Trying to become a better clinician, one case at a time. Emergency physician, member of an awesome team.
Joined September 2018
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So what do people think of 360 feedback for senior clinicians? Any pearls and pitfalls? And any suggested tools?
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Reflections from my last shift
ED already inundated with worried well Coronavirus pts. When we are inundated with critically unwell pts, we will truly have to consider how we rationalize our care and resources.
We need:
clear guidelines
true collaboration
More PPE!
#COVIDー19
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Reflections from my last clinical shift.
Spont Bacterial Peritonitis often presents with non-specific abdominal pain, ABSENCE of fever & systemic symptoms in patients with ascites.
Have a low threshold for grabbing your ultrasound and doing a diagnostic tap in the ED
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Reflections from my last clinical shift
Paediatric intubation tips
1. Expect rapid desaturation-consider bagging through induction
2. Have a NGT ready and watch for stomach insufflation
3. The cords are not as obvious as adults-aim for the glottic inlet
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Reflections from my last shift...as a patient
Amazed at the care recently shown to me and my family, but in particular the high level of professionalism.
As clinicians, our professionalism is ALWAYS on show, in everything we say & do.
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Reflections from my last clinical shift
The first & most important step in good advanced airway management in the ED:
Good basic airway management
Watch the chest and neck to assess ventilation, proper positioning, ETCO2 on your BVM +/- adjuncts
Reflections from my last clinical shift.
It’s been 7 years since I obtained my Fellowship. Despite my interest in teaching,lots of clinical knowledge drops out of my head. Sometimes on shift my ‘juniors’ are brimming with that knowledge. I am lucky to have such a team around me
Listening to @symon_ben talking at #QPEM19 and realising I’m a very task-oriented listener! And that there are many different types of listening. Understanding all of these and recognising when to switch between them will help us care for our patients better.
Reflections from my last shift
Ive noticed a growing trend of getting formal USS to rule out collections for every cellulitis case
Why?
This is a great ED skill-bedside USS in soft tissue infections:
- confirm cellulitis (cobblestoning)
- define collection
- look for nec fasc
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Reflections from my last clinical shift
The Bier block - often frowned upon in the ED world - is a very effective method of providing regional anaesthesia for wrist # reductions.
Max Prilocaine dose 2.5mg/kg (0.5ml/kg of 0.5%)
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Reflections from my last clinical shift:
Infective endocarditis is often missed because its presentation is insidious and non-specific. Temp is often mildly elevated only
RFs:
IVDU
Rheumatic heart disease
DM
Severe renal disease
Post invasive procedures, not just valves!!!
Reflections from my last clinical shift:
The ED is always busy. Sometimes that leads us to focus more on disposition.
Our goal should always be good assessment and management.
This sometimes get lost in the need to keep patients moving through the department.
Reflections from my last shift
40yo F with sudden onset severe LIF pain. My main ddx ovarian torsion vs renal colic
Some learning points for me:
- bedside urinalysis was v helpful
- I need to improve my USS skills - torsion a lot less likely if normal ovarian architecture
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So I’ve run over 400km in preparation for the upcoming Melbourne Marathon but I haven’t raised over $400 yet!
Help push me over the line and support this great cause.
Thank you so much!
mail-track.everydayhero.com/…
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Reflections from my last clinical shift:
Febrile neonate:
Prepare your staff to do your full septic workup ASAP - bloods/urine/LP
Draw up your antibiotics whilst the workup is being done.
- Cefotaxime 50mg/kg IV
- Ampicillin 50mg/kg IV
+/- Aciclovir 20mg/kg IV
Reflections from my last clinical shift:
Paediatric Status Epilepticus
- Ensure airway patent and oxygenate
- Benzo IV/IM/IN
- Repeat benzo
- 2nd line agent, likely levetiracetam 40mg/kg
- Check BSL
- Prepare to intubate to maintain airway for 3rd/4th line agents
Debrief team
More reflections...
Advocating for patients is best done at the end of their bed.
If you work in the ED, it is often helpful to try and get the hospital doctor to the bedside if possible. It may prevent multiple frustrating phone calls!!!
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