Life in the Emergency Lane

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This talk was brought to you as part of the biannual When I Grew Up series hosted by the Australian National University Medical Student Society. Our guest speaker is Professor Caldicott, who is an Emergency Department Consultant at the Calvary Hospital ACT. It is one of the most heartfelt and genuine talks that we believe all medical students and junior doctors should hear. There are so many pearls of wisdom about living and surviving as a doctor that we can all learn from. This is a raw, honest and entertaining reflection from a senior clinician practicing in one of the most challenging and exciting fields in medicine.

Our Guest Speakers Bio

Professor David Caldicott who is an Emergency Consultant at the Calvary Hospital and a Clinical Senior Lecturer in the Faculty of Medicine at the ANU. He is a spokesperson for the Australian Science Media Centre on issues of illicit drug use and the medical response to terrorism and disasters.

Professor Caldicott designed and piloted the Welsh Emergency Department Investigation of Novel Substances (WEDINOS) project in the UK, a unique program using regional emergency departments as sentinel monitoring hubs for the emergence and spread of novel illicit products. He is currently replicating this work in Australia with the ACT Investigation of Novel Substances (ACTINOS) Group.

MSK 22 – What is Osteoarthritis?

Osteoarthritis of the hip joint. Right side worse than the left with a loss of joint space + subchondral sclerosis and geodes. Remodelling is also present in the hip joint.

Osteoarthritis of the hip joint. Right side worse than the left with a loss of joint space + subchondral sclerosis and geodes.
Remodelling is also present in the hip joint.

Case courtesy of Dr Frank Gaillard, Radiopaedia.org. From the case rID: 35875

so, What is osteoarthritis?

OA is characterised by the loss of cartilage in synovial joints leading to changes in the periarticular bone.¹ Interestingly there’s more evidence of an inflammatory component to it’s pathology rather than just purely wear-and-tear.

Interesting and important fact:

Only advanced damaged from OA show up on X-rays.¹ Other investigations such as arthroscopy and MRI may be able to show damage in earlier stages.

For more information Listen to the episode:

 

 

References:

  1. Kumar P, Clark M (eds.) Clinical medicine. 7th ed. Edinburgh: Elsevier Saunders; 2009. p.518-521.

Additional Reading:

Professor Stephen Leeder

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Image Courtesy of ABC.net.au

Prof. Leeder’s address to ANU medical students

Interview with Prof. Leeder

There’s this parable about an accountant to an affluent family that had recently lost their stereotypically shrewd businessman father. Because the rest of the family didn’t know anything about the business or finances, the generous soul volunteered to help manage their inherited wealth for them. Of course, he remained the biggest benefactor to the wealth, sparing just enough for the family to get by and not burden themselves into investigating why their lifestyle took a bigger blow than the father did from the oncoming train.

Earlier this year, Prof. Stephen Leeder was let go from the Medical Journal of Australia; for raising objections about the decision to outsource production of the magazine to the academic publishing company, Elsevier. In summary, the company has been implicated in practices that threaten academic integrity. Fears are that the Dutch company will threaten the autonomy in the quality of papers submitted; a result of the increased role that the company will have over the production of the journal.

Continue reading

MSK14-Systemic Lupus Erythematosus

Typical 'malar' or butterfly rash in SLE showing across the nasal and cheeks

Typical ‘malar’ or butterfly rash in SLE showing across the nasal and cheeks

Systemic Lupus Erythematosus is an autoimmune disease involving multiple organs. Antibody testing include Antinuclear antibodies (ANA), antiphospholipid antibodies, antibodies to double stranded DNA (dsDNA) and anti-Smith (Sm) antibodies.  

Note: ANA is highly sensitive, but not specific. A positive anti-dsDNA and anti-Sm are highly specific antibodies for Lupus.

Find out the pathophysiology and the diagnostic criteria from this episode!

Interview Techniques

I mentioned before preparing for medical school interviews is really important. Don’t listen to people who advise otherwise. Leading up to the interviews I was practising on a nightly basis with whoever was willing to put up with me!

When you practice you need to develop techniques to ensure that you tackle interview questions efficiently and comprehensively, whilst avoiding the risk of sounding rehearsed. Sounding rehearsed is less likely to occur for MMI style universities but can be a major issue with traditional panel interviews. However, with the following strategy I found it reduced the risk of sounding rehearsed for any interview style.  

  • Situation – describe the situation or the context that you had found yourself.
  • Task – What were your tasks  that you had to tackle in the scenario that you have outlined
  • Activity – How did you go about achieving the tasks that you set out for yourself
  • Result – What were the outcomes of your activities. Did you adequately resolve the scenario if not why? What did you learn from the experience.

As you can see using this approach enables much greater focus and structure whilst reducing the risk sounding rehearsed. I’ve found that I was able to address many questions that were asked during the interview. The structure also ensure that your answers are clear and succinct (so you don’t waste time babbling on).

There is also an approach that you can employ the tackle the ethical scenarios that may be asked. The approaches is inspired by the Hippocratic Oath.

Consider these scenarios with the following ethical frameworks:

  • Justice: any approach you propose to tackle the ethical scenarios must be ensure that it fits within the law (so long as the law is within reason e.g killing a population because it is enshrined in the law is not an adequate excuse for the action – refer to the Nuremberg Trials and Nazi experimentation)
  • Autonomy: refers to respecting the patient’s right to choose the course of their life without external interference, e.g you can’t normally a force a treatment onto a patient.
  • Beneficence: you’re actions should be of benefit to the patient and or the individuals involved in the scenario
  • Non-Maleficence: do no harm (pretty self explanatory)  

If you get issues relating to consent or a scenario trying to explore your understanding consent you can approach this by considering the following points:

  • Informed: does the patient or person understand the information you are providing them?
  • Capacity: does the patient or person have the capacity to comprehend the information you are providing them? For example is a child able to provide informed consent (read more about Gallick Competency).
  • Free from duress: did the patient/person consent under their own volition or were they influenced by family/friends.

MSK 11 – 6 Steps you MUST know in fracture healing

Types of fractures Top row (Left to right): Transverse, Oblique, Segmental Bottom row (left to right) Angulated, Shifted, Comminuted

Types of fractures
Top row (Left to right):
Transverse, Oblique, Segmental
Bottom row (left to right)
Angulated, Shifted, Comminuted

What are the 6 steps of healing a bone fracture?

  1. Haematoma formation
  2. Granulation Tissue formation
  3. Soft Callus formation
  4. Hard callus conversion
  5. Ossification
  6. Remodelling

Find out more on the Common Rounds on how bone fractures can be described and what factors affect its healing.

MSK10 – When the bone gets inflammed – Osteomyelitis

diabetic-osteomyelitis

Diabetic Osteomyelitis; Case courtesy of Dr Frank Gaillard, Radiopaedia.org. From the case rID: 7663

Ever wonder what osteomyelitis was? What is the most likely cause of it? Find out on the Common Rounds.

Answer to FB question:

Osteomyelitis is an inflammation of bone and marrow, virtually always secondary to infection. Common organisms are pyogenic bacteria and mycobacteriaThese organisms may reach the bone by (1) hematogenous spread, (2) extension from a contiguous site, and (3) direct implantation