31 March 2021 - Social Determinants of Health
Program
1000-1015: Recap & quiz of last week’s teaching — Daniel Coghill
1015-1025: ECG of the Week — Jannet Chan
1025-1030: Image of the Week — Rachel Goh
1030-1100: Homelessness & Health — Sarah Bannerman
1100-1200: Indigenous Health Equity Training — Jonty Karro & Toni Mason
1200-1300: Radiology Tute — Leon Winata
1300-1330: Registrar Forum — Mim Scharkie & Phil Ward
Teaching this week will begin in the Conference Room in the Education Centre on Level 3 of Building C (Healy Wing).
Image of the Week
30yo man presents feeling unwell with a fever. He has a history of IVDU. You notice his nails…
What is this abnormality?
Splinter haemorrhage
What is this a sign of?
Subacute bacterial endocarditis
What are 3 other signs you might look for on physical exam?
Janeway lesions (painless macules on the palms and soles)
Osler nodes (tender nodules on the fingers)
Roth spots
Heart murmur
ECG of the Week
52yo lady presents with altered conscious state on a background of depression and suicide attempt.
Describe 3 abnormalities.
Dominant terminal R wave (>3mm) in aVR
Right axis deviation
Long QT
Sinus tachycardia (secondary to muscarinic M1 receptor blockade)
What is the most likely cause?
TCA overdose — see Austin Toxicology Guideline for TCA overdose
List the ECG abnormalities you might see with this case.
The degree of QRS broadening on ECG is correlated with adverse events:
>100ms is predictive of seizure
>160ms is predictive of ventricular arrhythmia
Tall R wave in aVR (R/S ratio >0.7)
The patient is now having a seizure. List 4 management priorities.
IV sodium bicarb 50mmoL boluses over 2 minutes (repeat 5 minutely), aiming for pH 7.50-7.55
Prepare for RSI intubation to secure airway and hyperventilate once intubated to maintain pH 7.50-7.55
IV midazolam 5mg
Activated charcoal 50g via NGT