Case 3: Demon in a Bottle

About the Author
Dr. Brendan Morrissey (@unsarcasticone) is an Emergency Medicine Advanced Trainee currently working at St. Vincent's Hospital Melbourne ED - one of Austalia's leading hospitals in dealing with drug and alcohol affected patients (see here for recent article in 'The Age'). He studied at University College Dublin, and has been working in Emergency Medicine across Australia and New Zealand for the last 8 years. His interests are Public Health and Medical Education.










The Case:

A 51-year-old man self-presents to your inner city ED one Friday evening; he’s complaining of mild abdominal pain and shortness of breath. A quick scan of his old notes at triage shows a background of Chronic Liver Disease secondary to alcohol. He does not appear in distress and is haemodynamically normal, so is placed in the long line for an empty cubicle.

Paging the Cardiology Registrar: Acute Coronary Syndrome in the ED

About the Author

Dr. Yousif Ahmad (@narrowcomplex) is a Cardiology Specialty Registrar in London, predominantly working at the Hammersmith Hospital which is one of London’s eight 'Heart Attack Centres', offering a 24/7 primary angioplasty service and a 'Primary Arrhythmia' service. Yousif is currently involved in coronary physiology research, and is passionate about medical education. He is teaming up with Pondering EM for the 'Paging the Cardiology Registrar' series, which will equip the junior ED doctor with the nitty gritty for key cardiac presentations, and importantly, explain what our cardiology colleagues are really interested in when they receive a phone call from the ED.

Pondering Cardiology in the ED

The first thing I would like to speak about is the relationship between Cardiology and the Emergency Department, and the unavoidable changes encountered over the last few years.

Pondering Acid-Base Part 1: Making Sense of the Chaos!

So much pathology is reflected in the acid-base status of a patient. 

I've always found acid-base analysis challenging. I probably look at a couple of VBGs on most of my shifts in the ED, and up until now have scarcely ventured beyond the basics.

I used to be able to say whether a patient was acidotic/alkalotic (or is it acidaemic/alkalaemic??), and I could usually indicate whether the primary aetiology was respiratory or metabolic. On a good day, I may have been able to stumble my way through saying if there was any degree of ‘compensation’ (I think). But beyond that I got lost in a haze of confusion and numbers.

Case 2: She Came Disguised as an Acute Abdomen...

Here is a presentation we put together on this case. We skim over a lot of the content, which is covered in greater detail in the written post. We used prezi.com for the ‘virtual canvas’ style presentation.



   

The situation…

It was a Saturday night in a small suburban ED. It was my first ever night shift as the senior doctor in the ED – I was intensely nervous and experiencing major cognitive overload!

Do We Use A Pre-Intubation Checklist?

Back in April, I attended what has been dubbed ‘the greatest medical conference of all time’ by some of the online critical care community - SMACCGold. As expected, the experience was phenomenal. I found myself in an excited frenzy about the career I am lucky enough to find myself persuing – Emergency Medicine.

Some of the hottest property in #FOAMed and EM/critical care gave talks that were inspiring and educational in equal measure. Watching the speakers perform in the flesh (rather than listening to them on a podcast) with the stunning ‘tribal’ backdrop on the main stage was awesome.

One of the talks that had the biggest impact on me was given by Tim Leeuwenburg. It was during the ‘Airways for All’ session on the third day. Tim, who authors the brilliant kidocs.org website, is a rural/prehospital GP with a keen interest in airway management (he is the proud owner of 5 surgical airways!). He was debating the mighty Minh Le Cong on the issue of pre-intubation checklists. Tim was arguing the case for and Minh against. You can find a fantastic blog post from Tim regarding checklists here.

Case 1: Who's afraid of the big bad Wolff?

The patient…

21 year old girl. Clean bill of health. 1 hour of unrelenting palpitations that stopped her being able to concentrate on writing her dissertation. On standing to get a cup of tea she feels very dizzy and like she is about to collapse. She lays down and calls for her boyfriend who phones an ambulance.

15 minutes later the palpitations stop and she feels back to normal… just before the paramedics arrive. She is still taken to the ED to be checked out.