I am putting this one up more to invite contributions from the community. It’s a case that has been included for our PRCC students – the guys who spend the entire third year of their four year graduate entry medical degree attached to a rural community (the so-called parallel rural community curriculum).
Time will tell whether this initiative translates to a career in rural medicine. However one thing is clear, the PRCC students are far more likely to get hands-on experience, whether it be doing minor gynae procedures, assisting at a LSCS, basics of airway management, assessment of undifferentiated patients in the ED or having own consulting sessions.
This week’s problem-based learning session is on a neonate with breathing and feeding difficulties. As an experiment, I am putting the case up and hoping that #FOAMed enthusiasts will be able to comment – because I’d love to demonstrate the power of #FOAMed to these rural students. So come on, don’t disappoint me…
Here’s the case
Hamish is 6 days old. He was born at 38 weeks as the second child to his 29 yo married mother. Antenatal course was reportedly unremarkable. Birth weight was 3 kg. He was discharged on day two after delivery, formula-fed and with an unremarkable ‘baby check’ by the obstetric RMO.
He presents to the hospital with parental concern that “there’s something wrong with my baby”. Mum reports difficulty in breathing and feeding (60ml of formula 5 x per day).
In terms of other history, birth parents and Hamish’s elder 4 yo brother are well with no medical problems. A paternal uncle died at 2 weeks of age from ‘hole in the heart’
On examination, Hamish looks ‘crook’ – he is pale, peripherally shut down. He is NOT cyanosed and appears afebrile. He is lethargic and sweaty. RR is 100 with intercostal recession HR is 150 with palpable upper limb pulses but the attending doctor reports difficulty with lower limb pulses. BP 63/40 arm, 45/30 leg. Heart sounds are dual with S3 gallop. There’s a ejection systolic murmur at the LSE grade 1-2/6. There is palpable firm hepatomegaly 4cm below costal margin.
I am interested in how the #FOAMed community would
(i) assess this child and come to a differential?
(ii) investigate and manage, from small rural hospital through to specialist centre?
(iii) what resources could be helpful along the way…
Over to you…
PLEASE COMMENT BELOW
Dr Ed Valentine is a dual-trained EM & ICU doc in the Old Dart, currently spending a year as a retrieval Fellow with London HEMS and responding as a BASICS volunteer in his home county of Wiltshire, UK
We talk about the role of BASICS in the UK to “value add” to the scene despite existing paramedic services and the relative proximity of tertiary hospitals in the UK compared with Australia.
Ed promises to come ‘down under’ to SMACC GOLD in March 2014, so we’ll set aside a cold one for him in the SMACC lounge
Geoff is a former airman turned doctor and rural GP-anaesthetist. He’s worked in many interesting places and sounds like he’ll continue to search for future challenges.
Today we caught up during an EMST/ATLS course to discuss life as a rural GP locum, difficult airway kit and shared passion for trauma.
Have a listen to the podcast and see what you reckon ….
Pleasure today to chat to Mr Ben Stanton – ICU Nurse and Retrieval Practitioner with medSTAR South Australia on both the retrieval practitioner role and tips for packaging of the critical patient for rural clinicians
Dr Kin Snyder & Dr Jonas Kasauakas have been locuming in rural South Australia; they shared their experiences with me at the Rural Doctors Workforce Agency Conference in Adelaide this weekend.
A flyer from SAPMEA is available with registration details
Great to talk to Dr Ken Milne who is actively trying to narrow the knowledge transfer gap of traditional methods (up to a decade from evidence to practice) using SoMe and FOAMed – a keen medical myth buster and small town emergency physician in rural Goderich, Ontario Canada (Ken claims is ‘Canada’s prettiest town’).
Ken hosts the excellent sceptics guide to emergency medicine blog and podcast, which is a MUST for rural doctors alongside existing resources like BroomeDocs and KIDocs.org
Ken is giving a keynote at this weekend Rural Doctors of South Australia conference – via the internet from Canada! Let’s hope we can entice him to join the rural stream at SMACC14 on the Gold Coast next year.
Now onto the podcast….
Rural practice embraces the breadth of medicine. FOAMed can help us keep up to date and deliver “quality care, out there”.
We all know that critical illness does not respect geography – I have been inspired by the FOAMed coming out from the luminaries of the EM/Crit Care field – with lessons applicable to the rural doctor.
If you are a rural doctor – think about coming along to SMACC2014 on the Gold Coast in March next year- it’s ostensibly about “social media & critical care” – but the lessons are broader and applicable to rural doctors across the breadth of their work.
The SMACC2013 podcasts are rolling out and downloadable now from iTunes – click here to listen.
Meanwhile, stop worrying, dive in and enjoy the FOAMed…
Imagine this scenario. Your longterm cardiac cripple patient – the one you successfully rescuscitated from a VF arrest some 8 years ago and who has eked out an existence due to an implantable defibrillator – has finally succumbed to a chronic illness and is deceased.
You’ve managed to wade through the completion of the death certificate – but 3 hours later are telephoned by the Funeral Director who tells me that the patient is to be cremated.
Here’s the question – does the ICD need to be removed? If so, does it need to be deactivated first? And can you do this as a “Medical Macgyver” with just a multitool and a strong arm?
Needless to say it is a Saturday and the cardiology clinic is closed until Monday. The nearest tertiary hospital is 600km away…
Would you cut the wires?
Retrieval nurses Ben Stanton & Sue Coretti were over on Kangaroo Island today to do some in-house training for our nursing staff on paediatric emergencies – the major strength being using local equipment and staffing, demonstrating failings in logistics rather than strategy.
After two hard days and a brief 10 mins of pelican feeding outside the hospital, I dropped Sue & Ben at the airstrip and grabbed a few minutes to quiz Sue about her role in training rural clinicians in emergencies (see her excellent presentation from last year’s Cairns aeromedical conference) and to discuss practical tips for dealing with such emergencies.
I also asked Sue about her feelings as an APLS Director and whether they matched my frustrations as an EMST Director … and mooted the possibility of greater involvement from medSTAR in the FOAMed community in the future?
Have a listen to the podcast :