Rural Anaesthesia Journal Club: with Alex and Mel

This is the second installment of the Rural Anaesthesia Down Under (RADU) Journal Club.

In this episode, I am joined by Drs Alex Harris and Melanie Little – both local, fellow Broome GP Anaesthetists. We got together and had a chat about 5 papers covering 4 topics:

  1. Perioperative anaphylaxis (the NAP6 Audit)
  2. Dose adjustment for spinal anesthesia in Caesarean
  3. The RELIEF trial – restrictive vs. liberal fluids for major abdo surgery
  4. The “Drowned Airway algorithm” – how to approach this scenario.

If you are not a podcast person then there is a brief written summary of the points below.  Otherwise, you can listen to the podcast here, or download it in the usual ways – iTunes etc.

NAP6 Infographic

Link to the Fulltext of the NAP6 Audit


Should we be adjusting the dose of spinal anaesthesia based on the patient’s weight or height… or both?   Ummmm… maybe not in 2018.

2 papers discussed here:

Harten et al from Anaesthesia, 2005

Siddiqui et al, Korean Journal Anaesthesia, 2016

Proposed adjustment table from Harten et al

How much fluid is enough?  Are too many bags a bad thing?  The pendulum has come to rest somewhere in the middle when it comes to fluid therapy for patients undergoing big belly operations.

Summary infographic
*** statistical significance









So for the average 80 kg bloke having a hemicolectomy this equation for “liberal” means:  800mls bolus at induction, 640 mls/hr as the operation goes on (~ 2 L for a3-hour op) then 120 ml/hr on the ward… this would seem a pretty standard amount of fluids where I work, not exactly flooding in a liberal sense.

OK, that is it – have a listen and feel free to comment on the podcast link or the Facebook page if you are one of the 450 odd Aussie GPAs


First10EM Journal Club: May 2018

Gday – welcome back! It is podcast time..

It is May and that means another episode of the journal club with Dr. Justin Morgenstern.

This month we cover biases, show our biases about bronchiolitis therapy, cute scrotums, judging and dealing with capacity and how butt-slapping might help you delouse your colleagues….

[DISCLAIMER: we do not recommend that extradural hemorrhage ever be treated with an Ezy-IO drill, it is silly and dangerous.]

If any of that sounds like your deal then have a listen.  If you are super patient and listen all the way through there is a real treat for you….

… a world premiere musical parody song by Dr. Gerry Considine and yours truly. ( we are kinda like Elton & Bernie)

Below is the list of papers that we dissect and discuss on the pod.


Davis DP, Hwang JQ, Dunford JV.    Rate of decline in oxygen saturation at various pulse oximetry values with prehospital rapid sequence intubation. Prehospital emergency care. 2008; 12(1):46-51. PMID: 18189177

Kodama D, Yanagawa B, Chung J, Fryatt K, Ackery AD. “Is there a doctor on board?”: Practical recommendations for managing in-flight medical emergencies. CMAJ. 2018; 190(8):E217-E222

Franklin D, Babl FE, Schlapbach LJ, et al. A Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitis. The New England journal of medicine. 2018; 378(12):1121-1131. PMID: 29562151

Lee SH, Yun SJ, Kim DH, Jo HH, Ryu S. Do we need a change in ED diagnostic strategy for adult acute epiglottitis? The American journal of emergency medicine. 2017; 35(10):1519-1524. PMID: 28460811

Marco CA, Brenner JM, Kraus CK, McGrath NA, Derse AR, .  Refusal of Emergency Medical Treatment: Case Studies and Ethical Foundations. Annals of emergency medicine. 2017; 70(5):696-703. PMID: 28559033

Goldfrank LR, Wittman I. Capacity? Informed Consent; Informed Discharge? Uncertainty! Annals of emergency medicine. 2017; 70(5):704-706. PMID: 28662910

Bulstrode H, Kabwama S, Durnford A, Hempenstall J, Chakraborty A. Temporising extradural hematoma by craniostomy using an intraosseous needle. Injury. 2017; 48(5):1098-1100. PMID: 28238447

Frohlich LC, Paydar-Darian N, Cilento BG, Lee LK. Prospective Validation of Clinical Score for Males Presenting With an Acute Scrotum. Academic emergency medicine. 2017; 24(12):1474-1482. PMID: 28833896

Oliver G, Oliver G, Body R. BET 2: Poor evidence on whether teaching cognitive debiasing, or cognitive forcing strategies, lead to a reduction in errors attributable to cognition in emergency medicine students or doctors. Emergency medicine journal :   EMJ. 2017; 34(8):553-554. PMID: 28724568

Kraus MW, Huang C, Keltner D. Tactile communication, cooperation, and performance: an ethological study of the NBA. Emotion. 2010; 10(5):745-9. PMID: 21038960

The SGEM: Batman Effect Podcast

Hello once again,

Just back from leave and straight into NIGHT SHIFT! Such is life.  This is a quick Editorial to let you know what is happening in the Broomedocs backroom.

I have been very busy behind the scenes working on a few fun and entertaining projects.   Recently I have been collaborating a bit with Dr. Ken Milne of the famous Skeptics Guide to Emergency Medicine site.  Ken was nice enough to invite me to podcast with him on his podcast, it was a real honor and a lot of fun.

We talked about the BATMAN EFFECT paper – which was the subject of an article I reviewed with Justin on the podcast a few months ago.  Ken is mildly obsessed with Batman and as such, we needed to deep dive into the article and talk nerdy about all things superhero!

You can hear the podcast over at the SGEM here.

In other news… there will be a world exclusive Music Video release on the SGEM on the 16th of May.  This is a collaboration between Ken, myself and SAs hippest GP – Dr. Gerry Considine.  Keep an ear out for that one!

A bit of Admin here:

The long-awaited Crisis Resource Management book is close to entering publication.  Scott Weingart, David Borschoff and the team have been busy trying to perfect the final product.  This is a huge effort; dozens of authors from all over the world have each distilled their expertise into a single page of simple, life-saving awesomeness.  I have seen the draft and it looks amazing.  This will soon be one of those resources every ED in the world will have on the shelf – watch this space.

On the topic of books – I have 2 other chapters [in different books] in the editorial phase which I hope will be coming out in upcoming months.  A big thank you to Dr. Leanne Hartnett and Dr. Matt Fitzpatrick who have tirelessly reviewed and corrected these in the last few months.

If you are a Rural GP Anaesthetist then I strongly urge you to join the Rural Anaesthesia Down Under (RADU) Facebook forum.  This is a closed group where we discuss all the science, subtlety and shenanigans of being a bush Gas doc.  If you are not on Facebook – it is worth the ticket of admission [hint: $0.00].  If you are interested then please search it out, or just send me an email, comment or tweet and I will get you hooked up with the growing hive-mind (now well over 300 GPAs ).

I am hoping to do another episode of the RADU podcast in coming weeks – so please send me any articles you want to us to discuss, dissect or debunk.

Only about 3 weeks until the inaugural GPs Down Under Conference on the Gold Coast. I will be there and hope to meet as many of you as I can.  I will be traveling with full podcast kit to catch a few of my heroes on the mic.  If you would like to share a story or some wisdom…  get in touch.

OK, that is it.

Back with more clinical stuff next week with another episode of the First10EM Journal Club with Justin.

Bye.  C