ED JAM

Oncological emergencies with Armando Hasudungan (YouTuber and Basic Physician Trainee)

On this weeks episode I travelled to meet BPT trainee and Youtube sensation Armando Hasudungan. Armando has more than 1.6 million subscribers on YouTube and is currently working as an oncology registrar. He has a passion for medical teaching and has helped millions of students around the world understand different medical conditions through interactive drawings. In this episode, Armando unpacked Febrile neutropaenia, hypercalcaemia and spinal cord compression: all serious oncological emergencies. The episode centred around three case studies and really highlighted the physiology, pathophysiology, treatment, differential diagnosis and story of the outcome. The episode is great for the novice learner to advanced clinician, Armando giving something for all listeners. The episode also reveals an amazing teacher, doctor, friend and creator, passionate to give everyone the tools to help patients. Please make sure you subscribe to Armando's channel- you are really missing out if you don't! Follow the links below to experience his amazing material. 

 

Subscribe to Armando channel click this link

Show notes below 

1. Febrile neutropaenia

Armando video click this link 

 

2. hypercalcaemia

https://armandoh.org/clinical-presentation/another-example/ 

 

Armando Video click this link

 

3. Spinal cord compression 

 

Armando Video click this link

 

Prehospital Trauma with Paramedic Pete

Prehospital trauma through the eyes of Peter Economou. Life in Australia as a paramedic is not for the faint hearted  !!!!. 

In this Episode I sat down with Peter Economou a very experienced paramedic. Peter has been working in this field for over 20 years and remains at the forefront of emergency care. He has held extensive positions as a paramedic and is one of the most respected clinicians working today. In this conversation we covered prehospital trauma, the role of team work, the use of the MARCHE nemonic , calciums role in trauma, needle decompression and how to deal with one of the hardest jobs in the world ( being a paramedic). 

 

 Case Notes 

 

Calcium in trauma

Ionised calcium levels in major trauma patients who received blood en route to a military medical treatment facility Click link to article 

https://emj.bmj.com/content/emermed/35/3/176.full.pdf?casa_token=-bkDDI-5zqEAAAAA:EigSbwsp3ywb1O5p6XmiaegBJvjg6CQp4PEHSgLMOjSHX9j05IjaMH0BDOyW7uX9w78YNdiFcPuTWQ

 

Ionised calcium levels in major trauma patients who received blood in the Emergency Department Link to article

https://emj.bmj.com/content/33/8/569.short?casa_token=K3zJwHMYKo0AAAAA:TWWYSj80paraxpGw4CFN255pMKxirThHYTGNz0rwPAlJj_Ez9dOywyN9B570FdqsrTmZOv6o88PQFg 

 

 

Haemostatic resuscitation

https://litfl.com/haemostatic-resuscitation/

accessed 22^nd August 2020. Link to website Life in the fast lane

 

 

Pelvic Binders

Effect of Early Pelvic Binder Use in the Emergency Management of Suspected Pelvic Trauma: A Retrospective Cohort Study

Link to Journal Article

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5664718/

 

 

Binder placement

Identifying risk factors for suboptimal pelvic binder placement in major trauma

https://www.sciencedirect.com/science/article/pii/S0020138320301741?casa_token=-TNOOV3myM4AAAAA:lROt14wZdPW9IHISjM2D8BB4oPcqTy2wch7-MRF7HRxC25AA464YR6PyERddkDIgMCMu79Llh8dl

 

 

Interesting books

• You Must See Some Terrible Things

By Patrick Kennedy

Link to novel

https://www.qbd.com.au/you-must-see-some-terrible-things/patrick-kennedy/9780731807659/

 

• A Life on the Line: A MICA Flight Paramedic's Story Paperback – 1 June 2019

Link to novel on amazon

 

Paracetamol Overdoses with Daniel Gaetani.

This week I travelled to one of the busiest emergency departments in the state, where I chatted to emergency consultant Daniel Gaetani. Daniel is an emergency doctor with a love for toxicology and all things ultrasound. This episode we unpacked the new paracetamol overdoses guidelines. 

We talked through four real cases and discussed indications for NAC infusions. The episode included pharmacokinetics of Panadol and how different formulations can affect our patients. We discussed the

rumack-matthews nomogram, LFTS , Panadol levels and even phosphate. Daniel gave us insight into when you should call toxicology and when to refer to transplant teams. We also went through how Daniel is using ultrasound in his Emergency department and where he envisions it being used in the future. 

 

Please see links below for all content used on this episode. 

 

Paracetamol Specific Resources

 

Chiew, A. et al. (2020). ‘Updated Guidelines for Management of Paracetamol Poisoning in Australian and New Zealand.’ Medical Journal of Australia 212(4): 175 – 183.

 

Katzung & Trevor’s Basic and Clinical Pharmacology 14th Edition Section VI: Drugs used to treat diseases of the blood, inflammation and gout

 

Life in the Fastlane (2020). ‘Paracetamol Toxicity.’ Accessed July 2020.

 

Murray, L. et al. (2015). ‘Toxicology Handbook, 3rd edition: Chapters 3.60 Paracetamol: Acute overdose, 3.61 Paracetamol: Modified-release formulation and 3.62 Paracetamol: Repeated supratherapeutic ingestion.’ Churchill Livingstone, Australia.

 

Murray, L. et al. (2015). ‘Toxicology Handbook, 3^rd edition: Chapters 3.60 Paracetamol: Acute overdose, 3.61 Paracetamol: Modified-release formulation  and 3.62 Paracetamol: Repeated supratherapeutic ingestion.’ Churchill Livingstone, Australia.

 

General Toxicology Resources

Murray, L. et al. (2015). ‘Toxicology Handbook, 3rd edition.' Churchill Livingstone, Australia. 

 

Local Policies and Procedures.

NSW Poisons Information Centre 13 11 26.

 

Case Notes Below 

https://docs.google.com/presentation/d/1BEws0s6CeAw-zG1jhumbIH6Kd5qVKuzD8bvbvglD8yo/mobilepresent?slide=id.g8dad0fe5d3_0_25

 

Behind the microscope- Hematological Emergencies

This week I traveled to Prince of Wales hospital and sat down at one of the biggest genomics/genetics laboratories in the country to talk to Rebecca. Dr Rebecca Walsh is a scientist, hematologist and genomisist (only a few of her titles!). Within the episode we discussed sickle cell crisis and what every ED staffer needs to know. We also discussed CAR-T cell therapy; currently a very hot topic. We also touched on febrile neutropenia, anaemia and pancytopenia. This episode will leave you with some key learning points from haematological emergencies. The episode finishes up with two cases that will have you in tears. 

 

CART-T cell therapy articles 

Chimeric Antigen Receptor Therapy- Journal 2018

Sickle Cell Article 

Sickle Cell Disease - Piel et al, 2017

life in the fast lane 

sickle-cell-crisis

For anyone interested in supporting people with sickle cell there is a support advocacy group 

https://aussicklecelladvocacy.org

 

Follow the EDJAM 

instagram @edjam_podcast

Catching babies in NETS

For this weeks episode I travelled to the NETS (The Newborn & paediatric Emergency Transport Service) base to talk to retrieval/PICU /NICU nurse Gillian Massey. Gill has extensive experience in paediatric and neonatal intensive care and has been working at NETS for 6 years. On this episode we cover: what is NETS, how the Neonatal/paediatric retrieval system works, how patients are triaged, what it's like to work at NETS, PPHN, nitric oxide and Gill's most exciting moment. We also dicussed paediatric/neonatal death and the impact it has on your personal life.  

Links below to relevant articles /websites.... Have a look! 

NETS data Decemeber 2019

NETS

Women and Babies: Persistent Pulmonary Hypertension of the Newborn (PPHN)

Current and Future Treatments for Persistent Pulmonary Hypertension in the Newborn

NETS Calculator

Crossbows and Snakebites An insight into Australian rural health.

On Episode 10, we discuss crossbows and snakebites with emergency nurse/midwife and author Christian Wright. Christian is a remote health nurse in the Northern Territory with extensive experience in emergency/paediatric rural medicine. Christian highlights the treatment of patients from minor to major in areas where access, circumstance and culture play a significant role.    

We discuss cross-cultural medicine, aboriginal sensitivities, working as a sole practioner and dealing with minor to major trauma. Christian also gives advice about support networks and cultural immersion.   

The case of the week is an interesting listen as Christian retells his encounter with a brown snake where he found himself as the patient. 

Snake bite article Stars align for Perth nurse bitten by a snake in Karijini National Park

 

Christian Wrights Publications

Are male partners of pregnant women treated negatively in maternity care?

click this link to article full text

Gastroschisis: A review of practice

click this link to article

Barriers to implementing diagnostic domestic violence screening

click this Link to full text article

Mind over Matter: Inside Hypnobirthing

Click this link to full text article

 

Recommended Readings for rural Health Professionals

CARPA Standard Treatment Manual 7th Edition

CARPA manual Link

Growing Up Our Way: The First Year of Life in Remote Aboriginal Australia

Link to full text article  

BOOK

“Why Warriors Lie Down and Die” by Richard Trudgen

link to book

 

Retrieval- Helicopters and Heroes with KO

In this week's episode I chat with Kevin, an emergency consultant and retrivealist. We discuss the role of retrieval systems in NSW, prehospital vs inter hospital transfers, doctor-paramedic teams, preparation of patient for retrieval and packaging a patient for transfer. We also discuss the impact of COVID 19 and as always a case of the week. This Canadian born legend is worth a listen. 

 

Show notes and Links 

Sydney Hems link 

Careflight website

Trauma with Sarah Newman AKA Serotonin

This week we chat with Dr Sarah Newman, emergency and retrieval doctor, about all things Trauma.  Sarah unpacks patient assessments, primary survey, blood products and shares some experiences from her time with NSW ambulance (think Helicopters).

 

Show notes 

The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients.

https://www.ncbi.nlm.nih.gov/pubmed/23477634

 

COVID 19

Dr Stephanie Fletcher, epidemiologist and public health expert, discusses all things COVID-19. What is a pandemic? What is COVID-19? What are the global effects of infectious diseases? What should we do to prepare for COVID-19 in Australia as both health care workers and the general population?

 

Links 

https://www.health.nsw.gov.au/Infectious/alerts/Pages/coronavirus-faqs.aspx

 

 

Paeds Asthma - With Dr Max Raos. Episode 5

Today we discuss Paediatric asthma with emergency physician Max Raos. Unpacking all the pathophysiology and treatments for children with asthma from mild to severe. Max is an emergency physician with a passion for paedatrics.                                                                                                  

  GINA Guidelines           

 https://ginasthma.org/wp-content/uploads/2020/04/Main-pocket-guide_2020_04_03-final-wms.pdf      

https://pubmed.ncbi.nlm.nih.gov/31249014/#:~:text=GINA%202019%3A%20a%20fundamental%20change%20in%20asthma%20management%3A,is%20no%20longer%20recommended%20for%20adults%20and%20adolescents

 

NSW paeds asthma management

https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2012_056.pdf

 

http://www.liverpoolpaediatrics.com/files/asthma_childrens_asthma_information_pack.pdf

 

ASCIA website

https://allergy.org.au/hp/ascia-plans-action-and-treatment/