Notes, handouts and references from JMO, resident and registrar teaching
Acute Heart Failure Management in the ED
Today in JMO teaching we talked about the management of acute heart failure in the ED, specifically the management of acute pulmonary oedema or “SCAPE” (Sympathetic Crashing Acute Pulmonary Edema).
I have attached the clinical vignette, tutorial notes and some interesting references for further reading.
EM docs’ excellent blog on “myths in heart failure management”
Palliative care in the ED
Today Brigitte the palliative care CNC came to talk to us about palliative care services and referral processes in our area, and provide some resources to assist us with having end-of-life conversations and prescribing in palliative care.
Main learning points for me were:
Brigitte kindly sent me some useful resources relating to today’s session. Her teaching powerpoint, some communication skills resources and community palliative care referral form can be found below.
Here are some resources to gain further knowledge in this area
Reading a paediatric ECG
McMaster University MacPeds Survival Guide
Syncope
When reading the ECG consider conduction disturbance (predisposing to complete heart block), acquired and inherited disorders associated with risk of dysrhythmia (WPW) or sudden cardiac death (Brugada, Arrhythmogenic RV Cardiomyopathy, QT abnormalities), and – especially in exertional syncope – left ventricular outflow obstruction (HOCM, aortic stenosis).
The acronym WOBBLER can help us remember to check these things in a left-to-right (P wave to T wave) approach:
Congenital Heart Disease in the ED
Consider duct dependent lesions if a patient presents in the first month (especially first week) of life with new onset cyanosis, ‘effortless tachypnoea’ or pallor/ shock.
Non specific symptoms and signs in infants include lethargy, poor feeding, sweating, and an enlarged liver.
For a good grasp of congenital heart disease emergencies this excellent podcast from the Emergency Medicine Cases team in Canada covers a lot of ground:
See also these videos from Open Pediatrics:
Fontan Circulation
Following ‘Fontan’ heart surgery the patient has a single functioning systemic ventricle which is used for providing cardiac output to the body. Blood flow to the lungs is not pumped by a ventricle, but relies on venous return directly from the venae cavae to pulmonary arteries. These patients are therefore very preload dependent and can be severely compromised by hypovolaemia.
Fontan patients are also at risk of thromboembolic disease and dysrhythmias. Adult patient survivors of congenital heart disease can have Fontan circulations.
This blog post is helpful from EM Ottawa:
Further information on patients with a Fontan circulation is provided in this article from University Hospital Birmingham
During the management of cardiac arrest in children and infants with known cardiac disease, specific modifications may be necessary to standard ACLS. These are discussed and summarise in this AHA article:
Cardiopulmonary Resuscitation in Infants and Children With Cardiac Disease
Hi everyone,
Here are a couple of articles that talk about how to present cases in ED in 3 minutes. This can be modified to be used in the ISOBAR format, or for case presentations using powerpoint. These are meant for medical students, but they are actually good for every level. I learnt a few things from them too.
The 3-Minute Emergency Medicine Medical Student Presentation: A Variation on a Theme
Oral Presentations in Emergency Medicine
Let me know if you find it helpful.
Cheers, Malcolm.
Topic; Cardiology
14:00-15:00 Practical Pacing and Cardioversion (Jane Senior and Barbie Payne)
15.00-15.30 Syncope (Jane Senior)
15.30-16.00 ECG Quiz– prizes to be won!
Please meet in the Resus room at 2pm to start the session
High risk factors for Syncope from ESC
This weeks timetable;
14.00-15.00 M&M department meeting
15.00-16.00 Assessment of an Acute Abdomen, Amir Ashrafizadeh-Surgical Registrar
Please try your best to be on time
Topic; Neurology/ Neurosurgery
14.00-14.30 Migraine– Are we following best evidence audit result (Rhianna Price)
14.30-15.00 Lumbar punctures– Why and when to do them in ED? (Jane Senior)
15.00-16.00 CTB Imaging- Neurotrauma (Jane Senior)
The decision to LP or not ? discussed on the ECI website with a selection of 3 videos ECI- LP series of videos
More resources for kids and LP from Dontforgetthebubbles
