for VTE prophylaxis prescribing tool)

Read the summary of changes:



VTE prophylaxis prescribing tool:


Joseph Epstein

Some current registrars may not have had the privilege of working with the retiring Professor Joe Epstein, whose professional and personal legacy is deeply woven into the history of both Western Health and the Australasian College of Emergency Medicine. He was presented with a tribute book of anecdotes from family and colleagues at a recent farewell dinner. His presence in the department will be missed.


Western Health Library Access

The Western Health library is a great resource for online journals and ebooks.

To begin, first request an account login online. Alternately an account can be created by visiting either the Western or Sunshine libraries in person and speaking to their friendly staff.

This will provide home access to most of the resources below:


whales login

WHALES (Western Health Access – Libraries Electronic Service)


Browzine: Emergency medicine topics

Browzine: all WH subscribed journals


spydus emergency ebooks

Emergency medicine books and eBooks on the library catalogue



Up to date (can only be accessed on-site)


Electronic Therapeutic Guidelines (eTG) (on-site only, unless you have setup offsite Clinician’s Health Channel access)