Emergency Medicine Tutorials
By Drs Chris Cresswell, Qasim Alam and Andrew Dean-Ballarat, Australia and New Zealand
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Podcast Description
For junior doctors by junior (or recently junior) doctors. With excerpts from great podcasts such as EMRAP and EMCRIT
| Name | Description | Released | Price | ||
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1 |
An Airway Death: Andrew Prescott - Advanced Paramedic | Audio @ or on the EMT website at https://sites.google.com/a/emergency-medicine-tutorials.org/www/Home/resuscitation-1/airway | 14 5 12 | Free | View In iTunes |
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2 |
RSI | A talk given as part of an airways study day for docs, nurses and paramedics. The powerpoint is available @ https://sites.google.com/a/emergency-medicine-tutorials.org/www/Home/resuscitation-1/airway/preparation-for-rsi-or-procedural-analgesia-sedation?pli=1 Audio @ | 13 5 12 | Free | View In iTunes |
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3 |
Airway Disasters I Have Seen or Caused | Powerpoint and audio available @ https://sites.google.com/a/emergency-medicine-tutorials.org/www/Home/resuscitation-1/airway Audio available @ | 13 5 12 | Free | View In iTunes |
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4 |
Stress Management | An 18 minute talk on managing stress, sleeping well and surviving a career in health care. Audio and powerpoint are available here: https://sites.google.com/a/emergency-medicine-tutorials.org/www/Home/general-principles/self-care-1 or audio is available here: | 8 5 12 | Free | View In iTunes |
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5 |
Coughs Wheezes and Squeeks | A quick run through common respiratory tract infections for the start of the southern hemisphere winter. Apologies to the northerers. Audio and powerpoint are available here https://sites.google.com/a/emergency-medicine-tutorials.org/www/Home/medical-3/respiratory/infectious-diseases/common-respiratory-tract-infections or audio here: | 8 5 12 | Free | View In iTunes |
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6 |
Funny Coloured Legs | Middle aged european male comes in with an exacerbation of CCF. He has chronic psychiatric illness and hypothyroidism. The RMO notes the patients unusual skin colouration and wonders if this could be due to myxoedema. Whatdayareckon? Scroll down for answer ..... Probable "slate grey" pigmentation from amiodarone which this patient was on. "Some patients have developed skin pigmentation (slate grey/purple colour) of the exposed areas. This pigmentation can be avoided if doses are kept as low as possible. If the pigmentation is cosmetically unsightly, amiodarone should be discontinued if alternative therapy is possible." CordaroneXtabinj.pdf from http://www.medsafe.govt.nz/ Accessed 22/4/12 | 25 4 12 | Free | View In iTunes |
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7 |
Shoulder dystocia - follow thru | Just for completeness to round off Jo's talk on shoulder dystocia she mentioned follow through. This is a technique of actively managing the delivery of the babies anterior shoulder, rather than waiting for it to deliver naturally - then perhaps finding 3 minutes down the track that you have a shoulder dystocia. | 22 4 12 | Free | View In iTunes |
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8 |
Maternal Emergencies | Audio and power point and checklist are at Emergency Medicine Tutorials Maternal Collapse / Emergencies | 18 4 12 | Free | View In iTunes |
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9 |
Breech Delivery by Lucy Pettit | Call for help: obstetrician, midwife, paeds. Theatre and anaesthetist on standby. Obsetrician will make decision re caesar vs vaginal delivery. IV access. Group and hold. Monitor fetal heart rate. Empty bladder eg in-out catheter Generally deliver with mother lying on bed. Some midwives/mothers prefer mother to stand. Hands off until legs and abdomen are delivered. Except gently turn baby by holding onto pelvis to ensure that babies back is anterior relative to mother so that babies chin does not get stuck behind symphysis. Once tops scapulae visible gently rotate one shoulder anteriorly and deliver arm, then rotate other shoulder anteriorly and deliver arm. Once the nape of the neck is visible rest baby on your arm then index and ring finger on cheeks and bent middle finger on chin. Other hand applying pressure on occiput and gentle pressure on shoulders to flex neck and deliver baby slowly in an upward swing. Ensure the delivery of the head is as slow as possible. Audio and powerpoint for this talk are at Emergency Medicine Tutorials - Breech Delivery | 18 4 12 | Free | View In iTunes |
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10 |
Post Partum Haemorrhage by Robyn McDougal | Tone: uterine atony causes most 70% PPH eg prolonged labour, grand multip Trauma: 20% of PPH due to uterine inversion or rupture! Tissue: retained pieces of plancenta or invasive placenta (cretas) cause 10% of PPH Thrombin: 1% of PPH due to coagulopathy Mx Call for help Fundal massage IV access: group and hold, coag. Send for O negative blood and call for platelets and FFP now. Catheter to empty bladder (to assist uterine contraction) and to measure urine output. Inspect v****a for lacerations (- repair) / uterine inversion (tocolytics such as salbutamol inhaler, magnesium sulphate eg 10mmol over 20 minutes, or GTN SL or IV and reduce uterus. May require GA) Bimanual compression (one hand in v****a, other hand on fundus) Misoprostal 800mg PR Carboprost 250µg IM Tranexamic acid 1g over 10 minutes then 1 g over 8 hours (not standard obstetric practice but extrapolating from other areas of Emergency Medicine practice) Refractory cases: laparotomy and arterial ligation / hysterectomy. | 18 4 12 | Free | View In iTunes |
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11 |
Shoulder dystocia by Midwife Jo McDonnell | The talk and powerpoint are available @ https://sites.google.com/a/emergency-medicine-tutorials.org/www/Home/obstetrics/complications-of-pregnancy/delivery-complications/shoulder-dystocia. Audio only @ http://itunes.apple.com/nz/podcast/emergency-medicine-tutorials/id441003312 | 12 4 12 | Free | View In iTunes |
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12 |
Maternal Emergencies | Welcome to a series of talks given at a Maternal Emergency study day. This was a small group session for midwives, nursing coordinators and junior doctors. This is in the context of a small hospital with most deliveries assisted by midwives only with doctors and obstetricians only called when there are problems. The obstetrician on call may be at home or operating so the midwives and junior docs have got to be good at managing obstetric emergencies. Our maternity unit is right next to our ED and ED docs sometimes get called to help. Sorry that the sound quality is rubbish | 12 4 12 | Free | View In iTunes |
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13 |
Airways Basics PGY 1 & 2 | 47 year old male brought in with falling level of consciousness, hypotension and widened QRS on monitor. Anaesthetised, paralysed. Found to have 1cm mouth opening due to TMJ arthritis - unable to get larygnoscope in his mouth .... Reasons to manage and airway Obstruction - partial or complete Failure of ventilation or oxygenation by other means Inability to protect the airway Probable deterioration that will lead to any of the above. Assessment Hx Previous airway problems / anaesthetic history GORD Obesity Other medical conditions eg that may effect choice of drugs eg hyperkalaemia, malignant hyperthermia Fasting status Seldom relevant in ED - but nice to know if they have belly full of beer Fasting associated with more vomiting in ED procedural anaesthesia Pain and trauma stops gastric emptying Symptoms Difficulty breathing or speaking Sore throat Signs Obesity Stridor Muffled or hoarse voice voice Gurgling Mouth Mouth opening Jaw size, jaw protrusion Swelling, fluid, pus, mass, blood, vomitus Anatomy Mallampati: patient sitting up and phonating ED: "modified Mallampatie Neck Mobility Swelling Scars Airway Management This is one definitive airway adjunct - but usually a lot we can and should do before we get to this. 72 year old women BIBA from private hospital with consultant physician at her side. DTs Rx benzos. Paramedic silently screaming "Come here!!!" with his eyes Patient lying on her back, cyanosed, obstructed airway Whatchagointado? Scroll down .... Recovery position - breathing easily and well The most important airway tools are your hands Jaw thrust Scoop vomit Reposition patient Recovery position Turn the vomiting patient with possible spinal injury You can temporise most airways with your hands. Most other adjunct are just ways to give your hands a rest. Jaw thrust = pull the angles of the jaw anterior so that you sublux the TMJs Also a good test of level of consciousness and stimulus to breath if you have given too much anaesthetic! Next most important tool? Scroll down .... Suck the crap out of them. BVM ventilation Notice the two hands on the mask - this is OK - not a sign of failure! OPA = Guedel Temporary method to open airway. If patient can tolerate an OPA they probable need an ETT We seldom use them because we are usually actively manually managing the airway. Sometimes needed as an adjunct to manual airway management. Sizing: angle of jaw to corner of mouth or centre of mouth depending on who you listen to. Red for adult male Orange for adult female NPA Useful for the partially obstructed airway. You can suction through them. NOT contraindicated if signs of basal skull fracture. (NG tubes have gone into the brain but not an NPA) Sizing tragus of ear to nostril. LMA Fantastic airway devise. Now acceptable to use in cardiac arrest rather than intubating. Provide good ventilation and some airway protection. Takes some practice. Sizing: weight based sizing on the packet. Generally size 5 for an adult male, size 4 for an adult female. Seldom used but often have one handy as a back up. A few particular problems conditions Tracheostomies Most acute trachy problems solved by good suctioning +/- repositioning of tracheostomy tube. What do you do for someone with a long standing tracheostomy tube who is bleeding from around the tube? Scroll down .... Possible erosion of trachy tube into innominate artery = bad Blow up the trachy cuff to try to tamponade the bleeding. Call ENT, anaesthetics and cardiothoracic surgeons to the bedside. Theatre on standby. Stridor If severe temporise with 5mg nebulised adrenaline and steroids Foreign body If the patient is moving air let them keep doing that. Don't try to intervene unless they are falling unconscious or apnoic then try Heimlich, back slaps, McGills, pushing FB down right main bronchus with ETT When to intubate? Obstruction - partial or complete Failure of ventilation or oxygenation by other means Inability to protect the airway Probable deterioration that will lead t | 2 4 12 | Free | View In iTunes |
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14 |
Non IV anticonvulsants work on kids | Another article has come out supporting the effectiveness of non-IV benzodiazepines for terminating paediatric seizures. This was comparing IV and IM. For some reason they compared lorazepam IV vs midazolam IM. Any way the IM midazolam worked as well as the IV lorazepam This is great as it can be quite stressful trying to get a IV line in a pudgy twitching limb. IN and buccal are other good routes. For me however, so often a whole lot of drug pours out of the nose or mouth afterwards that I'm not sure the kid has recieved an effective dose - so I like IM. http://www.ncbi.nlm.nih.gov/pubmed/22335736 | 7 3 12 | Free | View In iTunes |
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15 |
Splinters | Splinters are best cut out rather than pulled out and always look for the 2nd or 3rd piece. Use entonox, lots of local anaesthetic (consider an ankle block http://www.nysora.com/peripheral_nerve_blocks/classic_block_tecniques/3035-ankle_block.html for the foot then direct infiltration) and then cut down to the splinter with a scapel and release the splinter. Cut down the full length of the splinter. This way you can cut open the tract and give it a thorough clean. You can also more easily explore for other fragments - more often than not there is more than one fragment imbedded. Remeber to check tetanus status. Antibiotics shouldn't be needed. Image: Master Splinter from the Teenage Mutant Ninja Turtles. | 7 3 12 | Free | View In iTunes |
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16 |
Sleep inducing meditation by The Meditation Podcast | It works! Try it when you aren't too stressed. Then when you really need it you've already learned to swithc off. After awhile you won't need it any more: head - pillow - zzz. :-) | 6 3 12 | Free | View In iTunes |
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17 |
Breath Meditation by Professor Jon Kabat-Zinn | Try it daily for a week - it's worth it. | 6 3 12 | Free | View In iTunes |
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18 |
Self care | The ED environment can be tough. Many people find it difficult to "unwind" after a shift. Some fall into bad habits of using lots of alcohol. Others "vege" out in front of the TV. I had a "nervous breakdown" during my training. It's not pleasant. I recommend actively doing stuff to keep your body, mind and soul healthy. Cycling home is a good way to clear out the cobwebs, and exercise is essential for our mental health. Meditation I strongly recommend meditation as a way of maintaning your mental health. It helps get rid of a lot of mental "noise", helps prevent burn out and makes us better able to think straight and communicate better with our patients. If you've never done any meditating try just listening to Life flow 10 minute demo.mp3 which is the next episode in this podcast They are meant to work by inducing a change in frequency of your brain waves. Who knows if they work or not but the seem to be quiet good for chilling out. Originals can be bought at http://www.project-meditation.org/lifeflow.html. Professor Jon Kabat-Zinn is an American professor of medicine who teaches all sorts of patients meditation with great results. A breath watching meditation will be one of the next episodes of this podcast, You can buy more of his work here http://www.soundstrue.com/authors/Jon_Kabat-Zinn/ Meditation for Beginners is very good. Sleep Lots of doctors have trouble sleeping, expecially after a busy shift. Soon on this podcast will be a guided meditation from The Meditation Podcast which helps lots of people get to sleep. My boss tried it and freaked his wife out - she found him apparently comatose on the lounge floor at 7pm one night - it works. Taking regular breaks A great bit of advice given by a counsellor at the Part 2 exam course is that when studying stick to a regime of studying for 45 minutes then taking 15 minutes off to do something else: walk, sleep, meditate, hang with your flatmates or family. Your studying will be much more efficient and you will feel much more human. At work make your self take a break even if it's just 5 minutes every few hours to stop, sit down and have a cup of tea. You will work much more efficiently when you've had a break. Night Shift Night shifts suck. Everyone has there own tricks. Generally try to stay up late the night before your first night shift, sleep in the next morning and try to have another nap just before starting night shift. Avoid discharging anyone triage 3 or below overnight - we have a higher chance of making the wrong decision. Evidence suggests that our performance improves if we have a 30 minute nap during our meal break overnight. This is banned in some departments - check the local rules. Try to avoid driving a car after night shift - lots of people crash. Getting some soul in our work A lot of us went into medicine with high ideals about helping people but end up feeling like we've been sucked into and become part of a massive souless machine. I've got a seperate website, blog and podcast called Creating a Healing Space which has lots of practical ideas of how to get back to caring for patients, so that we enjoy our work and finish our shifts satisfied - even in a hectic environment like an ED. Chris Cresswell | 6 3 12 | Free | View In iTunes |
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19 |
Fluids PGY 1 & 2 Part 1 | How to assess fluid status, which fluids to use, how much and management of fluid overload. For PGY1 and 2 About 20 minutes long Powerpoint to go with this audio is here Fluids ppt | 6 3 12 | Free | View In iTunes |
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20 |
Fluids PGY 1 & 2 Part 2 | About 20 minutes long | 6 3 12 | Free | View In iTunes |
| Total: 20 Episodes |
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