Past teaching sessions and blog posts

This week Chandima Panditharathna gave us a presentation on TCA overdose and touched on Questiapine also. It was a great talk but he was up against stiff competition from LITFL and for the sake of time I am going to just link to this fantastic post from them rather than summarising Chandima's talk. Honestly, if you read this post you neen't bother opening a textbook on the topic.

The only thing I can add is to stress that this is one situation where you should have a very low threshold for taking control of the situation early with sedation and intubation. It is a lot easier to administer Bicarb to a patient who is ironed out and ventilated than one who is fitting on the floor, or worse, one who is fitting below a pile of security guards. Remember that these patients frequently oscillate between periods of deep sedation and periods of agitated delirium in which they are seeing frightening things and are very excitable. This is a really unhelpful thing in someone who is heading towards malignant tachyarrthythmias and metabolic acidosis.

And remember also that like all tox cases, cardiac arrest is bad but can have excellent outcomes despite very prolonged CPR. I am not overly positive about the whole CPR thing in general but in the case of a toxicological cardiac arrest, the heart is otherwise healthy and the insult is completely reversible; this is one of the few situations where I would argue for truly prolonged resuscitation while oxygenation, fluid status and pH are all optimised. When all else fails you might even like to try intralipid.

For Quetiapine, see my entry from a few weeks ago.

Everyone is blogging on this topic lately so I feel compelled to do so to. The trouble is, I am not sure yet if I am convinced by it. Either TXA is the best thing since mouldy bread or it's all just too good to be true. For anyone who came down in the last shower, CRASH 2 looked at TXA in trauma patients in around 20,000 patients across 274 hospitals and 40 countries and found a significant improvement in all cause mortality. Surely that is enough said. Cheap drug, huge study, meaningful outcome, statistical significance. What could people possibly find to complain about? Well read on for a closer look, along with some primary exam stuff (because you can bet it is coming as a pharmacology viva question in the next year or two).

A/Prof Beth Pennington was back to teach on Paediatric Burns. Her talk is attached here.

 

The gist this week was to get an approach to epistaxis and to think about some nasty ENT infections that we see a bit less than tonsillitis and croup. 

The talk is here.

click read more for a some details (as the ppt isn't much without me talking)

Dr Hamed Akhlaghi presented on metabolic acidosis and blood gases. When I get hold of his talk I will put it on. 

Thanks to Dr Peter Fritz for his VAQ aids for the fellowship exam - a great list of key points.

Metabolic Acidosis

Metabolic Alkalosis

Here is Mark's summary of blood gas interpretation.