Life in the Emergency Lane

Capture

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.

Is this a Male or Female hip?

After making a mistake earlier today, I thought it’d be a good time to review some basics.

Before we begin – is this a male or female pelvis?

Normal pelvis of an adult Case courtesy of Dr Ian Bickle, Radiopaedia.org, rID: 37956

Normal pelvis of an adult
Case courtesy of Dr Ian Bickle, Radiopaedia.org, rID: 37956

Read on if you don’t know!

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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!

What are Objective Structured Clinical Exams?

Before entering medical school, I had heard the term OSCE mentioned/referred to a number of times. I read a little about OSCEs but I had very little appreciation about what this type of examination is and how it is applied throughout the medical school examination process. Having now worked my through OSCE-like assessments, I would like to take this opportunity to discuss this examination technique for premed students who are curious about it. My impression is based on the ANU medical school assessments but I think the overall principles apply to most medical schools.

Throughout medical school you are being taught a wide range of clinicals skills, which are highly practical in nature. They are the fundamental skills that are used for examining/interacting with patients. These practical skills are different to the what is taught within practical classes (refer to practicals in medical school guide for an overview). Just like other aspects of the curricula it is important to assess students in the knowledge and application of these practical skills. The clinical skills can encompass discussing patient blood and biochemistry results to perform procedures/physical exams.

At the ANU medical school, a day is set aside to examine all students in the year level on these clinical skills. Students are divided into groups who are assessed over an hour. We have no idea what clinical skills will be examined on the day. However, throughout the semester you develop an appreciation for the key skills that are likely to be assessed in these exams (but you can always be surprised!). The exams start with students being taken to the clinical skills rooms. You are provided with a scenario outside (e.g a patient presents with chest pain, patient has noticed a lump, patient is complaining of a sore tummy in ED etc…). You read the scenario(s) that are provided with a minute or two to think about how to tackle the case.

You are then called into the room but before you can proceed with the clinical examination you will need to introduce yourself to the camera, which records your entire exam. The purpose of this is to ensure that you are in fact who you say you are and also the camera recording can help resolve any disputes about the marking of the examination. After completing this formal step the examiner may ask of you to perform the clinical skills (e.g cardioresp assessment) on the actor (or patient). You then introduce yourself to the patient, obtain consent for the procedure and begin the clinical examination. You have to be very efficient as you are under time pressure to perform the clinical exams. In each room you will be required to perform up to two exams or an exam and a viva (where you discuss a particular investigation or clinical scenario). Once your time is up you may need to sit down with the examiner to discuss your findings.

Otherwise you will be asked to leave the examination room in preparation for your next station. Usually in the adjacent room. You will be then asked to come into the next examination room to continue with the next set of clinical exams. So as you can see OSCEs are an efficient means of assessing a number of clinical skills within a relatively short period of time. These skills are important for your competency in the clinical years and beyond. Moreover, it is a tool by which the university can ensure that you are remaining up to date with the extensive range of clinical skills taught. I hope this article sheds a bit more clarity about OSCEs. Feel free to leave a comment or get in contact with us for further clarification.

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