Emergency Fellowship Notes - Bush Notes

Pregnant with dyspnoea after a flight? Pregnant patients presenting with possible pulmonary emboli prompt prudent providers to pursue perfusion-preferred, pelvis-protecting protocols, prioritizing preventive precautions over perilous, pointless probes.

That sound too confusing? Head over and check out the answers the exams want.

PREGNANT PE - RESPIRATORY

Anaphylaxis. We all know to get the adrenaline out, but do you know what comes next? Resus your anaphylaxis knowledge with adrenaline fueled revision.

ANAPHYLAXIS - RESUS

ECG's. 12 squiggly lines that can mean life or death. Both for your patient, and for your marks. The ECG Library has over 70 ECG's to review with high yield exam content. Check it out today

CARDIOLOGY - ECG LIBRARY Amaal Matu - “Bradydysrhythmias and Tachydysrhythmias - Heart Course ECG workshop”https://www.youtube.com/watch?v=lMwHzHsnk_M

That's right. Your favorite content on emergencyfellowshipnotes.com is now in app form. Access any time, track your progress. Pass your fellowship. There's an app for that now.

Click the big green button on the Bush Notes Learn homepage.

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Bush Notes Learn - We took Bush Notes on emergencyfellowshipnotes, and created a new interactive fellowship revision site - Bush Notes learn. Available for free at learn.emergencyfellowshipnotes.com

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We don't know exactly when. But something BIG is coming. Something VERY BIG. Something that would have revolutionised the way I studied for the fellowship exam. Something that doesn't exist... yet.

Its almost here. Its almost upon us. And its almost done.

Hopefully in the next few days we will have a big announcement - more than just an annoying placeholder for the big thing that's on its way.

As always, more on www.emergencyfellowshipnotes.com

Administration questions... the 'non medical' questions. You need to remember that ACEM exams cover 2 countries and laws and regulations vary. They can only really test the themes vs specifics of many topics. That being said, lets go for an annoying admin question:

Q: Management of a complaint for a missed diagnosis (Eg: Missed fracture on Xray)

A:
Patient management:
- Acknowledge patients complaint and apologise (Ideally within 24h) Reassure patient this will be addressed through hospitals safety and quality system
- Expedite rapid return and assessment
- Return to ED
- Senior review on arrival
- Explain clinical significance, treat patients medical problem, arrange appropriate follow up (Ironically this is only in about 30% of answers)
- Facilitate formal complaint if patient wishes
- Careful documentation of above

Missed diagnosis management
- Gather information - Systems, staff, processes (complexity, business of shift, degree of supervision, degree of understanding of condition, radiology reporting systems)
- Formal feedback to hospital (IIMS, RISK MAN, RCA, notify exec etc)
- Discuss with RMO at an appropriate time (not straight after nights) + debrief +/- management plan
- Provide education at departmental teaching to prevent recurrence of error
- Staff Education for RMO and staff - M+M etc.
- Feedback to patient regarding outcome/process changes
- May need to seek medicolegal advise if patient pursuing complaint.

The answers below are extensive and you won't have time for everything. Try and gauge if the question is asking more about patient management, or, if its focusing on the medical error as to how you tailor your answer.

More on emergencyfellowshipnotes.com

Check out more on Bush notes, available at www.emergencyfellowshipnotes.com

Q: What is your management of a needlestick injury

A:
First aid - wash with soap and water
Baseline bloods from source patient and injured worker - HIV viral load, HBV, HCV
Counselling regarding role of PEP/treatment
- Source patient HIV + >> PEP within 2 hours.
- Source patient HBV+ >> Hep B immunoglobulin
- Source patient HCV+ >> no treatment.
Follow up with ID/workplace health
Formal incident report (IIMS in NSW)

As a side note (Or another question you will be asked) - rates of transmission of blood borne viruses following a needlestick injury:
- HBV = 30-60%
- HCV = 3%
- HIV = 0.3%

emergencyfellowshipnotes.com Welcome to emergencyfellowshipnotes.com, home of Bush Notes. This is your guide to passing the final hurdles in your emergency fellowship training - the ACEM written fellowship examination. Here you will find 2 resources to help you do this: Bush Notes - this is the ultimate question and answer

Find more on emergencyfellowshipnotes.com. Today a question from paediatrics

Q: What is your ALS algorithm for paediatrics?

A:
- Ratio 15:2 (age

Another example from Bush Notes on emergencyfellowshipnotes.com. This time an airway/anaesthetic question:

Q: Describe your ideal "generic" airway plan for a patient in extremis

A:
- Get help - at least 1 more senior MO + 2 nursing staff
- Resus area, full monitoring (ECG, NIBP Q2min, ETCO2, Sats)
- Optomise oxygenation - upright with BVM 10 cm.H2O PEEP or NIV, FiO2 1.0
- Optomise BP - N/S bolus - 250+250 aim SBP >90, Vasoppressors = Metaraminol or adrenaline 10 mic boluses/infusion
Equipment
- Video + direct laryngoscope, bougie, ETT 7.0+8.0, suction
- needs defib pads on if cardiac
Drugs
- Ketamine 0.5-1mg/kg (Fent + midaz in older answers - Propofol bad if hypotensive so avoid)
- Rocuronium 1.5-2mg/kg
Describe plan
- A/B/C/D (Typically ETT/LMA/BVM/FONA)
- most experienced operator

They won't ask "Describe your airway plan for a patient in extremis", but they will describe a big sick patient who clearly needs an airway. This is your cue for an answer like this. Make sure you adapt the answer to the patient - there will be subtle differences that will pay marks.