ED teaching 13 November 2019

Case based discussions

  • Elise - massive ibuprofen overdose complicated by HAGMA and CNS depression
    This case provoked a group discussion about the role for gastric decontamination by NGT in a patient who already took oral AC but then experienced an unexpected deterioration. 
    There was also debate around optimal post-intubation analgesia/sedation regimes - fentanyl 1mcg/kg/hr IBW + propofol 2mg/kg IBW seemed to be a good starting point for many conditions.

  • Stephanie - is homocidality a mental illness?
    Another interesting debate regarding using mental health legislature to remove someone’s liberties because of forensic ideation

  • Sinead - managing a representation of an infected PPM site

  • Jolmer - on the sorrows of having an “off day” -  a collection of anecdotes

  • Tom - on advocating for patients with drop-dead ECGs in the face of cardiology apathy

This ECG was recorded in a patient with exertion chest pain and a slightly increased troponin. The patient was told to go home by cardiology for an outpatient stress test, presumably because they were in their late 20s and didn’t fit the typical ac…

This ECG was recorded in a patient with exertion chest pain and a slightly increased troponin. The patient was told to go home by cardiology for an outpatient stress test, presumably because they were in their late 20s and didn’t fit the typical acute coronary syndrome demographic.

Guest presentation

Dr Deb Wood FACEM - “Things I wish I’d known (BEFORE starting preparation for the ACEM fellowship exam)”

Simulation: Hypoxia in four different flavours 

A fabulous turnout of 4 doctors and 7 nurses getting their hands dirty in the resus room.

  • Atelectasis after right main bronchus intubation, resolved by withdrawing the ETT

  • Bilateral tension pneumothoraces as a complication of withdrawing the ETT after RMSB intubation, resolved with bilateral thoracostomies 

  • Tension pneumothorax as complication of blocked ICC,  resolved by repeat thoracostomy

  • APO as complication of hypertensive crisis and LVF, resolved with NIV and nitrates


Thomas Brough