Another quick one today.

Was asked recently to fill a teaching slot for the new junior docs in our department, and rather than go with something clinical straight off the bat, I thought I’d have a go at getting them thinking like an ED doc (or to quote my usual phrase “let’s put your ED hat on”). It’s another Prezi, so have 12.5mg of IM procholerperazine at the ready as we answer the question:

WHY ED DOCS ARE BACKWARDS

I would be remiss if I didn’t acknowledge this brillant screencast from Reuben Strayer as inspiration. Essential viewing for anyone working in or about to start working in the ED.

Gareth

P.S apologies to all trying to view on ipad/iphone (especially you @n_may), can’t seem to get this to work yet. If anyone more technically minded has a solution please get in touch!

Hi y’all

It’s been quiet in DrGDH land for a bit, apologies for that. As well as battling through the comedy/tragedy/sheer bedlam that is EM in the holiday season (nights over Xmas, thanks boss…), I’ve been applying for a new job while simultaneously trying to keep the one I’ve got, been struck down by Norovirus (that other holiday favourite), and even written a couple of posts over at StEmlyns.

After several requests to ‘summarise’ the reasons I’m sceptical about stroke thrombolysis (I suspect in an attempt to stop me going on and on about it…), I’ve put together this whistle stop tour of the evidence. Just the important points are summarised. For more coherent and detailed analysis I would suggest Andy Neil‘s epic treatise and the phenomenal podcast from SMART EM. Also have a look at this piece by Michelle Johnston looking at the difficulties of being a front-line ED doc expected to provide a therapy we are not convinced is beneficial.

Here we go…. works best full screen.

As always comments, criticisms welcome. Think I’m being too critical? Disagree with my interpretation? You know where to find me….

Gareth

Hi all,

If you read this blog, I’m sure you are also reading the amazing St Emlyn’s blog as well. If not, get over there ASAP!

Shameless self promotion alert: We have only just gone and hit the top spot on the LITFL review! @EMManchester ‘s plot for world domination continues apace….

I am honoured to be part of the team for St Emlyn’s, and as such have started posting over there.

I am reluctant to abandon this blog though, and have a few ideas for it circulating – stuff that is a too frivolous, controversial etc. for the respectable physicians over at St Emlyn’s.

Watch this space.

In the mean time,  here is a quick presentation I prepared for a recent teaching session. Can we really cause brain herniation with a LP needle? Do we need to CT everyone first?

(I make no apologies for the unpolished nature of this stuff, it may or may not have been prepared at the last minute/in front of the new series of Homeland/while holding the baby)

Full screen the video for best viewing. I’m sure there is a way to get the original Prezi on here, but my tech skills clearly not up to it!

Cheers all,

Gareth

References:

Why does tonsillar herniation not occur in idiopathic intracranial hypertension? Salman M. 1999

Computed tomography before lumbar puncture in acute meningitis: a review of the risks and benefits. Archer BD. 1993

Cerebral Herniation during bacterial meningitis in children. Rennick et al. 1993

Cranial computed tomography before lumbar puncture: a prospective clinical evaluation. Gopal et al. 1999

Would be wrong not to credit Dr Scott Weingart of EMCRIT fame, who’s Crashing Patient website as a much more detailed review of the whole subject.