Emergence Phenomena

TRICI Course 2023

noreply@blogger.com (Unknown) — Thu, 12 Jan 2023 01:18:00 +0000

Spots still available for our course on 23rd Feb at SEMS. Sign up info below:

Renal Emergencies

noreply@blogger.com (Unknown) — Mon, 06 Sep 2021 08:28:00 +0000

Dr Debajyoti M. Roy is a renal physician at Changi General Hospital and he's kindly given us permission to cast his talk on renal emergencies in the ED. A tour de force on balanced solutions, practical management, differences between AKI/CKD & dialysis complications.

Differntiate pleural effusions on CT!

noreply@blogger.com (Unknown) — Tue, 17 Aug 2021 02:59:00 +0000

Great video by Medmastery. Learnt so much and hope you do too. Support their channel and view their other great meducation posts.

Practicalities of transport - small adult edition!

noreply@blogger.com (Unknown) — Fri, 28 May 2021 05:46:00 +0000

A talk on the principles of transporting paediatric patients for the STACC virtual conference in May 2021. The principles are extrapolated from experience in retrieval, ED & critical care and can be applied to adults and intra hospital movement as well.

OMI - God!

noreply@blogger.com (Unknown) — Sun, 20 Dec 2020 12:22:00 +0000

This is a recorded zoom talk from the EM Sling online conference in December 2020. Different times call for a different style of conferencing for a topic in which you can make a difference.

Ever think that patient with a subtle TWI in AVL could have been “cathed” earlier? Is it always 2mm elevations or will something less do? Can you convince anyone that a deWinters wave is trouble brewing?

If so, then maybe you are a growing part of the EM populace which thinks that STEMI or NSTEMI doesn’t quite cut it as a sole paradigm for coronary intervention.

Heretic or convert or something in between… I offer no miracles - only perspectives.

The Great Disruptor: Covid-19

noreply@blogger.com (Unknown) — Wed, 08 Apr 2020 12:32:00 +0000

Covid-19 will be long remembered by this generation. This low lethality but high impact event has left a scar not only on medical fields but theplanet itself. Thoough suffering from a second wave currently, Singapore has a well documented way of dealing with this and our ED/hospital "positives" can be summarised into:

Good command and control from the beginning
One source of Information/dissemination + Updated info passed onto the floor daily
Swab & Go protocols
Segregation of fever & non fever areas in the ED

Fever area - PPE is gown / gloves /N95 / face goggles or shield
Resus - PPE is N95 / gloves
Resus (intubating and arrests) - PAPR with N95
Non fever areas - Surgical mask and gloves

Other good resources:

The original article of the index cases

Handbook by Chinese hospitals

Covid calculators

Johns Hopkins datacentre

Probably the best video you can get on the subject is this detailed look into the pathophysiology and management by ESICM:

And finally when to ECMO:

Syncope guide 2019

noreply@blogger.com (Unknown) — Tue, 17 Dec 2019 07:46:00 +0000

A new guide on our site on Syncope! Often overly investigated and common pitfalls abound.

See our guide section here - https://singem.blogspot.com/p/downloads.html

Link is here for pdf.

Comments and edits of course welcome.

Nul pointes..... the zero point survey?

noreply@blogger.com (Unknown) — Thu, 12 Sep 2019 08:37:00 +0000

Cliff Reid surmises that preparing yourself BEFORE the stress and immediacy of critical care tasks. Zen achieved via zero points... survey that is.
Not just for pre-hospital teams but also for ED situations.

Ventilation guide Ver. 2

noreply@blogger.com (Unknown) — Mon, 26 Aug 2019 08:18:00 +0000

An update of our ventilation guide is now available here (pdf).
Version 2 includes nods to new techniques as well as ventilation strategies for difficult or rarer conditions. As always this is free for download and replication/alteration for your purposes.

Essential # management

noreply@blogger.com (Unknown) — Fri, 26 Jul 2019 23:30:00 +0000

Excellent self explanatory talk.
Essentials indeed.

Teaming in the real world / work

noreply@blogger.com (Unknown) — Tue, 02 Jul 2019 04:43:00 +0000

Been away for a while but we will still be posting EM related content intermittently. Here's a teamwork demonstration like no other which is applicable in complex environments like ours.

Moral injury, not burnout

noreply@blogger.com (Unknown) — Thu, 21 Mar 2019 16:32:00 +0000

Dr Zubin Damania does great parody songs but his rants are equally engaging.
This call to arms denounces the odious habit of blaming people rather than systems/institutions. A different viewpoint indeed but well thought out and has evidence at its core.

Other very good links on this topic:

How you perceive these challenges (in the ED setting) depends on your world view however your perspective might be influenced by the following;

Stepping into a non metropolis resource limited setting
Being a patient or having a loved one be a patient
Talk with an "old timer" ED Doc. If they're still in this challenging environment after decades, they must be doing something right.

Systems inherently lack pathos so our efforts must be channeled into doing what best for patients and peer monitoring/support for ourselves/nurses/students.

As always... fight the power!

All about back pain

noreply@blogger.com (Unknown) — Sun, 23 Dec 2018 07:49:00 +0000

Hello again! We have a been away for a while on family and work commitments.
Here's some great nuggets on one of the most common conditions seen in a lot of EDs. It shows everything from pathogenesis to red flags to clinical exam.
Follow Dr Ebraheim's youtube channel for more of his series.

A TRICI TIME 20/9/2018

noreply@blogger.com (Unknown) — Wed, 10 Oct 2018 01:14:00 +0000

Pre conference workshop for the Duke-NUS Conference at Academia, SGH, Singapore on 20th Sep 2018.

You're not sitting on the fence - vote to save this patient!

Goody bags

Drone view of master planning

Y'all ready for this?

I see everything with this camera...

Ipad xrays? That is a swish radiographer

Team effort indeed

Something about a geyser of blood pouring out...apparently trauma patients bleed.

A good time was had by all. Hopefully they learnt something in the process. Thanks to HOPE ambulance again or providing the support and if you want to register for 2019 workshops - drop an email to: trici.sg.workshop@gmail.com

Webucation 5/9/18

noreply@blogger.com (Unknown) — Wed, 05 Sep 2018 03:00:00 +0000

This episode of webucation gives us insights into old diseases and new. From cardio to dermatology and from myth to righteousness. Credit as always to the original content providers.

Resuscitation communication - why its as important as any other treatment
4th Universal definition of MI - if you deal with heart attacks, you probably want to know this
Simplifying mechanical ventialtion - great guide on the basics
Myths of heart failure - still believing in some of these?
Moral injury - are you at risk of this or is it something we just live with?
The migraine cocktail - catch up with the latest admixture for this pesky pathology

Severe cutaneous reactions - a great run through one of my blindspots - dermatology. It sets out the differences and nuances of treatment of SJS / TENS etc

Sepsis checklist/bundle

noreply@blogger.com (Unknown) — Fri, 17 Aug 2018 05:43:00 +0000

Management of sepsis is an ever evolving science but the implementation of such measures in the ED can be challenging as there are so many moving parts.
Here's our version of a bundle to recognition and management. Comments welcome as always.
The checklist can be downloaded here.

There is no spoon?

noreply@blogger.com (Unknown) — Wed, 13 Jun 2018 01:09:00 +0000

Prof. Rinaldo Bellomo is extremely well published and speaks here at SMACC Berlin in a Matrix like talk on physiological belief.
Some great lines here and some well thought out arguments. Chiefly, "we make the measurable important but not the important measurable". Thanks to the SMACC team for making this available.

Webucation 5/5/18

noreply@blogger.com (Unknown) — Sat, 05 May 2018 10:08:00 +0000

Web wisdom this round comes from gurus in EBM, critical care, trauma and even some philosophers on the state of affairs in medical education/administration. Credit as always to the original content providers.

Breech delivery - info for when you need it!
High flows you should know - all about BiPap and the new-ish HFNC
The top 10 trauma papers - compiled by St Emlyn's
Shrug it off - a novel technique for your subclavian needs
The tPA drug war without end - controversial because science clashes with dollars
UTI pearls and pitfalls - you'l be surprised at what you learn about "simple" things

The trouble with mindfulness - one of the best articles I have read recently relating to error prevention and human behaviour. Well worth a read even if not in a "medical" mood.

Clinical you say?

noreply@blogger.com (Unknown) — Tue, 10 Apr 2018 09:11:00 +0000

Thanks to Journal Watch for this article:

Clinical Signs Accurately Identify Pneumonia, Study Suggests

by Jennifer Garcia

Four clinical variables — the presence of fever, elevated pulse rate, crackles on auscultation, and low oxygen saturation — can help identify patients with pneumonia in the primary care setting, according to new data.

"[T]he four variables identified by this analysis are easily measured clinical signs," write Michael Moore, BM BS, MRCP, FRCGP, from the University of Southampton, Aldermoor Health Centre, United Kingdom, and colleagues.

"If antibiotic prescribing was restricted to people who had one or more of these signs, it could substantially reduce antibiotic prescribing for this condition," the authors write in an article published online November 22 in the European Respiratory Journal.

For the prospective cohort study, the researchers evaluated 28,883 patients between 2009 and 2013 who presented to their primary care provider with symptoms of acute cough attributed to a lower respiratory tract infection

Among the 720 patients radiographed within the first week after their initial consultation, 16% (115/720) were diagnosed as having definite or probable pneumonia.

The researchers noted specific independent predictors of radiograph-confirmed pneumonia among this cohort, including temperature 37.8°C or higher (risk ratio [RR], 2.65; 95% confidence interval [CI], 1.46 - 4.81), pulse rate 100/minute or higher (RR, 1.90; 95% CI, 1.12 - 3.24), crackles on auscultation (RR, 1.82; 95% CI, 1.12 - 2.97), and oxygen saturation below 95% (RR, 1.73; 95% CI, 0.98 - 3.06).

Overall, 86.1% (99/115) of patients with pneumonia exhibited at least one of these clinical signs. In contrast, other factors, including presenting symptoms, age, sex, smoking history, and past medical history, provided no predictive information for a pneumonia diagnosis.

The authors note that previous studies have found fever, crackles, and elevated pulse rate to be predictors for the presence of pneumonia. However, unlike the current best diagnostic model, the presence of a runny nose was not found to be significant in the present study. In contrast, the addition of pulse oximetry has demonstrated clinical utility in previous retrospective studies in the primary care setting.

The researchers acknowledge limitations to the study, primarily that thoracic radiographs were only obtained in a small sample of the full cohort and that those patients selected for radiography were more ill and at higher risk for pneumonia. This may have resulted in fewer reported cases of radiograph-confirmed pneumonia in the cohort as a whole, and as well as overemphasis of the importance of the four clinical signs as positive predictors of pneumonia.

Given this limitation, the study authors caution that, although pulse oximetry may have a role in the diagnosis of pneumonia, further studies that include comprehensive assessment, including thoracic radiographs, will be required.

Funding for this study was provided through a grant from the National Institute for Health Research. The authors have disclosed no relevant financial relationships.

Eur Respir J. Published online November 22, 2017. Full text

Shouldering the burden

noreply@blogger.com (Unknown) — Fri, 23 Mar 2018 05:01:00 +0000

Its so reassuring when you get taught by the person who's invented the procedure!

Get Coached!

noreply@blogger.com (Unknown) — Mon, 26 Feb 2018 23:17:00 +0000

If there is a doc you SHOULD listen to for worldly advice without prejudice nor agenda, it is Atul Gawande. In this TED talk, he extols the virtue of coaching.

Common cold or apocalyptic strain?

noreply@blogger.com (Unknown) — Fri, 09 Feb 2018 02:57:00 +0000

Sometimes you can learn something even though its common. So make sure you're educated before you "educate" patients.

Source:
https://www.cdc.gov/flu/about/qa/coldflu.htm

Away on holiday... sort of.

noreply@blogger.com (Unknown) — Mon, 22 Jan 2018 16:23:00 +0000

We haven't disappeared from the FOAM world but have been on hiatus for education and holiday reasons. Happy new year to all our readers!

Singhealth has been actively involved in EM and disaster medicine in the region for decades. Not only are Singapore doctors sent on relief missions but also for educational outreach in non disaster times. Here are a few photos from a recent trip to give our perspective to Nepal EM docs, nurses and administrators on pre-hospital and hospital disaster management.

On a personal note, it was heartening to go back to Kathmandu and its environs as the last time I was there was during the Nepal earthquake and much has improved both socially and preparedness wise.

Group discussion and pre-presentation work

Outdoor hospital prep

Triage table tops

Field team bag preparation

How to moulage for excercises

Team presentation on their preparedness plans

The "dreaded" assessment - can't have learning without it!

Group pic

Webucation 22/10/17

noreply@blogger.com (Unknown) — Sat, 21 Oct 2017 16:34:00 +0000

This edition of web wisdom encompasses mythbusting in trauma and radiology. Also a tour de force in dissections and finally a must hear podcast if you work in medicine at any level - all about UTIs.

You think you know UTIs?

The last podcast will stun you. not because its a sexy topic but maybe because it will make you remember the relevant issues in a most common presentation. Test yourself - do you know how to handle UTIs?

Ortho damage control

noreply@blogger.com (Unknown) — Mon, 25 Sep 2017 03:10:00 +0000

Nice vid on damage control surgery from the orthopaedic standpoint. Dr Ebraheim's other educational videos can be found here.