26 May 2021 - Admin

Teaching this week will be over Zoom:

https://zoom.us/j/5981463478?pwd=RThaZzNkL2w5bldBMlNHeE1zZFFaZz09 

Meeting ID: 598 146 3478 

Passcode: 2021

Program

1000-1005: Welcome

1005-1030: Coding and PAS — Sabrina Lunardi

1030-1130: Documentation — Andrew Walby

1130-1140: Recap of last week’s Paediatric teaching — Alasdair Williamson

1140-1200: Break

1200-1300: Organ Donation — Shannesey Voros & Bernadette Hickey

1300-1310: ECG of the Week — Marty Lynch

1310-1315: Image of the Week — Kat Watson

1315-1400: Break-out Fellowship Written Group — Alex Handrinos

1315-1400hr: How to Get the Most Out of Your WBAs — Claudiu Radeanu

Summary

Thank you to Andy King for this week’s program summary.

Documentation in the ED

The ED gets funding based on the number and type of admitted patient treated by the hospital — coders will translate all diagnoses / procedures from our documentation for costing / funding. Here are some tips for how to optimise funding:

  • Uncertain of diagnosis? Use probably / suspected / likely

  • Document causal relationship (“due to / secondary to / caused by”), e.g. SBO secondary to laparoscopic procedure

  • Cannot code “on background of / associated with”

  • Avoid abbreviations / acronyms / symbols

In case you ever end up in court…

  • Document your designated role, i.e. Registrar

  • Document important positive and negative findings

  • Document things not done and why not

  • Document the name of doctors with whom you consult

  • Document handovers

  • Document follow-up plans, e.g. LMO within a certain timeframe

  • Document if the patient is NESB or if you took the history from someone else

Organ donations

  • Everybody approaching end of life in ED should be referred to the Donate Life coordinators at SVHM

  • Don’t extubate in ED

  • The senior available next of kin can consent to donation — if none can be found, a medical officer can consent provided there is prior evidence of intention to donate

Image of the Week

84F presents with unconscious collapse/out of hospital arrest.

Chest - Mobile.jpg
 

ECG of the Week

15 month old male brought in by parents for fever and parents noticed shaking and screaming while asleep.

ecg1.png

1) What does this ECG show?

Monomorphic ventricular tachycardia (rare in children)

Description: Broad complex regular tachycardia at a rate of approximately 250bpm with dysynchronous p waves and signs of AV dissociation.

2) What are the treatment options?

Pharmacological vs DCR

  • Amiodarone 5mg/kg

  • 2J/kg via synchronised direct current cardioversion

 

This was his ECG post-treatment with amiodarone:

ecg2.png

3) What syndrome does this ECG show?

Brugada syndrome

  • Coved ST elevation in Lead V1 consistent with Type 1 Brugada patten

  • Combined with documented VT = Brugada syndrome

NOTE: It’s subtle! Changes are possibly obscured by amiodarone administration.

4) What medications should be avoided?

See brugadadrugs.org for full list.

Commonly used ED drugs to definitely avoid:

  • Propofol

  • Bupivicaine

  • Flecainide

  • Procainamide

Commonly used ED drugs to preferably avoid:

  • Metoclopramide

  • Ketamine

  • Tramadol

  • Amiodarone

  • Lignocaine

  • Phenytoin

  • Fexofenadine (Telfast antihistamine)

  • Propranolol

  • Verapamil

Things that patient might have taken which may induce Brugada syndrome: alcohol, marijuana, cocaine

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