ED Thursday Teaching

27 07 2013

as with our department – – with people calling in sick and lack of motivation (the tyranny of distance for some ; not being a trainee) or recreational leave : our attendance was minimal.

having said that : we had a great session!

1st session :


got grilled in the resus bay about the knobology and stuff.

The key messages taken away is to be aware of plateau pressures and hot to measure them.

Found some good links from the great LITFL crew courtesy of Chris Nickson :




Case presentations

few great cases : 1 about a rather rare cause for abdominal pain (epiploic appendigitis), 1 about Kawasaki’s and mine about perilunate dislocations.


Grand Rounds

had Dr Louise Cullen from RBWH presenting about chest pains (and the new diagnostic strategy to safely rule out the super duper low risk ones)



Exams in 20 days time ! EEEPS



friday at shift

13 07 2013

started out wither another fast AF Seconday to cessation of beta blocker. given some magnesium ; slowed down …yay


next case was interesting 10 y/o bilateral conjunctivitis for 1 week, followed by urinary symptoms; fevers and possibly a painful left knee ?? – possibly trauma from the day prior

? kawasakis vs reiters vs septic arthritis…

will have to see what happened

bloods and a knee joint aspirate were sent


next case INR of >10 and jaundiced….. hmmm

diverticulitis on CT ! as well as HOP incidentally.

needed prothrombinex.


3rd middle prox metacarpal # – oblique —> volar slab

another sporadic post

12 07 2013

thought i’d put a note to my shift yesterday.

Patient 1.

A flutter with syncope – admit telemetry

cause ? (probably too much flecainide and all the agents – alpha blocker/beta blocker/CCB/flecainide)

need to revise : Drugs for anti-arryhmics esp flecainide

Physiology : cardiac AP


2. Man seen yesterday w ? gastritis (used NSAIDs for weeks for arthritis) and today presents with worsening tummy pain and rash.


Rash – confluent maculopapular kind – distributed all over – not specific distribution. blanching. looks like drug rash.

Tummy – RLQ pain +++


diagnosis – perforated appendix w free fluid on CT. 

lessons : good disposition for ppl with abdo pain – rash is a bad sign

need to look up literature about rash + abdo pain. ( i thought that was from nurofen !)


3. # cuboid + tuberosity of 5th metatarsal

anatomy – good to revise bones of feet and muscles of ant part of leg.


4. Scans done :

a. 1 FAST

b. 1 LUS – B lines in LLL suggestive of infiltrative process.


5. I+D right upper lip abscess

used infraorabital nerve block.

anatomy : revise face / triangle of danger