Disaster Medicine. Wing Commander Dr Paul Nealis

Be prepared. Be prepared for the unexpected, logistical challenges, politics and politicians, strange infections, psychological stress,  Aussie docs not recognising melioidosis and a mysterious man in a Hawaiian shirt … with a small fleet of Black Hawk helicopters. You need to be flexible, creative and psychologically tough. Military doctor Paul Nealis discusses disaster medicine in […]

mass cas

Mass Casualty and Hazardous Substances Management

  Key points   Declare an Mass Casualty Event -> telephonists automatically call in multiple staff from many departments Lock down the hospital Send triage nurses outside front door and ambulance door (with PPE if HAZSUB) with security and radio to triage people in or away from hospital Assign roles in ED ED staff to […]

Fast AF

Anaesthetising and shocking an 89-year-old

About once a year I get to cardiovert a nonagenarian.  There are a lot of good learning points from a case like this and I used a different anaesthetic from earlier posts (see Salvage Cardioversion of a Surgical Patient and Fast AF) The case This one was a sprightly 89-year-old (near enough to a nonagenraian) […]


Oxy morons. Avoid prescribing oxycodone

It has been interesting moon-lighting at another hospital to see how much oxycodone (common brands names: oxynorm and oxycontin) was being used professionally and recreationally. I was out with a friend who told me he had been given 1 1/2 oxycontin tabs by an acquaintance a while ago and had been high as a kite […]

Pull my finger

Pull my finger. Dorsal dislocation of PIP

A young adult male sustained an open dislocation of the PIP for his middle finger while playing rugby. Hopefully he wasn’t doing a Hopoate. The finger was neurovascularly intact.  The wound was not obviously contaminated. The finger was anaesthetised using a ring block at the level of the web space and the wound was cleaned. […]

Extradural (bilateral)

Head injury – when to CT

Various attempts have been made to create guidelines as to who should be scanned after a head injury. For someone who is not intoxicated, who has had a significant trauma and has a GCS < 13 it is usually a slam dunk: CT. For those with a GCS of 13 or 14, or they are […]

R shoulder

Old bones. Fractures can be hard to see. Get your eye in.

An 89-year-old tripped over her walker at the rest home. She had a history of a fractured R clavicle, but was not tender over her clavicle. She had pain in her R groin and R shoulder. Ctrl or Command + to enlarge, Ctrl or Command 0 (zero), to revert to normal size.  and Click to see the diagnosis Undisplaced fractures […]

inf posterior STEMI

ECG 101

An introduction to reading ECGs in ED ECG 101 from chris cresswell on Vimeo.   Ecg 101 with answers from chricres   Stamps available from: Self Inking Stamps Ltd  


Funky eyes. Alternating strabismus and impaired upwards gaze

An eye movement disorder not caused by a cranial nerve lesion This is an interesting neuro case. This is nothing you have to know for exams but it does help demonstrate some principles of eye exams, and helps us think about some important differentials such as botulism, which if we don’t think of in ED, […]

Korero Maori

How to pronounce Maori names. Ned Tapa and Chris Cresswell

Everybody appreciates it if you attempt to pronounce their name or the name of their town properly. Here Ned Tapa helps me get my tongue around some Māori names.   Letters There are only 15 letters in the Māori alphabet. 5 basic vowels and 10 consonants.   Two of the consonants are written as digraphs (two letters […]