IS-EMERCAST: Recent Episodes
Andrew Bezzina, Angus Bezzina
Welcome to IS-EMERCAST!. This is the partner and supplement to Med from the SHED – that highly useful resource on the net for Emergency Clinicians in the Illawarra-Shoalhaven. The perennial problem with trying to provide educational resources to a broad geographical area and a disparate group of clinicians always stumps us. Here is part of the answer. This podcast allows easily accessible clinical education and perspectives with a local flavour for those of us working in the Illawarra-Shoalhaven. It is brought to you by the Emergency Medicine Education and Training Program under the Auspices of the Australasian College for Emergency Medicine (ACEM) and funded by the Commonwealth Government. Whilst all efforts are made to ensure content is appropriate and up to date, all information and perspectives are those of the presenters themselves and do not represent the position of ACEM or Illawarra Shoalhaven Local Health District.
Medicine has seen the proliferation of guidelines/pathways/clinical decision rules in a dizzying white noise of advisories. They have been developed on the charitable side to minimise variance and provide some certainty of benefit for patients and ease for clinicians. But "do they do what it says on the packet"? This is a perspective and caution on the use of guidelines and pathways and a plea to remember critical thinking and clinical acumen.
Doctors from a small rural ED provide insights into their experiences of transfer conversations and this is juxtaposed with insights from 2 Emergency Physicians on the receiving side of those conversations.
Emergency Medicine is a practice that requires good procedural skills and clinical acumen but also good "soft" skills such as communication and team management but equally importantly self management. Dr Karen Coss, Director of Emergency Medicine at Tamworth Regional Referral Hospital in North Western NSW provides us with the insights she has learned through her reading and personal experience.
Use of intercostal catheters and the management of pneumothoraces have been undergoing significant change over the last decade. The recent New England article comparing conservative management with interventional takes this the next station along the road.
- There are many stressful elements to working in the Emergency Department many of them often not related to the patient interaction. One that has to be well up there especially for people who hate confrontation is the “difficult consult”. You ring the inpatient team representative and are faced with obstruction/interrogation/disrespect/anger/sometimes downright bullying……. Dr Tucker is a highly experienced EP including at a departmental management level – so we explore some of his views on this issue and how to manage it.
Working as clinicians in the ED, especially in the one ED over time, it's easy to develop a fixed view on life and where you fit in "the system". This is a road to cynicism, pessimism and burn out for many people. Dr Anne Smith provides perspectives balanced by an international career, experience in multiple Australian EDs and finally but not least from a woman's perspective in the world of Emergency Medicine.
A discussion with Dr Peter Smith around some of the issues that face EDs without a range of on site support services. Peter provides the benefits of his insights based on experience as a clinician and a department DIrector.
Wellbeing in the ED. What is it all about? An interesting interview with Bishan Rajapakse a local champion of the Wellbeing focus in Emergency Departments and health generally.
Managing the critically ill patient with multiple co-morbidities is a complex and difficult problem. Patient, family, carers and staff all need care in a busy environment with multiple competing priorities. Here is a way to consider it.
This is an open discussion with local expert Dr Simon Binks on how he approaches paediatric fever presentations in practical terms. We cover some of the basic questions around investigation strategies, use of pathways and risk stratification.
Kharbanda AB et al Development and Validation of a Novel Pediatric Appendicitis Risk Calculator (pARC). Pediatrics 2018 141:4
https://pediatrics.aappublications.org/content/pediatrics/early/2018/03/09/peds.2017-2699.full.pdf
Cotton D et al Validation of the Pediatric Appendicitis Risk Calculator in a Community Emergency Department SettingAnn Emerg Med Vol 74:4 October 2019
https://www.annemergmed.com/article/S0196-0644(19)30346-4/fulltext
MD Calc - www.mdcalc.com
PACSA via ACI
https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/GL2019_014.pdf
4th Universal Definition of MI
https://academic.oup.com/eurheartj/article/40/3/237/5079081
Sgarbossa
https://litfl.com/sgarbossa-criteria-ecg-library/
Posterior MI
https://litfl.com/posterior-myocardial-infarction-ecg-library/
De Winter waves
https://litfl.com/de-winter-t-wave-ecg-library/
D W Dodick - Nosological Entities? Thunderclap Headache. J Neurol Neurosurg Psychiatry 2002;72:6–11. https://jnnp.bmj.com/content/72/1/6.info
Long BJ, Koyfman A. - Benign Headache Management in the Emergency Department
The Journal of Emergency Medicine, Vol. 54, No. 4, pp. 458–468, 2018
https://www.jem-journal.com/article/S0736-4679(17)31189-7/fulltext
Edlow JA et al Clinical Policy: Critical Issues in the Evaluation and Management
of Adult Patients Presenting to the Emergency Department With Acute Headache
Ann Emerg Med. 2008;52:407-436.
https://www.annemergmed.com/article/S0196-0644(08)01463-7/fulltext
Wilson F Abdo and Leo MA Heunks - Oxygen-induced hypercapnia in COPD:myths and facts
Critical Care 2012, 16:323 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3682248/
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https://link.springer.com/article/10.1007/s002280050481
Schulz L et al Top Ten Myths Regarding the Diagnosis and Treatment of Urinary Tract Infections Journal of Emergency Medicine, Vol. 51, No. 1, pp. 25–30, 2016
http://dx.doi.org/10.1016/j.jemermed.2016.02.009
Semler M et al Balanced Crystalloids versus Saline in Critically Ill Adults N Engl J Med 2018;378:829-39.
https://www.nejm.org/doi/full/10.1056/NEJMoa1711584
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https://www.nejm.org/doi/full/10.1056/NEJMoa1711586
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BMJ Qual Saf. 2013 Oct; 22(Suppl 2): ii65–ii72.
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