March, 2009
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Victorian DHS warns of measles outbreak in Melbourne
Tuesday, March 31st, 2009Victorian Chief Health Officer warns of rise of pertussis and need for re-vaccination of at risk groups
Monday, March 30th, 2009Victorian Chief Health Officer has sent a warning of the rise of pertussis (48% increase in notifications from Dec 2007 to Dedc 2008) and need for re-vaccination of at risk groups.
We have been advised to consider booster vaccinations (assuming they have had primary vaccination as children) for:
- adults before planning pregnancy or for both parents as soon as possible after birth
- adults working with or caring for very young babies, especially health care workers and child care workers
- adults wishing to protect themselves from pertussis
People become immune either through pertussis immunisation or by catching the disease itself, but protection is not life long and begins to wane after 6-10 years. Sometimes immunised people still contract pertussis, but they are likely to have a less severe illness.
NSW to centralise major trauma into trauma centres as does Melbourne
Sunday, March 29th, 2009“Commissioner Peter Garling SC suggested NSW make drastic reforms and only have three trauma centres to deal with life-threatening injuries.”
“The NSW Government has seemingly decided on seven: Royal North Shore, Prince of Wales, Royal Prince Alfred, Westmead, John Hunter in Newcastle, and St George and Liverpool hospitals.”
“Three hospitals will specialise in paediatric trauma: John Hunter, Sydney Childrens and the Westmead.”
see News.com
Victorian DHS HealthSMART workshops – Cerner Millenium clinical system
Tuesday, March 17th, 2009Cerner Corporation’s Millenium Clinical System was selected as Victoria’s HeathSMART clinical system.
DHS will be holding workshops between 30th March 2009 – 3rd April 2009 seeking clinician input into the design and customisation of the Clinical System – the “Victorian state build” version of the Millenium software.
Scope of the system currently includes:
- Release 1
- Clinical workbench
- Patient and episode list, integrated results reporting (pathology and medical imaging), problem list, allergies, alerts and discharge summary
- ePrescribing
- Medication profile, discharge medication prescribing, decision support (eg. Drug/drug and drug/allergy interactions
- Release 2
- diagnostic service ordering
- Ordering of pathology investigations and medical imaging procedures, and decision support (eg duplicate service checking)
- medication management
- Inpatient, emergency and outpatient prescribing, medication administration record, bar coded drug/patient identification, observations and decision support (drug/dose range checking)
Although most ED’s in Victoria appear not to be utilising the Cerner system for their primary ED patient management system, it would seem inevitable that ED staff will be using the Cerner clinical system for their other needs.
How will this system interact with YOUR ED system (and Second Screen if you have it) and how functional will the electronic ordering and prescribing be in an ED environment?
For example you may wish to ensure the results reporting functionality allows the user when checking an ankle Xray to click a button which takes the user to ozemedicine wiki ankle injuries and patient information sheets page.
How will the reporting system ensure abnormal results are appropriately followed up and document what measures were taken, by whom and when – will they appropriately manage interim reports and final reports and flag them to the doctors caring for the patient if they differ?
Will we be forced to use a single unifying interface in ED rather than our dedicated ED systems – particularly if our ED systems will not be doing pathology/radiology ordering and reporting or ePrescribing?
How is this going to work – will we end up with just another fragmented IT system with multiple interfaces, or worse, a single interface which is not optimised for our ED environments?
There is a risk that the customisation will be driven by inpatient staff who may not be aware of the degree of IT development that has already been achieved in EDs and the possibilities, needs and risks on which ED staff can advise.
Contribution by ED staff and appropriate heed of their advice will be critical to the successful acceptance of such a system in the ED environment.
Here is your opportunity to participate in workshops – unfortunately, I will be at the ACEM Primary Exams at these times so I can’t attend.
Eastern Health and the Eye and Ear Hospital are the lead organisations implementing the system this year and next year with others to follow.
How to remove an embedded fish hook – have we got it all wrong?
Monday, March 16th, 2009Here is an online video tutorial, note the importance of adequate analgesia and assistants…
and another example of this technique but without analgesia or assistants:
fish hook removal technique – another demo
and to complete our series, another which adds a few nice touches as they give in to advice from the patient, but make sure your volume is turned down – he is male after all and pain scores may not be valid:
fish hook removal technique – 3rd demo
I’m not convinced that it should replace the more thoughtful and controlled approach we use, and certainly not condoning this technique as it would seem to add some risk of trauma to structures caught behind the barb such as digital nerves.
I guess it has its place and no doubt will become popular with the help of YouTube for the DIY first aiders on fishing boats. My biggest concern with this technique though is the risk the dis-embedded hook becomes lodged in someone’s eye.
You will then need to call the ophthalmologist for one embedded in the cornea, because you may need a few special implements:
fish hook removal from cornea technique
In contrast, the more controlled technique used in most ED’s supplemented with some LA and antiseptic to cleanse the part of the hook you are about to push through the skin:
embedded fish hook - 1
Using pliers, snip the proximal part of the hook off:
embedded fish hook - 2
using the pliers, push the hook so the point exits the skin – preferably away from digital nerves, arteries and tendons, and without pricking yourself:
then grab the now exposed tip of the hook with the pliers and pull through the remainder of the hook (you may need to slightly enlarge the exit wound with a scalpel blade to make this easier):
embedded fish hook - 4
A leech in the eye
Wednesday, March 11th, 2009The Emergency Medicine Australasia journal this month (EMA 2009: 21, 84-5) has published a case report by Partyka and Fogg, of the management of a leech attached to the conjunctiva of a patient’s eye after it had been flicked up with dirt whilst gardening.
It was successfully removed by first applying local anaesthetic drops (0.5% amethocaine) followed by 3 drops of 3% saline. After the leech released itself and was removed wiith forceps, the eye was then irrigated with 1L of 0.9% saline.
She was discharged with chloramphenicol eye drops and ointment and made an uneventful recovery.
ps. Dr Walpole has made a comment and raises the valid point that amethocaine (aka tetracaine) has been replaced as ophthalmic local anaesthetic of choice by proparacaine, although many of us use oxybuprocaine (Benoxinate).
Information about local anaesthetics can be found on the wiki here.
Management of life threatening asthma in children
Wednesday, March 11th, 2009To make life easier for ED resuscitation staff confronted with the asthmatic patient who is becoming exhausted and cyanosed, a hopefully easy to follow guideline derived from RCH and NSW NETS guidelines has been created on the Ozemedicine wiki.
It has been designed with links to further information on the drugs used as well as to contact details for retrieval services and the referenced articles.
Unfortunately, each hospital tends to have their own procedures for creating salbutamol, aminophylline and magnesium sulphate, but hopefully the ones outlined are easy to follow and are standard, at least in NSW and Victoria.
