SCGH ED ultrasound service
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This document describes the emergency department ultrasound service at James Wheeler Hospital. It includes: 1) There are 5 ED consultants with ultrasound qualifications who provide the service from 0800-1800 Monday to Friday, with limited availability after hours. One US fellow is also undergoing training. 2) The service provides full diagnostic scans, focused bedside scans to assist with diagnosis and management, and ultrasound-guided procedures. Common scans include EFAST, AAA, lung/heart/sepsis assessments. 3) The advantages of ED sonographers include timely access, clinical experience to tailor exams, and assistance with procedures and patient management. For appropriate scans, clinical questions and patient preparation are requested. Training opportunities in basic ultrasound
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SCGH ED ultrasound service
This document summarizes the emergency department ultrasound service at a hospital. It includes:
- The ultrasound team consists of 4 consultants, 1 fellow, and 1 registrar with various qualifications and experience levels.
- The service is available Monday-Friday 0800-1800 with limited availability after hours, and provides a unique ultrasound service in Australia and internationally.
- Ultrasound is used as a formal diagnostic test and to answer specific clinical questions at the bedside to assist with diagnosis, management, and disposition of patients. It is also used to guide procedures.
The document outlines the types of studies performed, as well as limitations and what is needed from referring clinicians to make effective use of the service.
SCGH ED Ultrasound Service
This document provides information about the emergency department ultrasound service at a hospital, including:
- The ultrasound team consists of 4 consultants, 1 fellow, and 1 registrar with various qualifications and experience levels.
- The service aims to provide dedicated ultrasound from 0800-1800 Mon-Fri to assist with timely patient management through focused diagnostic scans and procedures.
- The team performs a range of focused diagnostic scans, full protocol scans within their experience, and ultrasound-guided procedures to answer clinical questions and guide management and disposition decisions in the emergency department.
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An orthosis is an externally applied device that modifies the structural characteristics of the neuromuscular and skeletal systems to make something straight. An orthotist is trained to assess patients and design, measure, and fit orthoses. Orthoses aim to stabilize weak areas, support damaged joints, control abnormal movements, and prevent deformities. A thorough evaluation involves multiple specialists. Prescriptions consider biomechanics, materials, tissue tolerance, and classification. Patient assessments evaluate history, examination findings, and functional ability. Specific conditions require targeted tests and evaluations to identify deformities and guide treatment.
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The GAiN lab is a multidisciplinary team located in Newcastle General Hospital that offers 3D and video vector gait analysis. The lab recently moved to a new location with separate clinical and seating areas. They see mainly pediatric patients with conditions like cerebral palsy and provide clinical exams, gait analysis, and orthotic reviews. Referrals come from orthopedic consultants, and they have a long waiting list of around 30 weeks. Gait analysis provides detailed joint angle and force data to help determine treatment plans and evaluate outcomes.
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A 7-year-old girl presented to the emergency room after falling off her bicycle 3 hours prior. She injured her left arm and it was deformed and swollen with limited range of motion due to pain. Physical examination revealed a closed fracture of both bones in her left forearm. Acceptable reduction and alignment for pediatric fractures were discussed, including acceptable angular and rotational deformities based on the patient's age and location of the fracture. Treatment options included non-operative management with casting or operative management with intramedullary fixation, plates and screws, or percutaneous K-wire fixation if alignment could not be adequately achieved or maintained non-operatively.
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SCGH ED ultrasound service
This document summarizes the emergency department ultrasound service at a hospital. It includes:
- The ultrasound team consists of 4 consultants, 1 fellow, and 1 registrar with various qualifications and experience levels.
- The service is available Monday-Friday 0800-1800 with limited availability after hours, and provides a unique ultrasound service in Australia and internationally.
- Ultrasound is used as a formal diagnostic test and to answer specific clinical questions at the bedside to assist with diagnosis, management, and disposition of patients. It is also used to guide procedures.
The document outlines the types of studies performed, as well as limitations and what is needed from referring clinicians to make effective use of the service.
SCGH ED Ultrasound Service
This document provides information about the emergency department ultrasound service at a hospital, including:
- The ultrasound team consists of 4 consultants, 1 fellow, and 1 registrar with various qualifications and experience levels.
- The service aims to provide dedicated ultrasound from 0800-1800 Mon-Fri to assist with timely patient management through focused diagnostic scans and procedures.
- The team performs a range of focused diagnostic scans, full protocol scans within their experience, and ultrasound-guided procedures to answer clinical questions and guide management and disposition decisions in the emergency department.
Assessment of lower extermity for prescription of orthoses
An orthosis is an externally applied device that modifies the structural characteristics of the neuromuscular and skeletal systems to make something straight. An orthotist is trained to assess patients and design, measure, and fit orthoses. Orthoses aim to stabilize weak areas, support damaged joints, control abnormal movements, and prevent deformities. A thorough evaluation involves multiple specialists. Prescriptions consider biomechanics, materials, tissue tolerance, and classification. Patient assessments evaluate history, examination findings, and functional ability. Specific conditions require targeted tests and evaluations to identify deformities and guide treatment.
Penny Hewart
The GAiN lab is a multidisciplinary team located in Newcastle General Hospital that offers 3D and video vector gait analysis. The lab recently moved to a new location with separate clinical and seating areas. They see mainly pediatric patients with conditions like cerebral palsy and provide clinical exams, gait analysis, and orthotic reviews. Referrals come from orthopedic consultants, and they have a long waiting list of around 30 weeks. Gait analysis provides detailed joint angle and force data to help determine treatment plans and evaluate outcomes.
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A 7-year-old girl presented to the emergency room after falling off her bicycle 3 hours prior. She injured her left arm and it was deformed and swollen with limited range of motion due to pain. Physical examination revealed a closed fracture of both bones in her left forearm. Acceptable reduction and alignment for pediatric fractures were discussed, including acceptable angular and rotational deformities based on the patient's age and location of the fracture. Treatment options included non-operative management with casting or operative management with intramedullary fixation, plates and screws, or percutaneous K-wire fixation if alignment could not be adequately achieved or maintained non-operatively.
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CME intro 2016/2
This document outlines the format and content of the continuing medical education (CME) program at the hospital. It discusses that CME is a weekly forum focused on topics related to emergency medicine and primarily aimed at registrars but open to all clinicians. Presentations are prepared by consultants, registrars, and allied health staff on relevant topics and range from 15 minutes to 2 hours. Other regular content includes workshops, audits, trauma scenarios, case reviews, and quizzes. Attendance is considered part of registrars' term assessments and contributing presentations is encouraged after consultation with a senior mentor. An upcoming mandatory airway workshop is highlighted.
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This document discusses an xray image and asks questions to test knowledge of the disease shown. It asks the reader to name the disease shown in the xray, what disease process it suggests, and two differences between gout and pseudogout.
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Case 2 involves a 54-year-old female who experienced shortness of breath during an ascent and lost consciousness, and was diagnosed with immersion pulmonary edema.
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This document provides information about the emergency department ultrasound service at a hospital, including:
- The ultrasound team consists of 4 consultants, 1 fellow currently training, and 1 registrar currently working to complete competency in procedures like EFAST and AAA scanning.
- An emergency physician with fellow/registrar is rostered daily from 0800-1800 for ultrasound, with a limited service possibly available after hours.
- The service performs full diagnostic scans, focused scans to assess things like shock or sepsis, and ultrasound-guided procedures. Areas like musculoskeletal ultrasound require a private referral.
- The advantages of the emergency department sonographers include timely access and assistance with patient management decisions. Registrars are encouraged to
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This document summarizes four diving-related cases:
Case 1 involves a 42-year-old male who developed a cough and shortness of breath after a dive, and was diagnosed with saltwater aspiration syndrome.
Case 2 involves a 54-year-old female who experienced shortness of breath during an ascent and lost consciousness, and was diagnosed with immersion pulmonary edema.
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This document discusses common cognitive errors that can lead to diagnostic mistakes.
It provides examples of cases where cognitive biases and flawed thinking led to incorrect initial diagnoses. Specific cognitive biases discussed include availability bias, confirmation bias, and attribution errors.
The document emphasizes that diagnostic errors often stem from overreliance on intuitive, fast "System 1" thinking rather than slow, deliberate "System 2" thinking. It provides strategies for avoiding errors, such as taking diagnostic time-outs, considering alternative diagnoses, and maintaining self-awareness of one's cognitive processes and potential biases. Building a supportive work environment where mistakes can be discussed and learned from is also emphasized.
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Base excess tells you the amount of strong ion difference (SID) required to correct the pH to 7.4 if the pCO2 is held constant at 40 mmHg. Bicarb only tells you the concentration, not the deficit. So base excess more accurately quantifies the acid-base disturbance.
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This document discusses non-invasive tests for diagnosing acute coronary syndrome (ACS). It begins with some background on the history of cardiovascular disease and current statistics. It then provides an overview and algorithm for the chest pain pathway and risk stratification process for evaluating patients presenting with possible ACS. This involves an initial ECG, troponin tests, and evaluating symptoms and risk factors to determine whether the patient is at high, intermediate or low risk. For low risk patients a non-invasive strategy may be appropriate, while higher risk patients warrant further cardiac investigation and management.
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The document discusses various medical topics including:
- Studies on fluid resuscitation in children in Africa with illnesses like malaria.
- Criteria for diagnosing STEMI using EKG findings.
- Severe cutaneous adverse reactions to drugs like allopurinol and anti-epileptics.
- Factors to consider when assessing prognosis after cardiac arrest and resuscitation.
- Avoiding supplemental oxygen for STEMI patients.
- A charity that connects doctors with people who have disabilities.
Hyponatraemia - Case Report
This patient presented with a low Glasgow Coma Scale and stable vitals following a motor vehicle accident. Laboratory tests revealed hyponatremia with a sodium level of 106 mmol/L, low glucose and bicarbonate levels, and urine sodium greater than 20 mmol/L. The patient had a distended abdomen and bladder scan showing over 1000 mL of urine. This is diagnosed as syndrome of inappropriate antidiuretic hormone secretion (SIADH) given the clinical picture of euvolamic hyponatremia. Treatment involves slow sodium replacement to correct the hyponatremia and prevent complications like cerebral edema.
SCGH ED ultrasound service 2016.1
This document provides information about the emergency department ultrasound service at a hospital, including:
- The ultrasound team consists of 4 consultants, 1 fellow currently training, and 1 registrar currently working to complete competency in procedures like EFAST and AAA scanning.
- An emergency physician with fellow/registrar is rostered daily from 0800-1800 for ultrasound, with a limited service possibly available after hours.
- The service performs full diagnostic scans, focused scans to assess things like shock or sepsis, and ultrasound-guided procedures. Areas like musculoskeletal ultrasound require a private referral.
- The advantages of the emergency department sonographers include timely access and assistance with patient management decisions. Registrars are encouraged to
Australia & New Zealand ED Airway Registry - A year at SCGH ED
The document summarizes data from 131 intubations recorded in the Airway Registry at SCGH, which is a principle WA site in the ANZ ED Registry project involving 36 EDs. The data shows first pass success rates of 83% overall, with rates for different specialties ranging from 81-100%. 17% required 2 attempts and 3% required 3 attempts. Overdose was the most common indication. Apnoeic oxygenation via nasal prongs was used in 41% of cases. The document identifies areas for improvement such as ensuring all intubations are captured, improving documentation, and increasing use of apnoeic oxygenation and the C-Mac laryngoscope.
Clots and Zealots
This document discusses issues around the diagnosis and treatment of pulmonary embolism (PE). It raises questions about whether PE is overdiagnosed using CT pulmonary angiography (CTPA) and whether anticoagulation treatment provides benefits given the risks of bleeding. While diagnosis of PE has increased with CTPA use, mortality from PE has not clearly decreased. Subsegmental PE found on CTPA may be falsely positive in 30-70% of cases and untreated cases seem to have low mortality. Overall there is debate around the optimal approach to diagnosing and managing PE, particularly smaller clots, given risks of overdiagnosis and overtreatment.
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SCGH ED CME Intro 2014
This document provides information about the Continuing Medical Education (CME) program at James Wheeler Memorial Hospital. CME sessions are held on Thursdays to allow more registrars to attend. The format includes presentations on topics relevant to the registrar teaching program. Presentations are prepared by consultants, registrars, and allied health staff. Attendance at CME is considered part of the registrars' term assessment. Upcoming highlights include an airway workshop and a social media/FOAM workshop. The SCGHED website provides more information about CME topics and registrar resources.
TC emergency medicine wrap up 4
The document discusses various medical topics including:
- Studies on fluid resuscitation in children in Africa with shock.
- Criteria for diagnosing myocardial infarction on ECGs.
- Adverse skin reactions to medications.
- Factors that can contribute to surgical errors.
- A charity that connects doctors with people who have disabilities.
Retrieval Medicine and Disaster Management
This document provides information about retrieval and disaster response. It discusses general principles of retrieval and disaster response as well as specifics related to Western Australia. It covers various modes of transport for patient retrieval including factors that influence choice of transport. Key aspects of preparing patients for transport are emphasized. Specific details are provided about the Royal Flying Doctor Service (RFDS) in WA, including their fleet, bases, priorities and criteria for requesting transport. The document also discusses disaster response based on MIMMS principles and the triage sieve model. Hospital response for a major incident at Sir Charles Gairdner Hospital is outlined.
Tackling the Opioid Problem - Analgesic Prescribing in the Emergency Department
This document discusses the opioid crisis and approaches to pain management. It describes how Purdue Pharma aggressively marketed OxyContin in the 1990s, leading to widespread overprescription and misuse. This contributed significantly to the rise in opioid overdoses and deaths in the US. In response, pharmaceutical companies developed abuse-deterrent formulations of opioids like OxyContin and Targin to discourage tampering and injection. However, these formulations did not prove abuse-proof. The document advocates for careful opioid prescribing practices to limit diversion and abuse, including assessing risks, limiting durations, and involving specialist services. Non-opioid options like paracetamol, NSAIDs, and tramadol should be prioritized for mild-moderate pain
End of life discussions
Mrs. B, a 97-year-old woman living in a residential care home, was admitted to the hospital after a fall. Her daughter informed staff that Mrs. B had an advance health directive. Mrs. B was treated for aspiration pneumonia and other issues. Despite treatment, Mrs. B remained distressed and her condition deteriorated. She was found dead during an overnight medical team call. Opportunities to improve care included the residential home notifying the hospital of Mrs. B's advance directive and discussing her goals of care when she was confused upon admission.
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- Key anatomy seen on chest x-rays like the lungs, heart borders, f
Surgery revision
This document discusses OSCE (Objective Structured Clinical Examination), which is a clinical skills assessment used in medical education. OSCE involves candidates rotating through several stations to perform various clinical tasks within a time limit. Stations can be interactive, where an examiner observes and scores the candidate, or static, where the candidate answers questions without observation. Common interactive stations include history taking, clinical examination, and tag stations where the candidate interprets findings. The document provides examples of station profiles, checklists, and sample questions asked at different OSCE stations.
Mary Teed Resume.1
Mary Teed has nearly 15 years of experience as a diagnostic medical sonographer specializing in vascular procedures and imaging. She is proficient in abdominal, OB/GYN, and superficial structure ultrasounds and has worked in both inpatient hospital and outpatient clinical settings. Currently she is a lead sonographer at Highline Medical Center where she performs vascular exams, trains other staff, and ensures quality ultrasound services.
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The effects of USG in Pregnancy
An ultrasound uses sound waves to generate images of the fetus, placenta, and uterus during pregnancy. It is a noninvasive test used to determine gestational age, check for abnormalities, and monitor fetal growth and anatomy. While ultrasound is generally safe when used appropriately, some studies have found potential risks like increased anxiety for parents, left-handedness, premature birth, and learning disabilities from repeated exposures. The benefits include evaluating fetal health and development.
Different Departments Required in a Hospital
This presentation though long is a brief presentation on the different departments required for a hospital to run. Apt info for those having hospital administration as a paper
What is an Ultrasound Scan
An ultrasound scan uses high frequency sound waves to create images of the inside of the body. The sound waves bounce off organs and tissues and their echoes are picked up by a probe and turned into moving images on a screen. Ultrasound scans can be used to examine many internal organs and structures, detect abnormalities, and monitor fetal development during pregnancy. They provide information to help diagnose health issues without exposing patients to radiation.
Methodological scanning & report writing
This document provides guidelines for performing obstetric ultrasound scans. It outlines the key steps in the scanning process, including getting started, setting gains, performing fetal surveys and anatomical scans, assessing amniotic fluid and placenta location, and writing the report. Details are provided on anatomical landmarks, measurements, and normal structures to evaluate for various gestational ages. The importance of a clear, organized report that addresses the clinical question and provides relevant conclusions is emphasized.
Ultrasound screening in pregnancy
The document discusses ultrasound screening and testing during pregnancy in Hungary. It recommends five ultrasound examinations - one diagnostic and four screenings - according to guidelines from the Hungarian Society of Ultrasound in Obstetrics and Gynecology (MSZNUT). The screenings have defined protocols and occur at 11-13, 18-20, 30-31, and 36-37 weeks gestation. Different healthcare levels are required depending on the exam, and MSZNUT ensures regular training to meet proficiency standards. Fetal well-being testing like non-stress tests and biophysical profiles may also be used for high-risk pregnancies starting at 32 weeks.
Surgical F1 Prep Talk - Dafydd Loughran
This document provides guidance and advice to a surgical trainee beginning their first day on call. It emphasizes being prepared with up-to-date patient information and bloodwork. It discusses appropriately evaluating and managing common acute surgical conditions like appendicitis and pancreatitis. Guidance is provided on consenting for procedures and communicating effectively with referral sources. The overall message is to focus on the basics of patient care and know when to escalate concerns, as the document aims to equip the trainee for typical issues that may arise on their first day on call.
Approach to Surgical Patients
The document outlines the proper approach and process for treating a surgical patient, which includes: taking a thorough history and conducting a physical exam, developing differential diagnoses, ordering appropriate investigations, determining the best treatment plan, performing surgery if needed, providing postoperative care and monitoring the patient's recovery, and documenting each step of the process in the patient's notes. It emphasizes the importance of considering all factors before making decisions regarding a patient's diagnosis and treatment.
US.ppt
Ultrasound uses sound waves to produce images of structures inside the body. It is a widely used diagnostic tool that is relatively inexpensive, portable, and does not use ionizing radiation. During an ultrasound, a transducer emits inaudible sound waves that bounce off tissues and organs and are converted into images. Ultrasound has various applications including imaging fetuses during pregnancy, examining internal organs in the abdomen, and assessing blood flow via Doppler ultrasound. It provides several advantages over other imaging methods by being painless, safe, and able to capture real-time moving images of soft tissues.
PRE OP pre operative assessment before surgery
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Various departments of the hospital
This document provides descriptions of the various departments within a hospital. It discusses departments such as casualty, cardiology, critical care, general surgery, maternity/neonatal/paediatrics, gynaecology, anaesthetics, ears nose and throat, neurology, ophthalmology, orthopaedics, psychiatry, outpatient, inpatient, diagnostic imaging, nutrition and dietetics, medical social work, housekeeping, catering, administration, medical records, maintenance, IT, human resources, and finance. The document aims to give an overview of the functions and services provided by each department within a hospital.
Various departments of the hospital
This document provides descriptions of the various departments within a hospital. It discusses departments such as casualty, cardiology, critical care, general surgery, maternity/neonatal/paediatrics, gynaecology, anaesthetics, ears nose and throat, neurology, ophthalmology, orthopaedics, psychiatry, outpatient, inpatient, diagnostic imaging, nutrition and dietetics, medical social work, housekeeping, catering, administration, medical records, maintenance, IT, human resources, and finance. The document aims to give an overview of the functions and services provided by each department within a hospital.
6.preoperative assessment
This document outlines the key components of preoperative assessment for anaesthesia, including:
1. Taking a thorough patient history to identify any medical conditions or risks that could impact anaesthesia or surgery.
2. Performing a physical exam, including a focused assessment of the airway.
3. Determining the urgency of the planned surgery and communicating with the surgical team.
4. Ordering relevant preoperative investigations or tests based on the patient's age, health status, and type of surgery. The goals are to minimize risk and optimize preparation for anaesthesia and surgery.
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Trauma teams
The document discusses trauma teams and their roles. It defines a trauma team as a multidisciplinary group that works together to assess and treat severely injured patients. A team approach has been shown to significantly reduce resuscitation times compared to individual doctors. The roles of trauma team members are outlined, as well as techniques for effective communication, briefing, handover, and speaking up if concerns arise. Statistics from Western Australia in 2015 show the most common causes of death for major trauma patients were head injuries and brain death. Overall mortality rates were lower than the national average.
Haemostatic resuscitation
This document provides an overview of haemostatic resuscitation for trauma patients. It discusses the goals of haemostatic resuscitation which include rapidly correcting hypothermia, hypocalcaemia, acidosis and other factors impairing haemostasis. It also aims to resuscitate patients with a balanced combination of blood products resembling whole blood to avoid dilutional coagulopathy. The document reviews the components of blood, various blood products used in resuscitation and their effects, and studies supporting haemostatic resuscitation approaches. It also discusses practical considerations for haemostatic resuscitation in the emergency department setting.
Arthrocentesis
Mr. Arthur Ritis, a 52-year-old man with diabetes, hypertension, and a history of gout, presented with a hot, swollen, and painful right knee for 24 hours. Examination found a warm knee with a large effusion and mild tenderness. Blood tests showed elevated white blood cell count and C-reactive protein. Arthrocentesis of the knee found cloudy yellow synovial fluid containing urate crystals on microscopy. This confirms the diagnosis of an acute gout attack in the knee requiring treatment.
Ultrasound in cardiac arrest
This document discusses the use of echocardiography during cardiac arrest and peri-arrest situations. It provides an overview of basic echo views that can be useful. Echo can help identify the cause of arrest such as tamponade, pulmonary embolism, or wall motion abnormalities. Findings on echo such as hypovolaemia or myocardial activity can help guide management decisions. The document reviews where echo fits within the ACLS algorithm and issues surrounding its use during cardiac arrest. It provides examples of echo findings that may indicate treatable versus non-treatable causes of arrest.
Goals of patient care introduction
The document discusses the goals of implementing a new Goals of Patient Care (GOPC) form across hospitals in Western Australia to improve end-of-life care and decision making. It provides background on the form's trial implementation at various sites. The new form aims to have goals of care discussions with patients or their surrogates to determine appropriate treatment based on probable outcomes, not just resuscitation status. It outlines the form's structure with sections on baseline information, goal of care selection, discussion summary, and extended use. The document emphasizes improving communication around goals of care and ensuring treatment aligns with patients' values and preferences.
Physiology Directed CPR
This document discusses physiology directed CPR and haemodynamically directed CPR. It notes that cardiac arrest is not a diagnosis and various underlying pathologies must be considered. During closed chest compressions, a proportion of cardiac output is generated through cardiac and thoracic pumping. Studies show that targeting specific blood pressure and coronary perfusion pressure goals during CPR improves survival outcomes compared to standard AHA guidelines. Monitoring diastolic blood pressure and central venous pressure can help guide interventions like fluid administration or vasopressor use to meet haemodynamic targets and optimize circulation during CPR.
Ultrasound confirmation of ETT placement
This document discusses using ultrasound to confirm endotracheal tube placement. It states that ultrasound is a simple, fast, and reliable adjunct technique that can be used when other confirmation methods like capnography are unreliable or not available. There are two ultrasound techniques described - direct (transtracheal) ultrasound looks inside the trachea or esophagus to see if the tube is correctly placed, while indirect (transthoracic) ultrasound looks for movement of the pleura indicating lung ventilation. Ultrasound is not meant to replace capnography and auscultation but can be a helpful additional method in emergency situations or for patients who are not responding as expected after intubation. The document provides details on how to
Palliative care in the emergency department
This document provides guidance on symptom management for palliative patients in the emergency department. It outlines approaches for managing common symptoms like pain, delirium, dyspnea, nausea and vomiting. It recommends opiate medications for pain management, depending on whether the patient is opiate naïve or tolerant. It also provides guidance on managing other symptoms like bladder and bowel issues, secretions and more uncommon complications. The document emphasizes the importance of palliative care consultation and ensuring patients are not left to die alone.
Wilderness crisis and decision making weekend April 2018
This document announces a wilderness crisis and decision making weekend to take place in Margaret River, Australia from April 20-22, 2018. The weekend aims to build teamwork skills through quotes about collaborating, working together, and making decisions as a group. Activities will involve solving problems as a team rather than individuals.
Patient confidentiality in emergency department
Patient confidentiality must be maintained in the ED. Personal information about patients cannot be disclosed without consent, except in emergencies or if required by law. Duty consultants should be aware of any VIP patients but provide the same standard of care. Confidentiality must be respected even for those not under the practitioner's direct care. Mandatory notifications to regulatory bodies are required only for specific conduct issues. Advice can be sought from designated hospital staff if questions arise about disclosing information.
Abscess management
This document summarizes several studies on the use of antibiotics for abscess management. A 2016 RCT of over 1000 patients found that high-dose Bactrim led to higher cure rates of abscesses over 2cm compared to placebo, especially for those with MRSA, fevers, or immunosuppression. A 2017 RCT of under 800 patients found Bactrim and clindamycin had similar cure rates of abscesses under 5cm as placebo. However, antibiotics were associated with higher adverse gastrointestinal events. Overall, meta-analyses show antibiotics reduce treatment failures and new skin infections compared to incision and drainage alone, but with a risk of serious drug side effects.
Hyperthermia and hypothermia
This document discusses hyperthermia and hypothermia. It defines hyperthermia as a core body temperature above 41.5°C and describes the pathophysiology and various causes, including exercise-associated collapse, heatstroke, and drug-related illnesses. It also discusses hypothermia, defined as a core temperature below 35°C, and covers causes, clinical features at different temperature stages, complications, investigations, and management approaches including warming techniques. The prognosis depends on factors like maximum temperature reached and duration of temperature elevation.
Electrical injury
- This document contains information on various electrical injury cases presented to the emergency department, including details on mechanisms of injury, clinical presentations, investigations, and management strategies. Key points include treating electrical injury patients as trauma patients, avoiding premature withdrawal of resuscitation due to the unreliable signs of death, monitoring for cardiac dysrhythmias, rhabdomyolysis, and neurovascular compromise of injured extremities. High voltage or lightning injuries can cause severe internal injuries despite minor external burns and require prolonged cardiac monitoring and aggressive IV fluid resuscitation.
D-dimer audit
This document summarizes an audit of CTPA scans ordered without a D-Dimer test for patients over 50. Of 53 CTPA scans reviewed, 49 did not have a D-Dimer. For most scans, the decision not to order a D-Dimer was appropriately documented. However, for 8 scans (16%) there was no documented reason for not ordering a D-Dimer. The audit concluded that CTPA scans are generally being ordered appropriately to diagnose PE, but better documentation of the reasons for not ordering D-Dimers could help reduce unnecessary CTPA use.
It's all about the documentation
Good clinical documentation is critical for continuity of patient care, patient safety, legal records, and supporting accurate medical coding. The documentation provides information on why the patient was admitted and what treatments they received. The coders assign diagnosis and procedure codes based solely on the documented information. Ambiguous or incomplete documentation can result in inaccurate coding that affects funding. Ensuring documentation clearly specifies diagnoses, management plans, and interventions helps ensure patients are assigned to the appropriate Diagnosis Related Group (DRG) and the hospital receives appropriate funding for the services provided.
Paediatric rashes
This document provides an overview of common paediatric rashes. It begins with describing the anatomy of the skin and definitions of common rash morphologies such as macules, papules, vesicles and pustules. Common rashes that are described include scabies, acne, contact dermatitis, atopic dermatitis, impetigo, tinea and nonspecific viral rashes. Specific viral exanthems like measles, rubella and scarlet fever are also reviewed. Emergent rashes like erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis are discussed in terms of their presentations, causes and treatments. References are provided at the end.
Choosing Wisely - Rational Antibiotic Usage
This document summarizes a case study of a 28-year-old Australian woman who developed a rash and respiratory symptoms after returning from travel to Thailand. Initial testing ruled out common infections like malaria, dengue fever, and influenza. Her rash and symptoms were consistent with measles. Further diagnostic testing confirmed infection with herpes simplex virus 1 via a positive PCR test. The case highlights the importance of considering uncommon infections in returning travelers who present with rashes and respiratory symptoms.
What's Hot in Emergency Medicine June 2018
This document summarizes several hot topics in emergency medicine:
1) A study found imaging and blood cultures are often inappropriate for evaluating uncomplicated cellulitis according to guidelines.
2) A new pulmonary embolism pathway was introduced in 2018.
3) The Surviving Sepsis Campaign updated their sepsis bundles to a single 1-hour bundle in 2018.
4) There is debate around the evidence and recommendations of the Surviving Sepsis Campaign.
5) The terms used to describe new oral anticoagulants, like NOAC, are still appropriate according to hematology experts.
Emergency ophthalmology
- The document appears to be a slide presentation on ophthalmic examination techniques. It includes descriptions of examining the orbit, extraocular movements, pupils, anterior segment, cornea, anterior chamber, iris, lens, and discs using a slit lamp. It also mentions assessing vision, intraocular pressure, and performing direct ophthalmoscopy.
- The presentation notes that the value of experience is not just seeing much, but seeing wisely. It asks if the viewer sees what the presenter sees.
- A list of time-critical conditions that require urgent attention is provided, including acute angle closure glaucoma, penetrating eye injuries, endophthalmitis, and retinal artery occlusion.
Code Brown - Disaster Medicine in the ED
The document outlines the emergency department's response plan for a "Code Brown", which refers to mass casualty incidents that exceed the hospital's normal capacity. The 4 phases of response are notification, standby/preparation, reception of casualties, and stand down. Key steps include activating staff call backs, setting up triage and treatment areas, prioritizing patient care, and addressing issues like family inquiries, transportation bottlenecks, and media relations. The plan emphasizes timely triage, treatment and flow of patients. A post-incident debriefing within 7 days allows for evaluating the response and making improvements.
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SCGH ED ultrasound service
- 2. The Team 5 ED Consultants with DDU: 1 US Fellow Diploma of Diagnostic Ultrasound (General) – 2 yrs supervised scanning, Primary and Secondary exams Can write formal reports – can bill medicare for their imaging!!!! (but we don’t) ○ Rippey ○ Sweetman ○ Hay ○ Wheeler ○ Gawthrope Currently undergoing DDU training ○ Phillips 1 US Registrar ○ Mo Gaber……..?You Currently trying to complete ED requirements for ACEM competency in: EFAST / AAA scanning Practicing the art of: ○ Procedural ultrasound ○ Basic bedside diagnostic sonography As in all facets of medicine we are all still constantly learning and have different experience levels in different facets of sonography
- 3. The Service A dedicated US competent ED Physician +/fellow +/- reg rostered for ED sonography: 0800-1800 Mon-Fri A limited service may be available afterhours dependent on our rostering and the departmental load This is a very unique service in Australia / Internationally
- 4. Why have we chosen to do EDUS? We are impatient! We really believe it assists in timely and appropriate patient management
- 5. How do we use US! As a formal investigative imaging test ie. full abdomino-pelvic ultrasound As an extension of our bedside physical examination to answer specific clinical questions to assist in Dx / Mx and disposition of our patients: ie. Focused ultrasound study for Ix of Sepsis / SOB To safely and quickly guide bedside procedures
- 6. ED Sonography – What we do! Full protocol diagnostic sonography Focused (bedside) diagnostic sonography: Renal Tract Hepatobilary Gynaecological / Pelvic Early Pregnancy DVT Achilles Ocular Neck masses / Soft tissue masses – to the limit of our experience EFAST AAA SHOCK / SOB / SEPSIS Assessement Echocardiography ○ PE / AMI / Arrest / Effusion / Tamponade Lung Ultrasound ○ PTX / Effussion / HTX / Pneumonia / Collapse / Oedema ?Superficial Abscess Anything we think appropriate Procedural CVC / IVC / PICC insertion FNB / FNC Pericardiocentesis / Paracentesis / Thoracocentesis Abscess I & D FB removal …….
- 7. ED Sonography – What we DON’T do! Full protocol diagnostic scans in some specialty areas or outside of our personal experience ie: Musculoskeletal ○ ○ Vascular Studies: ○ Carotids / ABI’s / Flow studies Transplants ○ apart from Achilles Often need private referral – only one sonographer at SCGH that does this Renal / Liver Morphological 2nd & 3rd Trimester Pregnancy Scans US studies that are not the correct imaging study for that patient! US studies that will not affect the ED Mx of the patient - when there are other demands on our time!
- 8. What are the advantages of using ED sonographers? You know us! We are nice people! We are usually easily accessible & can give you timely answers! We are clinicains We will usually re-examine patient and Hx We will form our own DDx & tailor our US study to answer both our Q’s We are happy to assist with: ○ patient management (including procedures) ○ liasing with inpatient specialties / radiology / other hospitals We are keen to teach bedside ultrasound and basic anatomy
- 9. What we need from you! Appropriate patient assessment & consultation: An appropriate clinical question/s based on that assessment Hx, Ex, Ix (both recent and any old relevant studies) Not: Not: But: Appropriate preparation of the patient (as far as possible) Analgesia (to allow probing!) Bladder volume (fullish - pelvic & renal tract scans) Fasting (Abdo scans) Inform patient / nursing staff ○ ○ I want an US. I want an US to find the cause for this patients pain. I want an US to rule out / in…. or differentiate…. TV scans for ovaries & early pregnancy What examining for… If performing bedside ultrasound and not credentialed – please inform patient and nursing staff that this is a training study (we are happy to review and formalise the study)
- 10. What we want from you! Interest in learning US: Vascular access EFAST AAA scanning
- 11. Feedback?