R main stem intubation

The crashing intubated patient: DOTTS

Whenever a patient you have just intubated deteriorates, or a patient on a ventilator deteriorates quickly: DOTTS Disconnect and let them exhale: This gets the ventilator out of the equation and simplifies things / reduces our cognitive load: we understand BVMs (bag-valve-mask), ventilators and circuits confuse and scare us.  It also stops ventilation for a […]

Sgarbossa 10.13.23 pm

LBBB and Sgarbossa

  Left bundle branch blocks cause a lot of confusion. People often mistake the normal anterior ST elevation of LBBB as an MI Less frequently people miss significant concordant ST segment changes which may be a STEMI (by Sgarbossa Criteria) The Law of Discordance or the Law of Appropriate Discordance In a normal LBBB the […]

Military trauma

Trauma: Lessons from the Military. Wing Commander Dr Paul Nealis

    Key points Stop bleeding! Tourniquets are great. Pack bleeding wounds firmly.  A roll of gauze works well. “Haemostatic dressings” eg quik clot, don’t seem to make much difference.  It appears the pack needs to be absorbent probably because they absorb water out of the blood in the wound thereby increasing the concentration of […]


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. […]

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 […]


Making use of your character strengths. Dr Johanne Egan

The theory is that by developing your strengths, rather than trying to fix your weaknesses, you get more enjoyment out of your work and will perform better. It may also help you to work well as team with others with complementary character strengths, The VIA (Virtues in Action) Institute on Character is run by Prof […]