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Monthly Archives: January 2014

Difficult Decision Sim Scanario – Breakfast meeting 30/1/14


Some general feedback from today’s simulation.

Thanks to all who attended – we will email you with some more detailed feedback in the next few days – check your mail.

A few points we thought were relevant to all were as follows.


Best done at the end of the bed or at least away from the bedside

Calling a timeout or asking for a little quiet will ensure that you receive all the relevant information.

Don’t forget that there are many cognitive aids in resus – today the paediatric formulae – NETS calculator wasn’t used. It sits on the shelf in a folder – find it and use it.


Please post any comments.

See you next month for our Neurotrauma scenario – February 27th 07:00

Pacing in ED – permanent and temporary

Pacing in ED is not technically difficult. Below is a presentation from today’s teaching.

The decision to commence pacing is challenging and can be a cause for hesitation.

Failure of chronotropic therapy and an inadequately perfusing rhythm e.g.bradycardia, complete heart block should prompt initiation of treatment.

Transvenous pacing is the gold-standard but requires a skill set not always available.

Follow the link to a power point presentation from today’s teaching with an overview of pacemakers and pacing in the ED. At the end are links which I have included below for convenience – or if you want more detail. Send in your comments as usual.

Pacing in ED


X-ray education link

Thanks to Ali Mahoney for this one.

A comprehensive look, learn and test yourself site for medical students and junior doctors.

ED Inotropes

Choosing when to start, add or stop inotropes can be challenging.

On Tuesday we talked a bit more about the difference in actions and the uses of some of the inotropes we have in ED to use on our patients using a case presentation.

Open the presentation which I’ve added a bit more content to so it’s easier to follow if you weren’t there.

Please post any comments or questions.



For someone else’s views try Chris Nickson’s summary in life in the fast lane.


Snake Bites – a practical approach

Hi – another article from the inimitable Geoff Isbister. Slowly we are seeing the use of Venom Detection Kits (VDK) devolve in importance. Treat the patient – don’t worry too much about the kit.

Antivenom should be administered as soon as there is evidence of envenoming. The VDK may assist in regions where the range of possible snakes is too broad to allow the use of monovalent antivenoms.

Also one vial of suitable anti venom is enough – recovery from the clinical and laboratory effects are likely to be delayed. Specific and supportive treatment for these should be aggressively pursued and implemented.

Have a look at:

Snake Bite MJA_fm

Asymptomatic hypertension – don’t do anything!

Hi – the news we’ve all been waiting for.

ACEP published a consensus statement in July 2013, Weingart blogged in October, you have it now.

Is there any evidence to further assess OR treat asymptomatic hypertension in ED – NO.

Send them back to their GP for further evaluation and treatment – they’ll be fine.

There are some provisos so please read the article attached.


Here’s a link to Scott’s emcrit post: Weingarts’s podcast on asymptomatic hypertension

Comments welcome as usual