the underneaths of things

The Social Media slides

dreapadoir — Sun, 19 Feb 2012 04:14:41 +0000

Social Media and Web 2.0 for Emergency Medicine – the Luddiot’s guide

STEMI vs. BER?

dreapadoir — Tue, 14 Feb 2012 22:46:06 +0000

A 50-ish year old man presents with central crushing chest pain on a background of intermittent chest pains for a couple of days, tenuously related to exertion, maybe a bit postural, perhaps a recent coryzal illness, definitely a bit vague. This was his ECG with pain on arrival to ED:

ECG with pain

He got aspirin 300mg, a couple of sublingual GTN sprays and 5 mg of morphine rendering him pain free. Past history significant for a throat SCC treated by excision and DXRT some years previously. Continues to smoke heavily. His first troponin was <0.01.

So, is this BER, pericarditis or STEMI?

Closeup of precordial leads (ECG about 5 minutes after full one above)

Applying the Steve Smith formula for just this purpose to this ECG we get ~24.345, which is >23.4 and therefore suggests STEMI. So, is it??? Well, I left the hospital after snapping this ECG and seeing that first troponin was negative, so I don’t know the answer yet…but I will follow him up and keep y’all posted! Please comment on this post – I am keen to see what others think! Watch this space…

Steve Smith Equation value for Mr X

Hypothermia – of the unintentional variety

dreapadoir — Sun, 12 Feb 2012 12:32:23 +0000

This is more relevant to anyone attending the Ireland v. France non-match in Paris on the weekend than it is in Australia at the moment: I just wanted to share a link to Scott Weingart’s latest podcast on Severe Accidental Hypothermia on emcrit.org – a subject close to my heart. He gives a lovely succinct support of pleural lavage as the technique of choice in the ED for these patients. Check it out here.

social media + web 2.0 for emergency medicine – the luddiots guide

dreapadoir — Tue, 07 Feb 2012 03:36:45 +0000

Well, that didn’t work – see, I told you I was neither a hardware nor a software expert – I am just a user!

My Grand Round slides and notes are viewable here: http://www.slideshare.net/dreapadoirtas/social-media-and-web-20-for-emergency-medicine-the-luddiots-guide

Amal Mattu – ECG legend

dreapadoir — Tue, 07 Feb 2012 03:24:47 +0000

This is a cracking meded site, particularly this Amal Mattu slot – a true ED educator and ECG master

Dabigatran – bloody hell revisited

dreapadoir — Sun, 05 Feb 2012 23:06:16 +0000

http://www.emlitofnote.com/2012/01/scattering-tacks-in-road.html

So the trick is, bring out a dangerous medication with marginal benefit (in the shape of convenience) and increased side effect profile, then shortly after, release the assay to monitor the effect, and da-dah, no more problem, eh? Big pharma to the rescue!

My original post on this topic is trackbacked here.

Social media for Luddiots

dreapadoir — Thu, 02 Feb 2012 21:04:21 +0000

Statewide ED Grand Round on “Social Media and Web 2.0 for Emergency Medicine – the Luddiot’s guide” seemed well received on Wednesday – bit of discussion and debate. Strange format via video conference – hard to gauge audience reaction. Not sure I Like the lack of real time feedback. Will post the slides somewhere and link from here, but they were just the bones – the banter was the meat!

Fossil Cove – the joy of the boy!

dreapadoir — Mon, 23 Jan 2012 11:59:16 +0000

Risk in Emergency Medicine? Life isn’t safe!

dreapadoir — Wed, 11 Jan 2012 02:30:54 +0000

So, you think a normal set of serial trops and ECGs rules out MI? Negative D-dimer and negative CTPA rules out PE, right?

Think again, minimise the risk as much as you can in the confines of the available technology and your clinical acumen, accept the risk, move on, and sleep well at night – THERE IS NO SUCH THING AS A “RULE-OUT!”

Don’t be scared, but do be aware of risk on discharge. Remember, we don’t change the REAL mortality rate – it has been constant since the dawn of time at one per person – we just occasionally affect the timing!

This post of mine is really an attempt to share a fantastic post by @DrGDH on this idea of acceptance of risk in Emergency Medicine:

http://drgdh.wordpress.com/2012/01/09/scaring-the-shos-or-can-we-be-sure-discharge-is-safe/

White Christmas, Melbourne style!

dreapadoir — Sun, 25 Dec 2011 09:31:01 +0000

Melbourne was lashed by giant hailstones and thunderstorms today. We were spared major misery at Gill’s Mum’s house, but the Cardwell clan had some home and car damage and curtailed celebrations. Very different from any Irish Christmas I’ve ever experienced…and the thunder is rumbling on!