Update from Dr Louisa Lee – September 2021
COVID – related chaos continues and sadly optimism and hope – at least for now – has lost out to the reality of extended restrictions. Therefore, I’ve adjusted the September teaching timetable for Intern / HMO teaching. Click ED intern/HMO teaching to view the programme and obtain MS Teams link. I will keep persevering (like we all must) and hopefully try again for face-to-face teaching in October!
You might be interested in the following virtual / online learning:
Northern Sonosphere June Webinar on ED Pericardiocentesis – Dr Raj Kathirgmanathan (Emergency Physician) https://www.youtube.com/watch?v=u5A-ACMBdjY
Northern Sonosphere July Webinar on Pleural Effusion – Dr Sanjeevan Murugandan (Respiratory Physician & NH Pleural Lead) https://www.youtube.com/watch?v=DrPu-CMaATA
ED RN Tyson McLeod’s homemade video on Common Toxic Plants – https://youtu.be/QkCaz9kU7bM
St Vincent’s Hospital Melbourne Regional Emergency Teaching Forum on 15th September – https://media.northerndoctors.org.au/wp-content/uploads/2021/09/SVH-Regional-Teaching-Flyer-15th-Sept.pdf
VIRTUAL TEACHING SESSIONS – https://meet.jit.si/NorthernEDVirtualTeaching2021PS18QMG75
POINT OF CARE ULTRASOUND (POCUS) TEACHING – POCUS teaching will also look different in 2021. Bedside tutorials and credentialing will still continue but with a tighter selection process. In addition, there will be monthly workshops covering the core applications of POCUS in the ED. If you are interested in POCUS teaching and haven’t already expressed your interest to me, please drop me an email as POCUS teaching communications will be emailed out separate to my group teaching emails.
ACUTE BEHAVIOURAL DISTURBANCE – Behavioural emergencies are a common ED presentation and it’s important to know our role as ED clinicians. I’ve attached a little summary of tips + Rockie’s case presentation of a patient who had red flags for a medical cause.
TRAUMA – Trauma Clinical Lead ED consultant Dr Jonathan Ng has been pivotal in trying to streamline and improve the care of trauma patients at the Northern Hospital. Please be aware of some recent changes, including the revised Trauma Management Record (which can be filled out in lieu of electronic notes in the EMRG summary), the correct term for CT pan scan protocol (“Trauma Whole Body CT”), Neurosurgical updates and the Trauma Circulation box (for controlling haemorrhage) in the cupboards outside resus 5/cubicle 6. The Code Trauma policy on PROMPT is also being updated.
I’ve attached Ridwan’s Geriatric Trauma case presentation. It’s important to remember that older patients can sustain serious trauma from what might constitute a low risk mechanism (eg falls from standing height including the notorious slip in the shower). Think of them as a trauma patient in the same way you do for a patient involved in a high speed MVA – this way you are less likely to miss other injuries such as traumatic brain and C spine injuries. Other factors like an aging physiology, anatomical changes, comorbidities and medications can confound the clinical assessment, making it more difficult to diagnose serious injuries.
CHEST WALL BLOCKS – If you missed the Northern ED Ultrasound Committee’s POCUS webinar last month on Chest Wall Anaesthesia, you can download it here:
https://www.dropbox.com/s/5g5tdthra8wji97/POCUS%20chest%20wall%20webinar.mp4?dl=0
Or watch on Peter Pap’s Youtube:
A big thank you to Dr Scott Taylor for giving his excellent talk on Serratus Anterior Plane block, especially before starting night shift (now that’s dedication!). I have attached a couple of articles including a pilot study of this technique from the Alfred Hospital. It was a great webinar which will hopefully start a successful collaboration with our Anaesthetic colleagues in improving the pain of patients suffering chest wall trauma (eg rib fractures). Feedback has been that ED clinicians are not always following the comprehensive Acute Pain Services manual (Non-regional anaesthesia) found on PROMPT, which I’ve attached so ignorance is no longer an excuse! There is a fairly detailed section on Rib Fractures including a “Multiple Rib Fracture Pain Management Algorithm” on page 65. Importantly, patients must be referred to the Acute Pain Service, ideally before leaving ED, as well as physiotherapy.
Louisa Lee
EMERGENCY PHYSICIAN, EMERGENCY DEPARTMENT
DIRECTOR, NORTHERN ED INTERN/HMO TEACHING PROGRAM
DEPUTY DIRECTOR, NORTHERN ED ULTRASOUND FACULTY
EMET INSTRUCTOR
185 Cooper Street Epping Vic 3076
T (03) 8405 8013 | www.nh.org.au