Guest Speaker:Dr Indika De Lanerolle (MBBS, MD, MRCEM) is a Consultant Emergency Physician at the National Hospital of Sri Lanka in Colombo. He is also the first emergency physician in Sri Lanka.Interviewed By:Samoda Wilegoda - ED trainee at Westmead Hospital. Music/Sound Effects: Awakening by Vlad Gluschenko | https://soundcloud.com/vgl9, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US. Denna Dena Na (Papara Song).  Electronic Rock (King Around Here) by Alex Grohl, available via https://pixabay.com/music/beats-electronic-rock-king-around-here-15045/.  Tropical Evening by Vlad Gluschenko | https://soundcloud.com/vgl9, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US. Promotional VideoMusic - Tropical Evening by Vlad Gluschenko | https://soundcloud.com/vgl9, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US.Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Panel:Pramod Chandru and Shreyas Iyer.Music/Sound Effects: Bullet Train by tubebackr | https://www.tubebackrmusic.com/Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution-NoDerivs 3.0 Unported (CC BY-ND 3.0), https://creativecommons.org/licenses/by-nd/3.0/. Hands High by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US. Love Trip by Sarah Jansen Music | https://soundcloud.com/sarahjansenmusic, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US. Stay by Thomas Gresen | https://soundcloud.com/thomasgresen, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US. References: Carne B, Kennedy M, Gray T. Review article: Crisis resource management in emergency medicine. Emerg Med Australas. 2012 Feb;24(1):7-13. doi: 10.1111/j.1742-6723.2011.01495.x. Epub 2011 Oct 13. Review. PubMed PMID: 22313554. St Pierre M, Hofinger G, Buerschaper C, Simon R. Crisis Management in Acute Care Settings: Human Factors, Team Psychology, and Patient Safety in a High Stakes Environment. (2nd edn) Springer, 2011. Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Special Episode: The Indigenous Voice To The Australian ParliamentPresenter: Shreyas Iyer.Summary: There is a toxic amount of lies and misinformation regarding what is a very simple proposal for providing dignity to the First Nations people and helping our government make good decisions.  Polls show that the overwhelming majority of First Nations people are in favour of this proposal.  Better government policy and better use of government resources benefit all of us.  Listening to First Nations people and learning from their knowledge of the land also benefits all of us.  We shouldn’t expect this to be a panacea, but the status quo of wasting money and allowing our First Nations communities to languish is not tenable.  The 'No' campaign has not actually offered any alternative viable solutions. Our community is a melting pot of different peoples, but we all love this country and want to play our part in it.  We have provided our references, and also some useful resources for information regarding the Voice below. If you found this video helpful, please feel free to share and spread the word. If you would like to discuss this topic further or have any questions please feel free to reach out to us on social media.  On 14th October we have a chance to make a good decision for the future of this country, we have a chance to vote YES to the Aboriginal and Torres Strait Islander Voice to Parliament.  References https://www.wslhd.health.nsw.gov.au/ArticleDocuments/1232/WSLHD%20Year%20in%20Review%202021-22.pdf.aspx  https://www.abs.gov.au/articles/new-south-wales-aboriginal-and-torres-strait-islander-population-summary#where-aboriginal-and-torres-strait-islander-people-live https://www.abs.gov.au/statistics/people/aboriginal-and-torres-strait-islander-peoples/census-population-and-housing-counts-aboriginal-and-torres-strait-islander-australians/2021#new-south-wales  https://ulurustatement.org/history/the-journey-so-far/  https://aci.health.nsw.gov.au/projects/co-design  https://www.aph.gov.au/About_Parliament/Senate/Powers_practice_n_procedures/Constitution.aspx  https://theconversation.com/indigenous-recognition-in-our-constitution-matters-and-will-need-greater-political-will-to-achieve-90296  https://about.abc.net.au/speeches/noel-pearson-boyer-lecture-series-who-we-were-and-who-we-can-be/  https://www.survivalinternational.org/tribes/aboriginals#:~:text=There%20are%20about%20500%20different,large%20number%20of%20separate%20clans.&text=Archaeologists%20believe%20that%20the%20Aboriginals,continent%20around%2045%2C000%20years%20ago  https://www.indigenoushpf.gov.au/Measures/1-19-Life-expectancy-birth  https://www.indigenoushpf.gov.au/Measures/2-11-Contact-criminal-justice-system#keymessages  https://www.abc.net.au/news/2015-12-03/fact-check-aboriginal-men-in-jail-and-university/6907540  https://www.aihw.gov.au/reports/australias-health/indigenous-health-andwellbeing#Suicide%20and%20self-harm      https://www.abc.net.au/news/2022-11-30/closing-the-gap-report-released/101713892  https://www.pc.gov.au/closing-the-gap-data/annual-data-report/report/snapshot-socioeconomic#seo10  https://www.abc.net.au/news/2023-10-02/preventable-blindness-rates-have-been-halved/102916184   https://theconversation.com/governments-are-failing-to-share-decision-making-with-indigenous-people-productivity-commission-finds-210392#:~:text=The%20commission%20says%20too%20many,Agreement%20on%20Closing%20the%20Gap”  https://theconversation.com/many-claim-australias-longest-running-indigenous-body-failed-heres-why-thats-wrong-209511  Useful Resources https://voice.gov.au  https://ulurustatement.org  https://www.reconciliation.org.au/reconciliation/support-a-voice-to-parliament/  https://theconversation.com/the-voice-what-is-it-where-did-it-come-from-and-what-can-it-achieve-202138  https://theconversation.com/au/voice  https://www.abc.net.au/listen/programs/the-voice-referendum-explained  https://www.abc.net.au/news/2023-09-29/fact-check-voice-to-parliament-misinformation/102913680  https://www.amnesty.org.au/the-voice-to-parliamentfaqs/#:~:text=The%20Voice%20will%20give%20independent,gender%20balanced%20and%20include%20youth 

Guest Speaker: Dr Kavita Varshney (MBBS EMDM FACEM FCEM) is an emergency physician with a special interest in disaster medicine and clinical education. She is also the deputy director of Emergency Medicine at Westmead Hospital.Interviewed By:Dr Pramod Chandru (FACEM). Music/Sound Effects: Adventure by Roa Music | https://soundcloud.com/roa_music1031, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US. Lagoon by LiQWYD & Luke Bergs | https://www.liqwydmusic.com, https://soundcloud.com/bergscloud, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US. Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Guest Speaker: Dr Amith Shetty (FACEM, PhD) - Clinical Director, Patient Experience and System Performance Support Division, NSW Health, Australia. Interviewed By:Dr Pramod Chandru (FACEM). Music/Sound Effects: Ascension by Keys of Moon | https://soundcloud.com/keysofmoon, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 4.0 International (CC BY 4.0), https://creativecommons.org/licenses/by/4.0/. Eternal Sunshine by LiQWYD & Luke Bergs | https://www.liqwydmusic.com, https://www.lukebergsmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution-ShareAlike 3.0 Unported (CC BY-SA 3.0), https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Somebody by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US.  Promotional Video (Soundtrack):Somebody by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US. Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Panel: Pramod Chandru and Shreyas Iyer.Case Summary: 61-year-old male presenting with 2 distinct episodes of shortness of breath, chest pain, and associated presyncope.   Asymptomatic by the time of arrival to the emergency department.   ECG and observations at triage were unremarkable.  No recent travel or recent major surgeries.  Initial troponin and serial troponin were 80ng/L.   D-dimer was ordered given static troponin and the nature of symptoms: 0.58.  Although this D-dimer was negative when age-adjusted, a V/Q scan was pursued as the patient was not felt to fit a ‘low risk’ pre-test probability for PE (IV contrast shortage dictated V/Q over CTPA).  Bilateral segmental pulmonary PE identified on V/Q scan with mild right heart strain evident on subsequent CTPA and TTE.   Key Discussion Points: If a case does not follow the usual ‘pattern’ of your initial diagnosis, consider alternate aetiologies.  There are many tools available for risk-stratifying PE including PERC, age-adjusted D-dimer, and the YEARS diagnostic pathway. However, the way in which to appropriately utilize these tools is nuanced.   A paper published in JAMA in December 2021 demonstrates some ways in which these tools can be used together (see first reference below).   The PESI score (even prior to definitive diagnosis) can be useful to risk stratify patients with possible PE and help determine their disposition.   Take-Home Points: Pre-test probability is incredibly important, particularly in entities such as PE where only highly invasive imaging modalities are diagnostic.  Having a structured approach to protect yourself from your own mistakes is extremely important (such as a hypothesis and hypothesis testing approach).  References & Background Reading:  Effect of a Diagnostic Strategy Using an Elevated and Age-Adjusted D-Dimer Threshold on Thromboembolic Events in Emergency Department Patients With Suspected Pulmonary Embolism: A Randomized Clinical Trial. JAMA. 2021 Dec 7;326(21):2141-2149. doi: 10.1001/jama.2021.20750.  Thiruganasambandamoorthy, V., Stiell, I.G., Sivilotti, M.L. et al. Risk stratification of adult emergency department syncope patients to predict short-term serious outcomes after discharge (RiSEDS) study. BMC Emerg Med 14, 8 (2014). https://doi.org/10.1186/1471-227X-14-8. Crane SD, Risk stratification of patients with syncope in an accident and emergency department Emergency Medicine Journal 2002;19:23-27. Almulhim KN. The Characteristics of Syncope-Related Emergency Department Visits: Resource Utilization and Admission Rate Patterns in Emergency Departments. Cureus. 2022 Feb 8;14(2):e22039. doi: 10.7759/cureus.22039. PMID: 35340474; PMCID: PMC8913182.  Iwuji K, Almekdash H, Nugent KM, Islam E, Hyde B, Kopel J, Opiegbe A, Appiah D. Age-Adjusted D-Dimer in the Prediction of Pulmonary Embolism: Systematic Review and Meta-analysis. J Prim Care Community Health. 2021 Jan-Dec;12:21501327211054996. doi: 10.1177/21501327211054996. PMID: 34814782; PMCID: PMC8640977.  Schouten HJ, Geersing GJ, Koek HL, et al. Diagnostic accuracy of conventional or age-adjusted D-dimer cut-off values in older patients with suspected venous thromboembolism: systematic review and meta-analysis. 2012. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK133492/. Franco-Moreno AI, Bustamante-Fermosel A, Ruiz-Giardin JM, Muñoz-Rivas N, Torres-Macho J, Brown-Lavalle D. Utility of probability scores for the diagnosis of pulmonary embolism in patients with SARS-CoV-2 infection: A systematic review. Rev Clin Esp (Barc). 2023 Jan;223(1):40-49. doi: 10.1016/j.rceng.2022.07.004. Epub 2022 Sep 22. PMID: 36241500; PMCID: PMC9492501.  Christ M, Geier F, Popp S, Singler K, Smolarsky A, Bertsch T, Müller C, Greve Y. Diagnostic and prognostic value of high-sensitivity cardiac troponin T in patients with syncope. Am J Med. 2015 Feb;128(2):161-170.e1. doi: 10.1016/j.amjmed.2014.09.021. Epub 2014 Oct 15. PMID: 25447619.  Lindner G, Pfortmueller CA, Funk GC, Leichtle AB, Fiedler GM, Exadaktylos AK. High-Sensitive Troponin Measurement in Emergency Department Patients Presenting with Syncope: A Retrospective Analysis. PLoS One. 2013 Jun 18;8(6):e66470. doi: 10.1371/journal.pone.0066470. PMID: 23823330; PMCID: PMC3688899.  Music/Sound Effects: ENGINE by Alex-Productions | https://onsound.eu/, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US.  Feel It by MBB feat. JV Saxx | https://soundcloud.com/mbbofficial, https://www.instagram.com/JVSAXX/, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution-ShareAlike 3.0 Unported (CC BY-SA 3.0), https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Lakeside by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US.  Ocean Love by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US. Nostalgic Marshmallows by Arthur Vyncke | https://soundcloud.com/arthurvost, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution-ShareAlike 3.0 Unported (CC BY-SA 3.0), https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Sound effects from https://www.free-stock-music.com. Promotional Video (Soundtrack):Pina Colada by Scandinavianz | https://soundcloud.com/scandinavianz,Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US.Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Orthopaedics. Participants: Professor Herwig Drobetz (orthopaedic trauma surgeon at Lismore Base Hospital), Dr Anthony Wilson (orthopaedics registrar at Lismore Base Hospital), Pramod Chandru, Caroline Tyers, Mariez Gorgi and Kim Van Vu. Discussion:Gibson, P. D., Adams, M. R., Koury, K. L., Shaath, M. K., Sirkin, M. S., & Reilly, M. C. (2016). Inadvertent Reduction of Symphyseal Diastasis During Computed Tomography. Journal of orthopaedic trauma, 30(9), 474–478. https://doi.org/10.1097/BOT.0000000000000627.Presenter: Kim Van Vu - emergency medicine trainee at Westmead Hospital. Music/Sound Effects: Esta Noche by Vendredi & Shifumi | https://soundcloud.com/vendrediduo, Music promoted by https://www.free-stock-music.com,  Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US. Picasso by Ikson | https://youtube.com/ikson, Music promoted by https://www.free-stock-music.com. Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Orthopaedics. Participants: Professor Herwig Drobetz (orthopaedic trauma surgeon at Lismore Base Hospital), Dr Anthony Wilson (orthopaedics registrar at Lismore Base Hospital), Pramod Chandru, Caroline Tyers, Mariez Gorgi and Kim Van Vu. Discussion:Combined Randomised and Observational Study of Surgery for Fractures in the Distal Radius in the Elderly (CROSSFIRE) Study Group, Lawson, A., Naylor, J. M., Buchbinder, R., Ivers, R., Balogh, Z. J., Smith, P., Xuan, W., Howard, K., Vafa, A., Perriman, D., Mittal, R., Yates, P., Rieger, B., Smith, G., Adie, S., Elkinson, I., Kim, W., Sungaran, J., Latendresse, K., … Harris, I. A. (2021). Surgical Plating vs Closed Reduction for Fractures in the Distal Radius in Older Patients: A Randomized Clinical Trial. JAMA surgery, 156(3), 229–237. https://doi.org/10.1001/jamasurg.2020.5672. Presenter: Mariez Gorgi - emergency medicine advanced trainee at Westmead Hospital.Music/Sound Effects: Got My Love by LiQWYD & Markvard | https://www.liqwydmusic.com, https://soundcloud.com/markvard, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US. Sunset Beach by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.comCreative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US. Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Orthopaedics. Participants: Professor Herwig Drobetz (orthopaedic trauma surgeon at Lismore Base Hospital), Dr Anthony Wilson (orthopaedics registrar at Lismore Base Hospital), Pramod Chandru, Caroline Tyers, Mariez Gorgi and Kim Van Vu. Discussion:Weinberg, D. S., Scarcella, N. R., Napora, J. K., & Vallier, H. A. (2016). Can Vascular Injury be Appropriately Assessed With Physical Examination After Knee Dislocation?. Clinical orthopaedics and related research, 474(6), 1453–1458. https://doi.org/10.1007/s11999-016-4730-6.Presenter: Anthony Wilson - orthopaedics registrar at Lismore Base Hospital.References: Welling, D. R., Ryan, J. M., Burris, D. G., & Rich, N. M. (2010). Seven sins of humanitarian medicine. World journal of surgery, 34(3), 466–470. https://doi.org/10.1007/s00268-009-0373-z. Music/Sound Effects: Faces by RYYZN | https://soundcloud.com/ryyzn, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US. Get Away by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US. Slipz (audio logo) by tubebackr | https://www.tubebackrmusic.com/, Music promoted by https://www.free-stock-music.com. Swing by LiQWYD & Luke Bergs | https://www.liqwydmusic.com, https://soundcloud.com/bergscloud, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US. Thinking Of You by Ron Gelinas Chillout Lounge | https://open.spotify.com/artist/03JYfsI9Ke7JFuxHD239m2Music promoted by https://www.free-stock-music.com. Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Critical Care.Participants: Dr Alex Yartsev (intensivist at Westmead Hospital), Dr Mark Salter (emergency physician at Westmead Hospital), Maddy Jegatheeswaran (intensive care Fellow at Westmead Hospital), Gladis Kabil (registered nurse at Westmead Hospital), Kristian Adams, Pramod Chandru, Caroline Tyers, Amanda De Silva, Shreyas Iyer, and Samoda Wilegoda. Discussion:Sud, S., Friedrich, J. O., Adhikari, N. K. J., Fan, E., Ferguson, N. D., Guyatt, G., & Meade, M. O. (2021). Comparative Effectiveness of Protective Ventilation Strategies for Moderate and Severe Acute Respiratory Distress Syndrome. A Network Meta-Analysis. American journal of respiratory and critical care medicine, 203(11), 1366–1377. https://doi.org/10.1164/rccm.202008-3039OC. Presenter: Maddy Jegatheeswaran intensive care Fellow at Westmead Hospital.Music/Sound Effects: Blue Sweater by RYYZN | https://soundcloud.com/ryyzn, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Good Day by Ikson | https://youtube.com/ikson, Music promoted by https://www.free-stock-music.com. Slipz (audio logo) by tubebackr | https://soundcloud.com/tubebackr, Music promoted by https://www.free-stock-music.com. Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Critical Care.Participants: Dr Alex Yartsev (intensivist at Westmead Hospital), Dr Mark Salter (emergency physician at Westmead Hospital), Maddy Jegatheeswaran (intensive care Fellow at Westmead Hospital), Gladis Kabil (registered nurse at Westmead Hospital), Kristian Adams, Pramod Chandru, Caroline Tyers, Amanda De Silva, Shreyas Iyer, and Samoda Wilegoda. Discussion:Kabil, G., Liang, S., Delaney, A., Macdonald, S., Thompson, K., Saavedra, A., Suster, C., Moscova, M., McNally, S., Frost, S., Hatcher, D., & Shetty, A. (2021). Association between intravenous fluid resuscitation and outcome among patients with suspected infection and sepsis: A retrospective cohort study. Emergency Medicine Australasia, 34(3), 361–369. https://doi.org/10.1111/1742-6723.13893. Presenter: Gladis Kabil - registered nurse at Westmead Hospital and PhD candidate. Music/Sound Effects: Lagoon by LiQWYD & Luke Bergs | https://www.liqwydmusic.com, https://soundcloud.com/bergscloud, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. My Old East Coast by Vendredi feat. Melanie | https://soundcloud.com/vendrediduo, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Slipz (audio logo) by tubebackr | https://soundcloud.com/tubebackr, Music promoted by https://www.free-stock-music.com. Trick Or Treat by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. When The Lights Go On by Vlad Gluschenko | https://soundcloud.com/vgl9, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Critical Care.Participants: Dr Alex Yartsev (intensivist at Westmead Hospital), Dr Mark Salter (emergency physician at Westmead Hospital), Maddy Jegatheeswaran (intensive care Fellow at Westmead Hospital), Gladis Kabil (registered nurse at Westmead Hospital), Kristian Adams, Pramod Chandru, Caroline Tyers, Amanda De Silva, Shreyas Iyer, and Samoda Wilegoda. Discussion:Ameloot, K. et al. (2020) “Optimum blood pressure in patients with shock after acute myocardial infarction and cardiac arrest,” Journal of the American College of Cardiology, 76(7), pp. 812–824. Available at: https://doi.org/10.1016/j.jacc.2020.06.043. Presenter: Kristian Adams - intensive care trainee at Westmead Hospital.Music/Sound Effects: Alicante by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Dance by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Descriptions by RYYZN | https://soundcloud.com/ryyzn, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Get Away by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Healthcare Worker Well-Being.Participants: Dr Felicity Day (emergency physician), Dr Laura Brown (emergency physician), Natalie Harman (psychotherapist and counselor), Diane Premnath, Nasim Erfani, Caroline Tyers, Jack Ashley, Shreyas Iyer, and Mariez Gorgi. Discussion:Brand, S. L., Thompson Coon, J., Fleming, L. E., Carroll, L., Bethel, A., & Wyatt, K. (2017). Whole-system approaches to improving the health and wellbeing of healthcare workers: A systematic review. PloS one, 12(12), e0188418. https://doi.org/10.1371/journal.pone.0188418. Presenter: Diane Premnath - ED advanced trainee at Westmead Hospital.Music/Sound Effects: Adrenaline by Alex-Productions | https://onsound.eu/, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Down by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Emotional Piano Improvisation by Alexander Nakarada | https://www.serpentsoundstudios.com, Music promoted by https://www.free-stock-music.com, Attribution 4.0 International (CC BY 4.0), https://creativecommons.org/licenses/by/4.0/. Slipz (audio logo) by tubebackr | https://soundcloud.com/tubebackr, Music promoted by https://www.free-stock-music.com. Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Healthcare Worker Well-Being.Participants: Dr Felicity Day (emergency physician), Dr Laura Brown (emergency physician), Natalie Harman (psychotherapist and counsellor), Diane Premnath, Nasim Erfani, Caroline Tyers, Jack Ashley, Shreyas Iyer and Mariez Gorgi. Discussion:Kendrick, M., Kendrick, K., Morton, P., Taylor, N., & Leggat, S. (2020). Hospital Staff Report It Is Not Burnout, but a Normal Stress Reaction to an Uncongenial Work Environment: Findings from a Qualitative Study. International Journal Of Environmental Research And Public Health, 17(11), 4107. https://doi.org/10.3390/ijerph17114107. Presenter: Jack Ashley - ED trainee at Liverpool Hospital.Music/Sound Effects: Love Me Now by Vishmak | https://soundcloud.com/vishmak, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Motivational Piano Background Music by Nikita Lukyanov | https://soundcloud.com/lukyanovnikita, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Summer Mood by Roa Music | https://soundcloud.com/roa_music1031, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Healthcare Worker Well-Being.Participants: Dr Felicity Day (emergency physician), Dr Laura Brown (emergency physician), Natalie Harman (psychotherapist and counselor), Diane Premnath, Nasim Erfani, Caroline Tyers, Jack Ashley, Shreyas Iyer and Mariez Gorgi. Discussion:Zhang Q, Mu M-c, He Y, Cai Z-l, Li Z-c. Burnout in emergency medicine physicians: a meta-analysis and systematic review. Medicine 2020; 99:32(e21462). Presenter: Nasin Erfani - ED advanced trainee at Westmead Hospital.Music/Sound Effects: Coastline by Ikson | https://youtube.com/ikson, Music promoted by https://www.free-stock-music.com. Gatekeeper by The Piano Says | https://soundcloud.com/thepianosays, https://spoti.fi/3uvxbRU, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Paradise by Ikson | https://youtube.com/ikson, Music promoted by https://www.free-stock-music.com. Piano Rock Instrumental by Hyde - Free Instrumentals | https://soundcloud.com/davidhydemusic, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Slipz (audio logo) by tubebackr | https://soundcloud.com/tubebackr, Music promoted by https://www.free-stock-music.com. Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Toxicology. Participants: A/Prof. Naren Gunja (clinical toxicologist), Pramod Chandru, Amanda De Silva, Mariez Gorgi, Tim Selvaraj and Kit Rowe. Discussion:Tokuda, Y., Kikuchi, M., Takahashi, O., & Stein, G. (2006). Prehospital management of sarin nerve gas terrorism in urban settings: 10 years of progress after the Tokyo subway sarin attack. Resuscitation, 68(2), 193-202. https://doi.org/10.1016/j.resuscitation.2005.05.023.Presenter: Mariez Gorgi - ED advanced trainee at Westmead Hospital.Music/Sound Effects: Eternal Sunshine by LiQWYD & Luke Bergs | https://www.liqwydmusic.com, https://www.lukebergsmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Legendary Epic Heroic Cinematic Music | Heroic by Alex-Productions | https://www.youtube.com/channel/UCx0_M61F81Nfb-BRXE-SeVA, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Nightswim by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Slipz (audio logo) by tubebackr | https://soundcloud.com/tubebackr, Music promoted by https://www.free-stock-music.com. Something ’bout July by RYYZN | https://soundcloud.com/ryyzn, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Vamos by MBB & LiQWYD | https://soundcloud.com/mbbofficial, https://soundcloud.com/liqwyd, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Toxicology. Participants: A/Prof. Naren Gunja (clinical toxicologist), Pramod Chandru, Amanda De Silva, Mariez Gorgi, Tim Selvaraj and Kit Rowe. Discussion:Salter MD, Chandru P, Rowe K, Smith P, Gunja N. Prevalence of Pregnancy in Drug Overdose Presenting to a Tertiary Toxicology Service. Clinical Audit. 2022;14:19-29, https://doi.org/10.2147/CA.S341432. Presenter: Tim Selvaraj - ED trainee at Westmead Hospital.Music/Sound Effects: Hands High by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Mamacita by Mike Leite | https://soundcloud.com/mikeleite, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Paradise by Ikson | https://youtube.com/ikson, Music promoted by https://www.free-stock-music.com. Slipz (audio logo) by tubebackr | https://soundcloud.com/tubebackr, Music promoted by https://www.free-stock-music.com. Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Toxicology. Participants: A/Prof. Naren Gunja (clinical toxicologist), Pramod Chandru, Amanda De Silva, Mariez Gorgi, Tim Selvaraj and Kit Rowe. Discussion:De Fazio, P., Gaetano, R., Caroleo, M., Cerminara, G., Maida, F., Bruno, A., Muscatello, M. R., Moreno, M. J., Russo, E., & Segura-García, C. (2015). Rare and very rare adverse effects of clozapine. Neuropsychiatric disease and treatment, 11, 1995–2003. https://doi.org/10.2147/NDT.S83989.Presenter: Pramod Chandru. Music/Sound Effects: Descriptions by RYYZN | https://soundcloud.com/ryyzn, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Get Away by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Last Summer by Ikson | https://youtube.com/ikson, Music promoted by https://www.free-stock-music.com. Slipz (audio logo) by tubebackr | https://soundcloud.com/tubebackr, Music promoted by https://www.free-stock-music.com. Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Environmental Medicine. Participants: Dr Scott Squires, A/Prof. Andrew Coggins, Tim Selvaraj, Shoahaib Karimi, Yelise Foon, Mariez Gorgi, Shreyas Iyer, Kit Rowe, and Harry Hong. Discussion:Yeh, R., Valsdottir, L., Yeh, M., Shen, C., Kramer, D., & Strom, J. et al. (2018). Parachute use to prevent death and major trauma when jumping from aircraft: randomized controlled trial. BMJ, k5094. https://doi.org/10.1136/bmj.k5094.Presenter: Harry Hong - critical care trainee at Ryde Hospital. Music/Sound Effects: Fire by Noise Badger | https://soundcloud.com/noisebadger, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Never Give Up by Jay Someday | https://soundcloud.com/jaysomeday, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Nightswim by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Slipz (audio logo) by tubebackr | https://soundcloud.com/tubebackr, Music promoted by https://www.free-stock-music.com. Thinking Of You by Ron Gelinas Chillout Lounge | https://open.spotify.com/artist/03JYfsI9Ke7JFuxHD239m2Music promoted by https://www.free-stock-music.com. Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Environmental Medicine. Participants: Dr Scott Squires, A/Prof. Andrew Coggins (emergency physician), Tim Selvaraj, Yelise Foon, Mariez Gorgi, Shreyas Iyer, Kit Rowe, and Harry Hong. Discussion:Livingstone, D., Smith, K., & Lange, B. (2017). Scuba diving and otology: a systematic review with recommendations on diagnosis, treatment and post-operative care. Diving And Hyperbaric Medicine Journal, 47(2), 97-109. https://doi.org/10.28920/dhm47.2.97-109.Presenter:  - Yelise Foon - emergency medicine trainee at Westmead Hospital.Music/Sound Effects: Ascension by Keys of Moon | https://soundcloud.com/keysofmoon, Music promoted by https://www.free-stock-music.comAttribution 4.0 International (CC BY 4.0), https://creativecommons.org/licenses/by/4.0/. Dance by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Keep Going by Jay Someday | https://soundcloud.com/jaysomeday, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Nostalgic Marshmallows by Arthur Vyncke | https://soundcloud.com/arthurvost, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Sound effects from https://www.free-stock-music.com.  The Times by Jay Someday | https://soundcloud.com/jaysomeday, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Environmental Medicine. Participants: Dr Scott Squires, A/Prof. Andrew Coggins, Tim Selvaraj, Yelise Foon, Mariez Gorgi, Shreyas Iyer, Kit Rowe, and Harry Hong. Discussion:Douma, M., Aves, T., Allan, K., Bendall, J., Berry, D., & Chang, W. et al. (2020). First aid cooling techniques for heat stroke and exertional hyperthermia: A systematic review and meta-analysis. Resuscitation, 148, 173-190. https://doi.org/10.1016/j.resuscitation.2020.01.007. Presenter: Tim Selvaraj - emergency medicine trainee at Westmead Hospital. Music/Sound Effects: Maximalism by Punch Deck | https://soundcloud.com/punch-deck, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Slipz (audio logo) by tubebackr | https://soundcloud.com/tubebackr, Music promoted by https://www.free-stock-music.com. Wanna by Ikson | https://youtube.com/ikson, Music promoted by https://www.free-stock-music.com. Waterfall by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Gastroenterology. Participants: Dr Tim O'Sullivan (gastroenterologist and endoscopy fellow), Dr Oksana Williamns (emergency physician), Varan Perananthan (gastroenterology advanced trainee), Maria Martino (emergency medicine advanced trainee), Amanda De Silva, Shreyas Iyer, Jack Ashley.Discussion:Sreedharan, A., Martin, J., Leontiadis, G., Dorward, S., Howden, C., Forman, D., & Moayyedi, P. (2010). Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding. Cochrane Database Of Systematic Reviews. https://doi.org/10.1002/14651858.cd005415.pub3.Presenter: Maria Martino - emergency medicine advanced trainee at Westmead Hospital.  Music/Sound Effects: Good Day by Ikson | https://youtube.com/ikson, Music promoted by https://www.free-stock-music.com.Bring Me The Sky by Scott Buckley | https://soundcloud.com/scottbuckley, Music promoted by https://www.free-stock-music.comAttribution 4.0 International (CC BY 4.0),https://creativecommons.org/licenses/by/4.0/. Night Sky by Leonell Cassio ft. Julia Mihevc | https://soundcloud.com/leonellcassio, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Nightswim by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Slipz (audio logo) by tubebackr | https://soundcloud.com/tubebackr, Music promoted by https://www.free-stock-music.com. Sound effects from https://www.free-stock-music.com.  Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Gastroenterology. Participants: Dr Tim O'Sullivan (gastroenterologist and endoscopy fellow), Dr Oksana Williamns (emergency physician), Varan Perananthan (gastroenterology advanced trainee), Maria Martino (emergency medicine advanced trainee), Amanda De Silva, Shreyas Iyer, Jack Ashley.Discussion:Rout, G., Shalimar, Gunjan, D., Mahapatra, S., Kedia, S., Garg, P., & Nayak, B. (2020). Thromboelastography-guided Blood Product Transfusion in Cirrhosis Patients With Variceal Bleeding. Journal Of Clinical Gastroenterology, 54(3), 255-262. https://doi.org/10.1097/mcg.0000000000001214.Presenter: Varan Perananthan - gastroenterology advanced trainee at Westmead Hospital.  Music/Sound Effects: Faces by RYYZN | https://soundcloud.com/ryyzn, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Help You Out by Leonell Cassio ft. Jonathon Robins | https://soundcloud.com/leonellcassio, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Picasso by Ikson | https://youtube.com/ikson, Music promoted by https://www.free-stock-music.com. Slipz (audio logo) by tubebackr | https://soundcloud.com/tubebackr, Music promoted by https://www.free-stock-music.com. Sound effects from https://www.free-stock-music.com.  Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Gastroenterology. Participants: Dr Tim O'Sullivan (gastroenterologist and endoscopy fellow), Dr Oksana Williamns (emergency physician), Varan Perananthan (gastroenterology advanced trainee), Maria Martino (emergency medicine advanced trainee), Amanda De Silva, Shreyas Iyer, Jack Ashley.Discussion:Horibe, M., Iwasaki, E., Matsuzaki, J., Bazerbachi, F., Kaneko, T., & Minami, K. et al. (2021). Superiority of urgent vs early endoscopic hemostasis in patients with upper gastrointestinal bleeding with high-risk stigmata. Gastroenterology Report, 9(6), 543-551. https://doi.org/10.1093/gastro/goab042. Presenter: Jack Ashley - emergency medicine trainee at Liverpool Hospital.  Music/Sound Effects: Blue Sweater by RYYZN | https://soundcloud.com/ryyzn, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Outside by Ikson | https://youtube.com/ikson, Music promoted by https://www.free-stock-music.com. Medical Examination by MaxKoMusic | https://maxkomusic.com/, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Slipz (audio logo) by tubebackr | https://soundcloud.com/tubebackr, Music promoted by https://www.free-stock-music.com. Sound effects from https://www.free-stock-music.com.  Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Neurology. Participants: Dr Hugo Morales (neurologist), Dr James Tadros (emergency physician), Jessica Stabler (epilepsy fellow), Kim Van Vu, Mariez Gorgi and Shreyas Iyer. Discussion:Chamberlain, J., Kapur, J., Shinnar, S., Elm, J., Holsti, M., & Babcock, L. et al. (2020). Efficacy of levetiracetam, fosphenytoin, and valproate for established status epilepticus by age group (ESETT): a double-blind, responsive-adaptive, randomised controlled trial. The Lancet, 395(10231), 1217-1224. https://doi.org/10.1016/s0140-6736(20)30611-5. Presenter: Jessica StablerMusic/Sound Effects: Help You Out by Leonell Cassio ft. Jonathon Robins | https://soundcloud.com/leonellcassio, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.  Nightswim by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Ocean Love by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. River by MusicbyAden | https://soundcloud.com/musicbyaden, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Slipz (audio logo) by tubebackr | https://soundcloud.com/tubebackr, Music promoted by https://www.free-stock-music.com. Sound effects from https://www.free-stock-music.com.  The Travelling Symphony by Savfk | https://www.youtube.com/savfkmusic, Music promoted by https://www.free-stock-music.comAttribution 4.0 International (CC BY 4.0), https://creativecommons.org/licenses/by/4.0/.  Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Neurology. Participants: Dr Hugo Morales (neurologist), Dr James Tadros (emergency physician), Jessica Stabler (epilepsy fellow), Kim Van Vu, Mariez Gorgi and Shreyas Iyer. Discussion:Keh, R., Scanlon, S., Datta-Nemdharry, P., Donegan, K., Cavanagh, S., & Foster, M. et al. (2022). COVID-19 vaccination and Guillain-Barré syndrome: analyses using the National Immunoglobulin Database. Brain. https://doi.org/10.1093/brain/awac067. Presenter: Kim Van Vu - ED Trainee at Westmead Hospital.Interude Reference: http://www.petervuust.dk/Credits:This episode is produced with help of HETI's Emergency Medicine Training Network 5.Music/Sound Effects: Open Arms by Jay Someday | https://soundcloud.com/jaysomeday, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Motivational Piano Background Music by Nikita Lukyanov | https://soundcloud.com/lukyanovnikita, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.  Second Goodbye by Sapajou | https://soundcloud.com/sapajoubeats, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Slipz (audio logo) by tubebackr | https://soundcloud.com/tubebackr, Music promoted by https://www.free-stock-music.com. Smile by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Sound effects from https://www.free-stock-music.com.  Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Neurology. Participants: Dr Hugo Morales (neurologist), Dr James Tadros (emergency physician), Jessica Stabler (epilepsy fellow), Sai Nagaratnam (neurology advanced trainee), Mariez Gorgi and Shreyas Iyer. Discussion:  Nham, B., Reid, N., Bein, K., Bradshaw, A., McGarvie, L., & Argaet, E. et al. (2021). Capturing vertigo in the emergency room: three tools to double the rate of diagnosis. Journal Of Neurology, 269(1), 294-306. https://doi.org/10.1007/s00415-021-10627-1.Presenter: Sai Nagaratnam. Resources:Emergency Care Institute: https://aci.health.nsw.gov.au/networks/eci. Credits:This episode is produced with help of HETI's Emergency Medicine Training Network 5.Music/Sound Effects: Energetic Electronic Vlog Music | Breeze by Alex-Productions | https://www.youtube.com/channel/UCx0_M61F81Nfb-BRXE-SeVA,Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Medical Examination by MaxKoMusic | https://maxkomusic.com/, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Miss You by RYYZN | https://soundcloud.com/ryyzn, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Sound effects from https://www.free-stock-music.com.  Vamos by MBB & LiQWYD | https://soundcloud.com/mbbofficial, https://soundcloud.com/liqwyd, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Why’d You Wanna End by Leonell Cassio ft. Alex Lippett | https://soundcloud.com/leonellcassio, Music promoted by https://www.free-stock-music.com, Attribution-ShareAlike 4.0 International (CC BY-SA 4.0), https://creativecommons.org/licenses/by-sa/4.0/.  Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Paediatrics. Participants: Dr Kerf Tan (emergency physician), Dr Karl Pobre (paediatric emergency physician and paediatrician), Mariez Gorgi, Amanda De Silva, Shreyas Iyer, Harry Hong, and Samoda WilegodaDiscussion:Bourke, E., Say, D., Carison, A., Hill, A., Craig, S., & Hiscock, H. et al. (2021). Emergency mental health presentations in children with autism spectrum disorder and attention deficit hyperactivity disorder. Journal Of Paediatrics And Child Health, 57(10), 1572-1579. https://doi.org/10.1111/jpc.15535.Presenter: Shreyas Iyer.Summary: This was a retrospective cross-sectional study which aimed to explore the issues faced by young people with a known diagnosis of autism spectrum disorder (ASD) or attention deficit hyperactivity disorder (ADHD) presenting to the emergency department with a mental health complaint. This study found 374 mental health presentations to the Royal Children’s Hospital in Melbourne in 2018 in which patients had a background of ASD and/or ADHD (in the age group of 7 to 17 years). This represented 28% of mental health presentations for this specified age group. Those with a diagnosis of both ADHD and ASD were more likely to require ambulance or police transport to hospital (RR 1.5).  Children with ADHD (with or without ASD) were at a higher risk of being brought to hospital under section.  The most common presentation for both the ADHD and ASD cohorts was acute severe behavioural disturbance.  Patients with ASD had a significantly increased risk of physical restraint (RR 2.8), chemical restraint (RR 2.8) and of seclusion (RR 3.3). It is important to understand what ASD and ADHD are and what the perspective of the child might be so that we can approach these patients with empathy and try and avoid potential triggers for behavioural escalation.    Take-Home Points: This study gives numbers to support what we already know; that patients with ASD and ADHD are both at structural risk of suffering secondary trauma in the emergency department because of the environment.  When assessing these patients, involve senior and experienced clinicians early to try and expedite their journey through the emergency department.  There needs to be systemic change with regards to the design of our emergency departments to better manage these patients; this will require input from an executive level.   Credits:This episode is produced with help of HETI's Emergency Medicine Training Network 5.Music/Sound Effects Energetic Electronic Vlog Music | Breeze by Alex-Productions | https://www.youtube.com/channel/UCx0_M61F81Nfb-BRXE-SeVA, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Jolly Way by Artegon | https://soundcloud.com/artegon, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Nightswim by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Second Goodbye by Sapajou | https://soundcloud.com/sapajoubeats, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Slipz (audio logo) by tubebackr | https://soundcloud.com/tubebackr, Music promoted by https://www.free-stock-music.com. Sound effects from https://www.free-stock-music.com.  Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

Theme: Paediatrics. Participants: Dr Kerf Tan (emergency physician), Dr Karl Pobre (paediatric emergency physician and paediatrician), Mariez Gorgi, Shreyas Iyer, Harry Hong, and Samoda WilegodaDiscussion:Dainty, K., Atkins, D., Breckwoldt, J., Maconochie, I., Schexnayder, S., & Skrifvars, M. et al. (2021). Family presence during resuscitation in paediatric and neonatal cardiac arrest: A systematic review. Resuscitation, 162, 20-34. https://doi.org/10.1016/j.resuscitation.2021.01.017.Presenter: Mariez Gorgi (emergency medicine advanced trainee).Summary: This systematic review set out to determine the impact of family presence during resuscitation (specifically in cardiac arrest) on patient outcomes, family-centered outcomes and healthcare-provider outcomes. A total of 38 papers were included in the review; consisting of observational studies, qualitative interviews or surveys, spanning from 1999 to 2019 in 11 different countries. No papers explored the impact of family presence on patient outcome. Most parents wished to be offered the opportunity to be present in the resuscitation in order to provide comfort to their child, as well as assisting in accepting the outcome and knowing that everything that could be done had been done for their child.  The opinion of healthcare providers was more widely varied, citing the concern of psychological trauma to the parents, interference with management of the patient and stress on the treating team (performance-related anxiety).  However, the more experienced a healthcare worker with having family presence in a resuscitation, the more agreeable they were to this.  However, the evidence provided in all papers was of very low quality, and there is an urgent need for better quality data surrounding this topic.  Important things to consider with family presence is to flag that you may need them to leave the room during the resuscitation, and having a dedicated support person for the family present.  Hot and cold debriefs involving all relevant staff (paramedics, nursing staff, allied health, doctors) are also incredibly important following a resuscitation such as this.   Take-Home Points:  It would be great to have better studies looking into family presence in resuscitation (looking into outcomes for the patients themselves as well as better qualitative data looking into what happens to families and healthcare workers afterwards).  If there is family around, they should be asked whether they want to be present in the resuscitation.  There should be a resource allocated to families to prevent their presence taking away from the resuscitation itself.  If you are struggling following a resuscitation, seek support.  Resources (to support doctor well-being) -  Applications: Shift (Black Dog Institute app for healthcare workers), Calm, Headspace, Feeling Good, Smiling Minds, Insight Timer.   JMO support line (NSW): 1300 566 321. Employee Assistance Program (free confidential service for all NSW Health employees) - 1300  687 327.  Doctors for doctors: www.drs4drs.com.au. Beyond Blue: 1300 224 636. Lifeline: 13 11 14.  Suicide call-back service: 1300 659 467.  Credits:This episode is produced with help of HETI's Emergency Medicine Training Network 5.Music/Sound Effects Breathe by Roa Music | https://soundcloud.com/roa_music1031, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Emotional Piano Improvisation by Alexander Nakarada | https://www.serpentsoundstudios.com, Music promoted by https://www.free-stock-music.com, Attribution 4.0 International (CC BY 4.0), https://creativecommons.org/licenses/by/4.0/. Inspiration by MaxKoMusic | https://maxkomusic.com/, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.  Sound effects from https://www.free-stock-music.com.  Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

Theme: Paediatrics. Participants: Dr Kerf Tan (emergency physician), Dr Karl Pobre (paediatric emergency physician and paediatrician), Yelise Foon, Mariez Gorgi, Shreyas Iyer, Harry Hong, and Samoda WilegodaDiscussion:Goyal, M., Chamberlain, J., Webb, M., Grundmeier, R., Johnson, T., & Lorch, S. et al. (2020). Racial and ethnic disparities in the delayed diagnosis of appendicitis among children. Academic Emergency Medicine, 28(9), 949-956. https://doi.org/10.1111/acem.14142.Presenter: Yelise Foon.Summary: Delay in the diagnosis of appendicitis is associated with perforation and significant subsequent morbidity.  Currently the pre-operative perforation rate for appendicitis is 30%.  Some known risk factors for a delayed diagnosis for appendicitis include a young age, female gender, African-American race, non-English speaking backgrounds and government insurance factors (predominantly in the US).  This was a multi-centre retrospective cohort study conducted over 3 years utilizing the PECARN registry, which aimed to compare the rate of appendiceal perforation, delayed diagnosis of appendicitis and diagnostic imaging use among different ethnicities. Of the 7298 children diagnosed with appendicitis where race/ethnicity data was collected, 34.9% of non-Hispanic white children had a perforated appendix, compared with 36.5% of non-Hispanic black children.  Non-Hispanic black children also had higher rates of delayed diagnosis (defined as having a relevant emergency visit in the week prior to diagnosis): at 4.7% compared with 2.0% for non-Hispanic white children.  Further non-Hispanic black children with a delayed diagnosis of appendicitis were less likely to undergo definite imaging (including MRI, ultrasound, or CT) compared with their non-Hispanic white counterparts (with 28.2% versus 46.2% undergoing imaging).  However, given that this study came out of the US, the generalisability of this study to Australian emergency departments is unclear.  Health literacy is likely to be a large contributor to delayed presentation of appendicitis and something to be carefully considered when treating any child (and their family).  There are tools such as the Paediatric Appendicitis Score (PAS) and the Alvarado Score which may assist in objectively quantifying the possibility of appendicitis (particularly for junior staff).   Take-Home Points:It is important for us to consider how we can minimise racial and ethnic disparities and make sure we are conscious of them. Credits:This episode is produced with help of HETI's Emergency Medicine Training Network 5.Music/Sound Effects Feel Me by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. In The Eyes by Peyruis | https://soundcloud.com/peyruis, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. It’s All Good by Roa Music | https://soundcloud.com/roa_music1031, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Love Trip by Sarah Jansen Music | https://soundcloud.com/sarahjansenmusic, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Mamacita by Mike Leite | https://soundcloud.com/mikeleite, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Slipz (audio logo) by tubebackr | https://soundcloud.com/tubebackr, Music promoted by https://www.free-stock-music.com. Sound effects from https://www.free-stock-music.com.  Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

Theme: Cardiology.Participants: Dr Karan Rao (cardiologist), Dr Nick Moore (ED consultant), Dr Hao Tran (cardiology advanced trainee), David Emmerig (ED trainee), Aran Sandrasegaran, Amanda De Silva, Pramod Chandru, Shreyas Iyer, and Samoda WilegodaDiscussion:Stewart, J., Lu, J., Goudie, A., Bennamoun, M., Sprivulis, P., Sanfillipo, F., & Dwivedi, G. (2021). Applications of machine learning to undifferentiated chest pain in the emergency department: A systematic review. PLOS ONE, 16(8), e0252612. https://doi.org/10.1371/journal.pone.0252612.Presenter: Hao Tran.Credits:This episode was produced by HETI's Emergency Medicine Training Network 5.Music/Sound Effects Descriptions by RYYZN | https://soundcloud.com/ryyzn, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Got My Love by LiQWYD & Markvard | https://www.liqwydmusic.com, https://soundcloud.com/markvard, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Sunset Beach by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Sound effects from https://www.free-stock-music.com.  Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

Theme: Cardiology.Participants: Dr Karan Rao (cardiologist), Dr Nick Moore (ED consultant), Dr Hao Tran (cardiology advanced trainee), David Emmerig (ED trainee), Aran Sandrasegaran, Amanda De Silva, Pramod Chandru, Shreyas Iyer, and Samoda WilegodaDiscussion:Boyle, R., & Body, R. (2021). The Diagnostic Accuracy of the Emergency Department Assessment of Chest Pain (EDACS) Score: A Systematic Review and Meta-analysis. Annals Of Emergency Medicine, 77(4), 433-441. https://doi.org/10.1016/j.annemergmed.2020.10.020.Presenter: David Emmerig. Credits:This episode was produced by HETI's Emergency Medicine Training Network 5.Music/Sound Effects Ascension by Keys of Moon | https://soundcloud.com/keysofmoon, Music promoted by https://www.free-stock-music.comAttribution 4.0 International (CC BY 4.0), https://creativecommons.org/licenses/by/4.0/.  Descriptions by RYYZN | https://soundcloud.com/ryyzn, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Maximalism by Punch Deck | https://soundcloud.com/punch-deck, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Something ’bout July by RYYZN | https://soundcloud.com/ryyzn, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Sound effects from https://www.free-stock-music.com.  Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

Theme: Cardiology.Participants: Dr Karan Rao (cardiologist), Dr Nick Moore (ED consultant), Dr Hao Tran (cardiology advanced trainee), David Emmerig (ED trainee), Aran Sandrasegaran, Amanda De Silva, Pramod Chandru, Shreyas Iyer, and Samoda WilegodaDiscussion:Green, S., & Schriger, D. (2021). A Methodological Appraisal of the HEART Score and Its Variants. Annals Of Emergency Medicine, 78(2), 253-266. https://doi.org/10.1016/j.annemergmed.2021.02.007. Presenter: Shreyas Iyer. Credits:This episode was produced by HETI's Emergency Medicine Training Network 5.Music/Sound Effects Descriptions by RYYZN | https://soundcloud.com/ryyzn, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Feel It by MBB feat. JV Saxx | https://soundcloud.com/mbbofficial, https://www.instagram.com/JVSAXX/, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0, Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US Nothing Better by Vendredi ft. ELLE | https://soundcloud.com/vendrediduo, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Medical Examination by MaxKoMusic | https://maxkomusic.com/, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.  Sound effects from https://www.free-stock-music.com.  Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

Theme: Workplace Violence. Participants: Dr Margaret Murphy, Dr Lex Narushevich, Arvind Karthikeyan, Adamina Drazkiewicz, Aran Sandrasegaran, Amanda De Silva, Pramod Chandru, Harry Hong, Shreyas Iyer, and Caroline Tyers. Discussion:Davids J, Murphy M, Moore N, Wand T, Brown M. Exploring staff experiences: A case for redesigning the response to aggression and violence in the emergency department. Int Emerg Nurs. 2021 Jul;57:101017. doi: 10.1016/j.ienj.2021.101017. Epub 2021 Jun 24. PMID: 34174545.  Presenter:Amanda De Silva (emergency medicine trainee at Westmead Hospital). Summary:  It is widely recognized that emergency departments (EDs) are a high-risk environment when it comes to violence towards healthcare workers.  A big contributor to this is the environment in the ED – it is chaotic, messy, busy, and sees a large turnover of patients. Compounded by access block and understaffing, this often exacerbates tense and potentially volatile situations.  The Australian College of Emergency Medicine has created a policy regarding violence in emergency departments to provide a guideline by which departments can maintain a safe working environment.  They examine the Code Black response and identify important elements of ED design to encourage a positive patient journey through the ED.  This observational study was conducted in the Western Sydney Local Health district across four hospitals, one of which is Westmead Hospital.  It involved interviewing 20 staff members from across the four sites to gauge their personal experience with violence in the emergency department. The data was analyzed and codes were created to capture concepts in the data.  The study identified several points of interest when it comes to Code Blacks.  Perpetrators of these events tended to be patients who had presented with drug or alcohol-related illness, as well as mental illness.  There are several common triggers of violence, including extensive wait times, frustration/fear/anxiety, and being involuntarily detained for psychiatric care.  Staff members feel undertrained when it comes to responding to violence in the ED – 6/20 staff reported not being given formal training when starting their job in ED, while many others reported learning through on-the-job training and observation.  Good communication was identified as crucial to managing an escalating situation.  Staff members were unsure when to activate a Code Black, and also reported feeling reluctant to call one for fear of interrupting other busy colleagues.  There is no culture of formal debriefing after a Code Black, and staff members are often left to manage their own stress.   Take-Home Points  Communication and de-escalation skills are vital to the Code Black response and in preventing violence in the ED.  Early escalation of concerns about agitated patients is important, to allow for these communication skills to be utilized and to diffuse escalating situations before they reach a point of physical violence.  More education is required around the Code Black response, with particular attention paid to the specific roles of each member of the response team and how they can assist in managing violent situations.  Credits:This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney and, Deepa Dasgupta. Music/Sound Effects Beach by Limujii | https://soundcloud.com/limujii, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Eternal Sunshine by LiQWYD & Luke Bergs | https://www.liqwydmusic.com, https://www.lukebergsmusic.comMusic promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.  Lie 2 You by Leonell Cassio ft. Dylan Emmet | https://soundcloud.com/leonellcassio, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.  Sound effects from https://www.free-stock-music.com.  Sittin’ Throwin’ Rocks by Leonell Cassio ft. Lily Hain | https://soundcloud.com/leonellcassio, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

Theme: Workplace Violence. Participants: Dr Margaret Murphy, Dr Lex Narushevich, Arvind Karthikeyan, Adamina Drazkiewicz, Amanda De Silva, Pramod Chandru, Harry Hong, Shreyas Iyer, and Caroline Tyers. Discussion:Jeong, I., & Kim, J. (2018). The relationship between intention to leave the hospital and coping methods of emergency nurses after workplace violence. Journal Of Clinical Nursing, 27(7-8), 1692-1701. https://doi.org/10.1111/jocn.14228. Presenter:Dr Arvind Karthikeyan - ED Trainee at Tweed Hospital.Summary: The main aim of this study was to identify the relationship between emergency nurses’ intention to leave the hospital and their coping methods following workplace violence. The coping methods were split into emotion-focused and problem-focused mechanisms.  The study was a cross-sectional study in which surveys were sent out to 7 hospitals in 7 different cities around Korea (completed by nursing staff working in the emergency department). They received 246 returned surveys, and 32 were incomplete, leaving 214 questionnaires to derive their results from. Verbal abuse was the most frequent violence experience.  Of those who experienced violence, 61% considered leaving the hospital. Emotion-focused coping appeared to have a stronger association with nurses’ intention to leave following workplace violence.  This highlights the need for resources and processes in place within the emergency department to support staff and encourage healthy coping mechanisms in response to incidents of violence.  Take-Home Points:  This article highlights the importance of healthy coping strategies. Having a more formalised, standardised counselling service for healthcare providers would be extremely beneficial (ideally an ‘opt-out’ service).   Credits:This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney and, Deepa Dasgupta. Music/Sound Effects Paradise by MBB | https://soundcloud.com/mbbofficial, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.  Sound effects from https://www.free-stock-music.com.  Youth by JayJen & Krishi Sarma | https://soundcloud.com/jayjenmusic, Music promoted by https://www.free-stock-music.com,Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

Theme: Workplace Violence. Participants: Dr Margaret Murphy, Dr Lex Narushevich, Arvind Karthikeyan, Adamina Drazkiewicz, Aran Sandrasegaran, Amanda De Silva, Pramod Chandru, Harry Hong, Shreyas Iyer, and Caroline Tyers. Discussion:Nikathil, S., Olaussen, A., Symons, E., Gocentas, R., and Mitra, B., 2017. Review article: Workplace violence in the emergency department: A systematic review and meta-analysis. Emergency medicine Australasia : EMA. 29. 10.1111/1742-6723.12761. (Nikathil et al., 2017). Presenter: Aran Sandrasegaran - ED SRMO at Westmead Hospital.Summary: Workplace violence in the emergency department is a systematic review and meta-analysis published in 2017 in EMA by Nikathil, et al. From 7235 abstracts, 22 studies were deemed relevant. A meta-analysis was conducted on the primary outcome variable-proportion of violent patients among total ED presentations. A secondary meta-analysis used studies reporting on the proportion of drug and alcohol-affected patients occurring within the violent population. It reported the prevalence of violence in Australian Emergency Departments (EDs) as at least 36 events per 10 000 patients, with about 45 in every 100 violent presentations estimated to be associated with alcohol and/or other drugs. These findings had good confidence intervals. The study reported that young males were the young (aged between 28-42 years) males were the primary demonstrators of violence. Due to statistical heterogeneity in study methodology, definitions and rates, and under-reporting the results are not a full reflection of the incidence of WPV in EDs.    Take-Home Points: Studies examining violence in the ED consistently report a high prevalence of workplace violence (WPV). Nikithil et al. is the only recent study to confirm a high proportion of violence in terms of patient presentation. Drugs and alcohol were commonly associated with violent episodes, often in the absence of an underlying psychiatric diagnosis. The findings of this study are likely an underrepresentation due to statistical heterogeneity and under-reporting and analysts and future studies must consider this. Public health and legal interventions are urgently required to curb workplace violence in EDs. References:  International Labour Office/International Council of Nurses/World Health Organization/Public Services International. Framework Guidelines for Addressing Workplace Violence in the Health Sector. Geneva: International Labour Office, 2002. Nikathil, S., Olaussen, A., Symons, E., Gocentas, R., O'Reilly, G. and Mitra, B., 2017. Increasing workplace violence in an Australian adult emergency department. Emergency Medicine Australasia, 30(2), pp.181-186. Credits:This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney and, Deepa Dasgupta. Music/Sound Effects Cinematic Epic Music | Story by Alex-Productions | https://www.youtube.com/channel/UCx0_M61F81Nfb-BRXE-SeVAMusic promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License,  https://creativecommons.org/licenses/by/3.0/deed.en_US.  Eternal Sunshine by LiQWYD & Luke Bergs | https://www.liqwydmusic.com, https://www.lukebergsmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.  Medical Examination by MaxKoMusic | https://maxkomusic.com/, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.  Sound effects from https://www.free-stock-music.com.  Vacations by Mehul ShaRma | https://www.instagram.com/mehulsharma4284/, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

Theme: Christmas SpecialParticipants: Kit Rowe, Harry Hong, Caroline Tyers and Shreyas Iyer.   Discussion:Mohammad, M., Karlsson, S., Haddad, J., Cederberg, B., Jernberg, T., & Lindahl, B. et al. (2018). Christmas, national holidays, sport events, and time factors as triggers of acute myocardial infarction: SWEDEHEART observational study 1998-2013. BMJ, k4811. https://doi.org/10.1136/bmj.k4811.Ferner, R., & Aronson, J. (2020). Harms and the Xmas factor. BMJ, m4067. https://doi.org/10.1136/bmj.m4067.Presenter:Caroline Tyers. Credits:This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney and, Deepa Dasgupta. Music/Sound Effects  Arcade by Flanzen | https://soundcloud.com/flanzen, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Jingle Bells by Alexander Nakarada | https://www.serpentsoundstudios.com, Music promoted by https://www.free-stock-music.comAttribution 4.0 International (CC BY 4.0), https://creativecommons.org/licenses/by/4.0/. Sound effects from https://www.free-stock-music.com. Wakeboard by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Winter by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

Theme: Christmas SpecialParticipants: Pramod Chandru, Kit Rowe, Caroline Tyers and Shreyas Iyer.   Discussion:Snake Bites - a case from The Australiasian Medical Gazette (from the late 1800s). Presenter:Kit Rowe. Credits:This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney and, Deepa Dasgupta. Music/Sound Effects We Wish You A Merry Christmas by Alexander Nakarada | https://www.serpentsoundstudios.com, Music promoted by https://www.free-stock-music.com, Attribution 4.0 International (CC BY 4.0), https://creativecommons.org/licenses/by/4.0/.  Sound effects from https://www.free-stock-music.com. Time by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Time by Mike Leite | https://soundcloud.com/mikeleite, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

Theme: Christmas SpecialParticipants: Harry Hong, Kit Rowe, Caroline Tyers and Shreyas Iyer.   Discussion:Brookfield, C., Phillips, P., & Shorten, R. (2019). Q fever—the superstition of avoiding the word “quiet” as a coping mechanism: randomised controlled non-inferiority trial. BMJ, l6446. https://doi.org/10.1136/bmj.l6446.Presenter:Harry Hong - ED trainee at Westmead Hospital. Credits:This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney and, Deepa Dasgupta. Music/Sound Effects Christmas Is Coming by MaxKoMusic | https://maxkomusic.com/, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Sound effects from https://www.free-stock-music.com. Winter by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

Theme: Pulmonary Embolism.Participants: Dr Bristi Roy (respiratory physician), Dr Vanessa Wong (respiratory advanced trainee), Dr Arwen Morath (emergency physician), Dr Pramod Chandru, Kit Rowe, and Caroline Tyers.   Discussion:van der Pol, L., Tromeur, C., Bistervels, I., Ni Ainle, F., van Bemmel, T., & Bertoletti, L. et al. (2019). Pregnancy-Adapted YEARS Algorithm for Diagnosis of Suspected Pulmonary Embolism. New England Journal Of Medicine, 380(12), 1139-1149. https://doi.org/10.1056/nejmoa1813865.Presenter: Dr Vanessa Wong (respiratory advanced trainee at Westmead Hospital). Summary: PE is a leading cause of maternal death in pregnant women.  However, the radiation exposure to both mother and foetus involved in the diagnosis of PE remains a complex issue.  This is a multi-centre prospective study that utilised the YEARS algorithm (published several years prior) and a D-dimer to predict PE in pregnant women presenting with suspected PE.  The study was conducted over a 5-year period from October 2013 to May 2019.  It looked at pregnant women over the age of 18 years that had been referred to ED or the obstetric ward with concerns for potential PE.   The YEARS algorithm focuses on the 3 elements of the Well’s criteria considered to be the highest yield (being clinical signs of DVT, haemoptysis, and PE as the most likely diagnosis).   As part of the algorithm, those patients with clinical signs of DVT underwent a doppler US and were commenced on anticoagulation (and presumed to have a PE) if this was positive for DVT.   PE was excluded in those patients without any of the YEARS criteria and with a D-dimer less than 1.0.   PE was also excluded in those who had 1-3 of the YEARS criteria and a D-dimer < 0.5, while those with 1-3 of the YEARS criteria and a D-dimer > 0.5 went on to have a CTPA to look for PE.  The primary outcome was the cumulative incidence of symptomatic VTE on objective testing during a 3 month follow-up period.   The secondary outcome was the proportion of patients in whom CTPA was not indicated to safely exclude PE.   There were 510 pregnant women recruited into the study (46% of whom were in the third trimester of pregnancy) with 12 being excluded   Of the 498 patients included, 4 had signs and symptoms of DVT with a positive doppler ultrasound.  20 patients of the remaining 494 were diagnosed with PE as part of the pathway.  During follow-up, one popliteal DVT was diagnosed, and no patient had PE.  CTPA was avoided in 195 patients (39%).   Take-Home Points: This provides a framework for assessing patients, particularly in the first and second trimesters of pregnancy (and may aid in safely excluding PE without CTPA for low-risk patients).  However, in high-risk patients, pursuing a scan remains the most appropriate approach.   References: van der Hulle T, Cheung WY, Kooij S, et al. Simplified diagnostic management of suspected pulmonary embolism (the YEARS study): a prospective, multicentre, cohort study. Lancet 2017;390:289-297. Credits:This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney and, Deepa Dasgupta. Music/Sound Effects Dusk by MusicbyAden | https://soundcloud.com/musicbyaden, Music promoted by https://www.free-stock-music.comCreative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. It’s Time by Jay Someday | https://soundcloud.com/jaysomeday, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Magic by Savfk | https://www.youtube.com/savfkmusic, Music promoted by https://www.free-stock-music.com, Attribution 4.0 International (CC BY 4.0), https://creativecommons.org/licenses/by/4.0/. My Old East Coast by Vendredi feat. Melanie | https://soundcloud.com/vendrediduo, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Nightswim by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Sound effects from https://www.free-stock-music.com. Tropical Fever by LiQWYD & Luke Bergs | https://www.liqwydmusic.com, https://soundcloud.com/bergscloud, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

Theme: Pulmonary Embolism.Participants: Dr Jimmy Chien (senior respiratory physician), Dr Kevin Lai (senior emergency physician), Dr Arwen Morath (emergency physician), Dr Pramod Chandru, Harry Hong, Kit Rowe, and Caroline Tyers.   Discussion:The Use of PE Response Teams (PERT) in the Care of High-Risk Pulmonary Embolism   This is a discussion with senior respiratory physician Dr Jimmy Chien who helped to develop the PERT system at Westmead Hospital.  Within this segment, “Venoarterial Extracorporeal Membrane Oxygenation in Massive Pulmonary Embolism-Related Cardiac Arrest: A Systematic Review” by Scott et al, is also discussed.  The graphs included in this study are examined closely, so we would recommend reviewing this article while listening to this segment.   Summary: The first place to establish a PE response team was in Massachusetts.   It took 2 years to form the PE response team at Westmead Hospital (involving a respiratory physician, an ED physician, an intensivist, an interventional radiologist, a vascular surgeon, and a haematologist).  We call a PERT call for patients who have high or intermediate-risk PE.   High-risk PE entails a patient with haemodynamic instability (in whom mortality lies between 25-50%).  Within the intermediate group, there are two subdivisions: intermediate high-risk (with radiological signs of RV strain with an increase in troponin or pro-BNP) and intermediate low-risk (with either evidence of RV strain OR a troponin rise, or a PE-severity index score class III-IV).   When looking within the high-risk PE group, the age group with the worst outcomes (both in PE and with thrombolysis) was those aged > 65 years.   The study exploring VA-ECMO in patients with high-risk PE and cardiac arrest (detailed above) also demonstrated that survival rates below the age of 65 years were relatively high, while those over the age of 65 years had a significantly higher mortality rate.  The Westmead PERT team has data on 52 patients thus far; of whom 21% were high-risk, 58% were intermediate high-risk and 21% were intermediate low-risk.  The most recent analysis of mortality for the Westmead PERT team high-risk PE patients demonstrated a mortality rate of only 10% (compared with the previously stated 25-50%).   Take-Home Points: In addition, the length of stay for these patients managed by the PERT team has been reduced from 13 days pre-PERT to around 8.5 days.   The PERT team facilitates high-level nuanced conversations dependent on the clinical judgment, experience, and knowledge of the specialists involved.  The development of this PERT team has resulted in improved outcomes for PE patients, and more streamlined care for these patients while in the emergency department and on the ward.   References:  Scott, J., Gordon, M., Vender, R., Pettigrew, S., Desai, P., Marchetti, N., Mamary, A., Panaro, J., Cohen, G., Bashir, R., Lakhter, V., Roth, S., Zhao, H., Toyoda, Y., Criner, G., Moores, L. and Rali, P., 2021. Venoarterial Extracorporeal Membrane Oxygenation in Massive Pulmonary Embolism-Related Cardiac Arrest: A Systematic Review*. Critical Care Medicine, 49(5), pp.760-769.  Piazza, G., Hohlfelder, B., Jaff, M., Ouriel, K., Engelhardt, T., Sterling, K., Jones, N., Gurley, J., Bhatheja, R., Kennedy, R., Goswami, N., Natarajan, K., Rundback, J., Sadiq, I., Liu, S., Bhalla, N., Raja, M., Weinstock, B., Cynamon, J., Elmasri, F., Garcia, M., Kumar, M., Ayerdi, J., Soukas, P., Kuo, W., Liu, P. and Goldhaber, S., 2015. A Prospective, Single-Arm, Multicenter Trial of Ultrasound-Facilitated, Catheter-Directed, Low-Dose Fibrinolysis for Acute Massive and Submassive Pulmonary Embolism. JACC: Cardiovascular Interventions, 8(10), pp.1382-1392.  Herzallah, K., Saleh, Y., Elkinany, S., Abdelkarim, O., Abdelnabi, M. and Almaghraby, A., 2020. Saddle pulmonary embolism successfully managed by thrombus aspiration followed by ultrasound-enhanced catheter-directed thrombolysis. Journal of the American College of Cardiology, 75(11), p.2445.  Credits:This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney and, Deepa Dasgupta. Music/Sound Effects Be Myself by Nettson | https://soundcloud.com/nettson, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Chile by ASHUTOSH | https://soundcloud.com/grandakt, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Happier by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Memories by Roa Music | https://soundcloud.com/roa_music1031, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Sound effects from https://www.free-stock-music.com. Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

Theme: Pulmonary Embolism.Participants:  Dr Kevin Lai (senior emergency physician), Dr Arwen Morath (emergency physician), Dr Pramod Chandru, Naveendran Rajendran, Harry Hong, Samoda Wilegoda Mudalige, Kit Rowe and Caroline Tyers.   Discussion:Robert-Ebadi, H., Robin, P., Hugli, O., Verschuren, F., Trinh-Duc, A., & Roy, P. et al. (2021). Impact of the Age-Adjusted D-Dimer Cutoff to Exclude Pulmonary Embolism. Circulation, 143(18), 1828-1830. https://doi.org/10.1161/circulationaha.120.052780. Presenter: Naveendran Rajendran - ED Resident at Westmead Hospital. Summary: This was a multinational, prospective, diagnostic outcome study designed to determine the impact of the use of age-adjusted D-dimer on clinical practice in the outpatient setting.   This study follows on from the ADJUST-PE study released in 2014, which established the safety of using an age-adjusted D-dimer cut-off retrospectively.   The primary outcome was the incidence of symptomatic thromboembolic events in the period following which a PE had been excluded in a patient based on a negative D-dimer (with the age-adjusted cut-off), and a low pre-test probability.  The secondary outcome looked at the number of D-dimer results which sat between the conventional cut-off of 0.5 and the age-adjusted value in the whole cohort, as well as more specifically in those aged over 75 years (to determine the diagnostic yield of the age-adjusted cut-off).   Of the 1421 patients with a low pre-test probability for PE and a D-dimer below 0.5, only 1 was found to have a non-fatal PE.  The proportion of patients with D-dimers that fell between the conventional cut-off of 0.5 and the age-adjusted cut-off was 301 of 1507 patients, with 0 identified thromboembolic events noted during follow-up.   This translates to a 20% increase in the number of negative D-dimer tests using the age-adjusted cut-off, with an even more pronounced increase of 67% in the group of patients over the age of 75.   Take-Home Points: The age-adjusted D-dimer is a potential tool to assist with risk-stratifying patients presenting with possible PE.  Previous concerns regarding various assays may have limited the implementation of an age-adjusted D-dimer in prior years.  Further audits to quantify the impact of utilizing the age-adjusted D-dimer (with regards to imaging, treatment, costs, etc.) are required.   References: Righini M, Van Es J, Den Exter P. Age-Adjusted D-Dimer Cutoff Levels to Rule Out Pulmonary Embolism: The ADJUST-PE Study. Journal of Vascular Surgery. 2014;59(5):1469.Credits:This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney and, Deepa Dasgupta. Music/Sound Effects Got My Love by LiQWYD & Markvard | https://www.liqwydmusic.com, https://soundcloud.com/markvard, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Medical Examination by MaxKoMusic | https://maxkomusic.com/, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.  Shine by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Sound effects from https://www.free-stock-music.com. Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

Theme: General SurgeryParticipants: Dr Michael Haddock (ED consultant), Dr Sergei Tsakanov (general surgical Fellow), Sunny Rajput (ED trainee), Edgardo Solis (general surgical registrar), Shreyas Iyer, Samoda Wilegoda Mudalige, Kit Rowe, Caroline Tyers, Harry Hong and Yelise Foon. Discussion:A Randomized Trial Comparing Antibiotics with Appendectomy for Appendicitis. The CODA Collaborative. (2020), 383(20), 1907-1919. https://doi.org/10.1056/nejmoa2014320.Summary: This study was undertaken in the United States towards the end of their initial COVID-19 wave.   The results were reported at 90-days, however, they still have analysis intended for the first 2 years (so it is an ongoing study).    It looked at patients 18 years or older, with image-confirmed acute appendicitis in emergency departments across 25 centers in the United States.    Septic, diffusely peritonitic, complicated, or recurrent appendicitis patients were excluded.   The study compared antibiotics (with IV antibiotics for at least the first 24 hours, followed by oral antibiotics to complete a total 10-day course) with appendectomy.   The primary outcome was a ‘general health survey’ which was conducted at the 24 hours, 1-, 2-, and 4-weeks, and 3-, 6- and 12 months following discharge.   The secondary outcomes included resolution of symptoms, adverse events, complications (including abscess formation, C.diff infection, the requirement of a more extensive operation, perforation, and neoplasm rates), ED presentations related to appendicitis, length of stay in hospital, and days of missed work (for patients and caregivers).   The results of this study found that antibiotics were non-inferior to appendectomy at 30-days according to the ‘general health survey’.   However, representation to the emergency department was significantly higher for those treated with antibiotics (9% compared with 4% for appendectomy patients), as were adverse events.   It is important to note that the presence of an appendicolith is an indicator for complicated appendicitis (carrying the risk of ischemia and subsequent appendiceal perforation) and an increased likelihood of failed management with IV antibiotics alone- however, such patients were included in this study.   Take-Home Points: Acute uncomplicated appendicitis may be considered for treatment with IV antibiotics alone, although an appendicolith would still exclude a patient from this at this stage in most cases.   10% of patients treated with IV antibiotics alone will fail in the initial treatment phase and may represent to the emergency department during their antibiotic course.   Thus, the emergency department may start to see a new cohort of patients; rather than ‘post-operative complications’, we may start to see ‘post-non-operative complications’ (such as recurrence, intra-abdominal abscess, or those from antibiotics themselves).   7/10 of patients will be able to avoid an operation with antibiotics in acute uncomplicated appendicitis.  However, long-term data (over the course of more than 5 years) is still required to characterize this issue further.   Credits:This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney and, Deepa Dasgupta. Music/Sound Effects Sound effects from https://www.free-stock-music.com. Heart Of The Wicked by Cjbeards | https://soundcloud.com/cjbeards, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Nightswim by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Sweet by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. You by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. You’re Welcome by RYYZN | https://soundcloud.com/ryyzn, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

Theme: General SurgeryParticipants: Dr Michael Haddock (ED consultant), Dr Sergei Tsakanov (general surgical Fellow), Sunny Rajput (ED trainee), Edgardo Solis (general surgical registrar), Andy Chen (general surgical registrar), Shreyas Iyer, Samoda Wilegoda Mudalige, Kit Rowe, Caroline Tyers, Harry Hong and Yelise Foon. Discussion:Nepogodiev, D., Bhangu, A., Glasbey, J., Li, E., Omar, O., & Simoes, J. et al. (2020). Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study. The Lancet, 396(10243), 27-38. https://doi.org/10.1016/s0140-6736(20)31182-x. Summary: This was a cohort study extending over 24 countries hit by the initial COVID-19 pandemic, conducted from January 1st to March 31st 2020. The aim of the study was to evaluate the effect of COVID-19 infection on post-operative recovery, with particular focus on 30-day mortality and pulmonary complication rates in patients with peri-operative COVID-19 infection. 1128 patients were included in the study, with 74% undergoing emergency surgery and 24% having elective surgery. 294 patients had a pre-operative diagnosis and 806 had a post-operative diagnosis of COVID-19.  30-day mortality for the cohort overall was 23.8%. Post-operative pulmonary complications occurred in half of the patients with peri-operative COVID-19 infection and were associated with significantly higher mortality. This can be compared with data suggesting a pre-pandemic post-operative pulmonary complication rate of only 10% and 30-day mortality of up to 3%. Even in those patients undergoing elective procedures, the mortality rate was 18.9%.  Take-Home Points: This data suggests that a diagnosis of peri-operative COVID-19 carries significant risk for higher rates of mortality and pulmonary complications.  This supports current practice within Australia where elective surgeries are not taking place.  However, as this pandemic continues to evolve and potentially becomes a part of the ‘new normal’, guidelines surrounding both emergency and elective surgery will need to be further developed and finessed. Interlude:Virtual Ward Rounds:- https://open.spotify.com/show/5K2TdBc35lh77oWJFHWOuhCredits:This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney and, Deepa Dasgupta. Music/Sound Effects Medical Examination by MaxKoMusic | https://maxkomusic.com/, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.  Memories by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  One Wish by Roa Music | https://soundcloud.com/roa_music1031, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Sound effects from https://www.free-stock-music.com. Tropical Fever by LiQWYD & Luke Bergs | https://www.liqwydmusic.com, https://soundcloud.com/bergscloud, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.  Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

Theme: General SurgeryParticipants: Dr Michael Haddock (ED consultant), Dr Sergei Tsakanov (general surgical Fellow), Edgardo Solis (general surgical registrar), Shreyas Iyer, Samoda Wilegoda Mudalige, Kit Rowe, Caroline Tyers, Harry Hong and Yelise Foon. Discussion:Jaung, R., Nisbet, S., Gosselink, M., Di Re, A., Keane, C., & Lin, A. et al. (2021). Antibiotics Do Not Reduce Length of Hospital Stay for Uncomplicated Diverticulitis in a Pragmatic Double-Blind Randomized Trial. Clinical Gastroenterology And Hepatology, 19(3), 503-510.e1. https://doi.org/10.1016/j.cgh.2020.03.049. Summary: This was the first randomized-controlled trial comparing antibiotics to no antibiotics in uncomplicated acute diverticulitis with a placebo control.   The primary outcome assessed was the length of stay in hospital, with secondary outcomes including withdrawal rates from the study, the occurrence of adverse events, readmission to hospital within 1 week and 30 days, procedural interventions, change in the serial inflammatory markers, and patient-reported pain scores at 12 and 24 hours from admission.  Exclusion criteria included meeting 2 or more of the SIRS criteria (including fever, and WCC <4 or >12), and inability to give consent or answer symptom-related questions (due to language barrier or cognitive impairment), amongst others.  The study found that placebo was not inferior to antibiotics for uncomplicated acute diverticulitis regarding hospital length of stay.   There was also no significant difference between groups with regards to adverse events and readmission to hospital within 1 week and 30 days (although the power of the study was not high enough to definitively answer these outcomes).    Take-Home Points: There may be a role for treating uncomplicated acute diverticulitis without antibiotics, although this is not the standard of practice in Australia yet.  If these patients are treated without antibiotics, there would need to be an adequate follow-up plan (to account for patients potentially deteriorating and developing a complication of diverticulitis).  This is a growing area of research; with practices varying between institutions.   References:  Chabok A, Pahlman L, Haapaniemi S, Smedh K, et al. Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. British Journal of Surgery. 2012;99(4):540-540.  Daniels L, Unlu C, de Korte N, et al. Randomised clinical trial of observational versus antibiotic treatment for a first episode of CT-proven uncomplicated acute diverticulitis. Br J Surg.2017; 104: 52-61.  Credits:This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney and, Deepa Dasgupta. Music/Sound Effects Medical Examination by MaxKoMusic | https://maxkomusic.com/, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.  Night Sky by Leonell Cassio ft. Julia Mihevc | https://soundcloud.com/leonellcassio, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.  Sound effects from https://www.free-stock-music.com. Timeless by Helkimer | https://soundcloud.com/helkimer, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  What You Want by LiQWYD & Luke Bergs | https://www.liqwydmusic.com, https://soundcloud.com/bergscloud, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

Theme: COVID-19. Participants: Dr Matthew O'Sullivan (infectious diseases specialist), Prof. Sanjay Swaminathan (immunologist), Dr George Zhou (intensivist), Ali Sayeed (ICU registrar), Dr James Tadros (ED consultant), Dr Pramod Chandru (ED consultant), Harry Hong, Samoda Wilegoda Mudalige, Shreyas Iyer, Kit Rowe, and Caroline Tyers.Discussion:Ansems, K., Grundeis, F., Dahms, K., Mikolajewska, A., Thieme, V., & Piechotta, V. et al. (2021). Remdesivir for the treatment of COVID-19. Cochrane Database Of Systematic Reviews, 2021(8). https://doi.org/10.1002/14651858.cd014962.Presenter - Ali Sayeed, ICU Registrar at Westmead Hospital.Summary: Remdesivir is a small molecule pro-drug that inhibits viral replication via its inhibition of RNA polymerase - In Australia, it has been provisionally approved by the TGA for its use in COVID-19.  The theory behind using Remdesivir is really in the early stages of COVID-19 pneumonitis (by reducing the viral load and thereby preventing the augmentation of the inflammatory response).  This was a systematic review with included meta-analyses looking at the use of Remdesivir in COVID-19 compared with placebo or standard care.  It included only randomised control trials, with the primary outcomes being all-cause mortality, changes in clinical status (such as time to liberation from mechanical intervention) and adverse events.  The 5 studies analysed for this review were: the Beigel study (ACTT-1 trial) which enrolled 1,000 patients, the Spinner trial which had 600 patients, the Wang trial with 230 patients, the Mahajan trial with 82 patients, and the WHO Solidarity trial with over 5,000 patients.  Remdesivir was found to have little to no impact on all-cause mortality at 28 days.  The duration to liberation from non-invasive and invasive mechanical ventilation was found to be 17 days in the Remdesivir group compared with 20 days in the control group in the Beigel study, and 7 days in the Remdesivir group compared with 15 days in the control group in the Wang study, although neither of these results were statistically significant.  The Beigel study demonstrated a difference in time to recovery in the Remdesivir group compared with the placebo group, with a median difference of 5 days (however it is unclear whether this result was statistically significant).  The significant heterogeneity in study protocols, methodology, subgroups and settings made it very difficult to compare these studies statistically.   Take-Home Points: Remdesivir likely has very limited or no effect on hard outcomes in COVID-19 (in particular on mortality).  The benefit of Remdesivir is not constant across disease severities; if there is a benefit it is likely to be a subset of patients (which appears to be those on low-flow oxygen).   It does not appear to affect hospital length of stay (there is not sufficient evidence to suggest it does).  All outcomes were based on low certainty evidence, and it is unlikely that there will be further evidence on Remdesivir alone to come, as most patients will be receiving combination therapy in ongoing studies.   Of all the treatment modalities that we have for COVID-19, Remdesivir appears to be the one that has the least impact, but it was the one that was available first, and has very few side effects.   At present in NSW, COVID-19 patients requiring oxygen are being treated with a combination of Dexamethasone, Remdesivir and Baracitinib (or Tocilizumab).  References:  Beigel JH, Tomashek KM, Dodd LE, Mehta AK, Zingman BS, Kalil AC, et al. Remdesivir for the treatment of COVID-19 – final report. New England Journal of Medicine 2020;383:1813-26.[DOI: 10.1056/NEJMoa2007764].  Spinner CD, Gottlieb RL, Criner GJ, Arribas Lopez JR, Cattelan AM, Soriano Viladomiu A, et al. Effect of remdesivirvs standard care on clinical status at 11 days in patientswith moderate COVID-19: a randomised clinical trial. JAMA2020;324(11):1048-57. [DOI: 10.1001/jama.2020.16349] [PMID:32821939].  Wang Y, Zhang D, Du G, Du R, Zhao J, Jin Y, et al. Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial. The Lancet2020;395(10236):1569-78. [CLINICALTRIALS.GOV: NCT04257656][DOI: 10.1016/s0140-6736(20)31022-9].  Mahajan L, Singh AP, GiSy. Clinical outcomes of using Remdesivir in patients with moderate to severe COVID-19: a prospective randomised study. Indian Journal of Anaesthesia2021;65:41-6. [DOI: 10.4103/ija.IJA_149_21].  WHO Solidarity Trial Consortium. Repurposed antiviral drugs for COVID-19 - interim WHO solidarity trial results. New England Journal of Medicine 2021;384(8):497-511. [CLINICALTRIALS.GOV:NCT04315948] [DOI: 10.1056/NEJMoa2023184] [EUCTR:EUCTR2020-001366-11] [ISRCTN: ISRCTN83971151].  Living Guidelines [Internet]. Caring for people with COVID-19. 2021 [cited 16 September 2021]. Available from: https://covid19evidence.net.au/#living-guidelines.  The RECOVERY Collaborative Group. Dexamethasone in Hospitalized Patients with Covid-19. New England Journal of Medicine [Internet]. 2021 [cited 16 September 2021];384(8):693-704. Available from: https://www.nejm.org/doi/full/10.1056/NEJMoa2021436.   Kalil AC, Patterson TF, Mehta AK, Tomashek KM, et al. Baricitinib plus Remdesivir for Hospitalized Adults with COVID-19. N Engl J Med 2021; 384:795-807.  Gupta A, Gonzalez-Rojas Y, Juarez E, Crespo Casal M, Moya J, Falci DR, Sarkis E, Solis J, Zheng H, Scott N, Cathcart AL, Hebner CM, Sager J, Mogalian E, Tipple C, Peppercorn A, Alexander E, Pang PS, Free A, Brinson C, Aldinger M, Shapiro AE. Early COVID-19 Treatment with SARS-CoV-2 Neutralizing Antibody Sotrovimab [Internet]. medRxiv; May 2021 [cited 16 September 2021]. Available from: https://www.medrxiv.org/content/10.1101/2021.05.27.21257096v1.   Tomazini B, Maia I, Cavalcanti A, Berwanger O, Rosa R, Veiga V et al. Effect of Dexamethasone on Days Alive and Ventilator-Free in Patients With Moderate or Severe Acute Respiratory Distress Syndrome and COVID-19. JAMA [Internet]. 2020 [cited 16 September 2021];324(13):1307. Available from: https://jamanetwork.com/journals/jama/fullarticle/2770277.  Hasan MJ, Rabbani R, Anam AM, Huq SMR, Polash MMI, Nessa SST, Bachar SC. Impact of high dose Baracitinib in severe COVID-19 pneumonia: a prospective cohort study in Bangladesh. BMC Infect Dis. May 2021; 21(1): 427. Available from: https://pubmed.ncbi.nlm.nih.gov/33962573/.  Kit's Corner Signbank [Internet]. Auslan.org.au. 2021 [cited 01 October 2021]. Available from: https://www.auslan.org.au/dictionary/words/COVID-19-1.html. Credits:This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney and, Deepa Dasgupta. Music/Sound Effects Angel by Ikson | https://youtube.com/ikson, Music promoted by https://www.free-stock-music.com. Blue Sweater by RYYZN | https://soundcloud.com/ryyzn, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Nightswim by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Misfits (Instrumental) by RYYZN | https://soundcloud.com/ryyzn, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Sound effects from https://www.free-stock-music.com. Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

Theme: COVID-19. Participants: Dr Nicole Gilroy (infectious diseases specialist), Prof. Sanjay Swaminathan (immunologist), Dr Caroline Bahn (infectious diseases advanced trainee), Dr Joanna Koryzna (ED consultant), Dr James Tadros (ED consultant), Dr Pramod Chandru (ED consultant), Harry Hong, Samoda Wilegoda Mudalige, Shreyas Iyer, Kit Rowe, and Caroline Tyers. Discussion:Sharifian-Dorche, M., Bahmanyar, M., Sharifian-Dorche, A., Mohammadi, P., Nomovi, M., & Mowla, A. (2021). Vaccine-induced immune thrombotic thrombocytopenia and cerebral venous sinus thrombosis post COVID-19 vaccination; a systematic review. Journal Of The Neurological Sciences, 428, 117607. https://doi.org/10.1016/j.jns.2021.117607.Presenter - Vincent Tsui, ED Trainee at Westmead Hospital.Summary: According to the European Medicine Agency's Pharmacovigilance Risk Assessment Committee, 169 cases of central venous sinus thrombosis and 53 cases of splanchnic vein thrombosis were reported from 34 million people who had received the AstraZeneca COVID-19 vaccine.  This systematic review examines published cases of vaccine-induced thrombotic thrombocytopaenia and central venous sinus thrombosis following the Astra Zeneca, Johnson & Johnson, and Janssen COVID-19 vaccines, to comment on the incidence, symptoms, investigations, treatment, and complications.  Only English papers were included in their review.  12 papers on Astra Zeneca vaccination and 2 papers on the Johnson and Johnson vaccine were included, out of the 877 articles identified in their search.   The most common symptom of CVST was headache (and there was no characteristic development or distribution of the headache).  In their case series, there were 54 cases of CVST, with 36 of these being women.   Most patients had their symptom onset within one week following the first vaccination (with a range from 4-19 days following vaccination). Most patients with CVST had a platelet abnormality, with all patients having a positive D-dimer and platelet factor IV immunoglobulin.   The recommended treatment for these patients is anticoagulation, and avoidance of administration platelets (in addition to IVIG and/or plasmapheresis).    Take-Home Points: This is a very rare disease even in presence of COVID-19 vaccines.  It is also a very difficult disease to diagnose, although early recognition is critical with regard to morbidity and mortality.   The ACEM guide and local health district pathways for diagnosing VITT reflect the findings of this systematic review.   The public response to the information surrounding VITT and the resultant vaccine hesitancy reflects the changing nature of health information and consent in modern medicine.  References:Burnet.edu.au. 2021. Initial modelling projections for second epidemic wave in Sydney, NSW | Burnet Institute. [online] Available at: https://www.burnet.edu.au/news/1506_initial_modelling_projections_for_second_epidemic_wave_in_sydney_nsw.Interlude Segment:Presenter - Prof. Sanjay Swaminathan. Credits:This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney and, Deepa Dasgupta. Music/Sound Effects Island by extenz | https://soundcloud.com/extenz, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Overcome by Jay Someday | https://soundcloud.com/jaysomeday, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en.  Sound effects from https://www.free-stock-music.com. Summer Chill Reggaeton | ISLAND by Alex-Productions | https://www.youtube.com/channel/UCx0_M61F81Nfb-BRXE-SeVAMusic promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Waterfall by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

Theme: COVID-19. Participants: Dr George Zhou (intensivist), Dr James Tadros (ED consultant), Dr Pramod Chandru (ED consultant), Dr Nicole Gilroy (infectious diseases specialist), Prof. Sanjay Swaminathan (immunologist), Harry Hong, Samoda Wilegoda Mudalige, Shreyas Iyer, Kit Rowe, and Caroline Tyers.  Discussion:Rosén, J., von Oelreich, E., Fors, D., Jonsson Fagerlund, M., Taxbro, K., & Skorup, P. et al. (2021). Awake prone positioning in patients with hypoxemic respiratory failure due to COVID-19: the PROFLO multicenter randomized clinical trial. Critical Care, 25(1). https://doi.org/10.1186/s13054-021-03602-9. Presenter - Caroline Tyers, ED Trainee at Westmead Hospital.Summary: This was a prospective, multicentre, open-label, parallel-arm, randomized clinical superiority trial conducted in Sweden between October 2020 and February 2021, which examined the impact of awake prone positioning on the rates of endotracheal intubation in COVID-19 patients with hypoxaemic respiratory failure.   Interim analysis of 75 patients revealed a 33% rate of intubation in both the prone and control groups, with no significant differences in secondary outcomes either.   The study was consequently terminated early due to an assessment of futility.   However, the small sample size of patients in this study limited the statistical power of this study.  In addition, the use of prone positioning in the control group, as well as the prone group, may have also attenuated the differences in outcomes between the two groups.   This likely reflects the standard of practice that has been established for patients with hypoxaemic respiratory failure where prone positioning can be used as a rescue technique to improve oxygenation (see landmark PROSEVA trial, 2013).  Evidence for awake prone positioning can be found in a recently published meta-trial (published in The Lancet in August 2021) which demonstrated a decrease in intubation or mortality of 5% in the prone group.    Take-Home Points: There is some limited evidence for awake prone positioning in COVID-19 patients with hypoxaemic respiratory failure, in reducing rates of intubation and mortality.   Given that awake-prone positioning is relatively easy to implement, with minimal associated risks, it has thus become a standard of care in treating COVID-19 patients with hypoxaemic respiratory failure.    Practically, however, awake prone positioning can be uncomfortable for patients, and difficult to implement; particularly in an emergency department where there may be limited pillows, varying patient body habitus, as well as limited medical staff, time, and difficulty providing continuous patient observation.  Interlude Segment:Presenter - Dr George Zhou. Credits:This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney and, Deepa Dasgupta. Music/Sound Effects Crescendo by Alexander Nakarada | https://www.serpentsoundstudios.com, Music promoted by https://www.free-stock-music.com,Attribution 4.0 International (CC BY 4.0), https://creativecommons.org/licenses/by/4.0/. Imagine by Helkimer | https://soundcloud.com/helkimer, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Medical Examination by MaxKoMusic | https://maxkomusic.com/, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.  Sound effects from https://www.free-stock-music.com. You & Me by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en. Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

Theme: Emergency Medicine Participants: Yelise Foon, Harry Hong, Dr Pramod Chandru, Shreyas Iyer, Caroline Tyers, Kit Rowe, and Samoda Wilegoda.Discussion 1:Morley, C., Unwin, M., Peterson, G., Stankovich, J., & Kinsman, L. (2018). Emergency department crowding: A systematic review of causes, consequences and solutions. PLOS ONE, 13(8), e0203316. https://doi.org/10.1371/journal.pone.0203316Presenter - Kit Rowe, ED Trainee at Westmead Hospital. Summary: This is a systematic review from 2018 involving 102 studies.  47% of these studies were from the US, with 18% from Australia and 9% from Canada. 14 studies investigated causes, while 52 studies looked at potential solutions to emergency department  (ED) crowding, and 40 studies examined the consequences of ED crowding.  The findings were divided into consequences (regarding the patient, staff, and system-level effects), causes, and solutions (both with reference to input into ED, throughput within ED, and output out of ED).  This study highlights a notable paucity of research into the causes of ED crowding.  It also demonstrates that the nature of ED crowding is multi-faceted. Take-Home Points: This is a complex issue that needs a system-wide approach but that also needs to focus on the fact that every system is different, every patient is different, and every patient is different within every system. We really need to look at the causes; there is a real paucity in research of what actually drives overcrowding in ED.   Discussion 2:Brown, S., Ball, E., Perrin, K., Asha, S., Braithwaite, I., & Egerton-Warburton, D. et al. (2020). Conservative versus Interventional Treatment for Spontaneous Pneumothorax. New England Journal Of Medicine, 382(5), 405-415. https://doi.org/10.1056/nejmoa1910775Presenter - Harry Hong - ED senior resident medical officer, at Westmead Hospital.Summary: This is a multicentre prospective randomized open label non-inferiority trial that compared the insertion of a chest tube with conservative management for first-time primary spontaneous moderate to large pneumothorax in patients from 14 to 50 years of age. The primary measured outcome was complete lung re-expansion radiologically at 8 weeks.  A 90% success rate in the conservative group at 8 weeks was determined as the acceptable non-inferiority threshold (compared with the 99% success rate of intervention). 25 out of the 162 patients allocated to the conservative group required intervention, while 10 out of the 154 allocated to the intervention group declined treatment. 98.5% in the intervention group had resolution within 8 weeks as compared with 94.4% in the conservative management group, and thus conservative management was deemed non-inferior to intervention. Conservative management spared 85% of patients from an invasive intervention and resulted in fewer hospitalization days, a lower likelihood of prolonged chest tube drainage, less need for surgery, and fewer adverse events than interventional management (and the percentage of recurrent pneumothorax was also lower in the conservative management group). Exclusion criteria included previous primary spontaneous pneumothorax on the same side, secondary or bilateral pneumothorax, coexistent haemothorax, tension pneumothorax, pregnancy, social circumstances preventing safe discharge or planned air travel within 12 weeks. Take-Home Points:There is evidence to suggest conservative management is not any worse in treating a primary spontaneous pneumothorax in this subset of patients; you may not need to rush into interventions if the patient is stable.Discussion 3:Perry, J., Sivilotti, M., Émond, M., Hohl, C., Khan, M., & Lesiuk, H. et al. (2020). Prospective Implementation of the Ottawa Subarachnoid Hemorrhage Rule and 6-Hour Computed Tomography Rule. Stroke, 51(2), 424-430. https://doi.org/10.1161/strokeaha.119.026969.Presenter - Caroline Tyers - ED Trainee at Westmead Hospital. Summary: This implementation study is a follow-on from several other studies published by Perry et al. from 2010 onwards which first established the Ottawa Subarachnoid Haemorrhage Rule and the 6-Hour CT rule. It was a prospective, multicentre before-after controlled study to determine the impact of the Ottawa SAH and 6-hour-CT rule on clinical practice. It involved 2 consecutive study periods: a control period from 2010 to 2013 and an intervention period between 2013 and 2016 in which the tools were implemented.  3672 patients with acute headache were enrolled; with 1743 in the control phase and 1929 in the intervention phase.  These patients had to be > 16 years old, have a GCS 15, and be presenting with a headache that had reached maximal intensity within 1 hour, with onset in the prior 14 days. The sensitivity of the 6-hour-CT rule was 95.5% for SAH, with an associated 13% decrease in a subsequent lumbar puncture (LP). This study suggests that the Ottawa SAH rule and 6-hour-CT rule are ready to use and may help to decrease the use of additional investigations to exclude SAH in these patients.  Take-Home Points: Not every patient requires LP or CTA.  Although not perfect, the 6-hour-CT rule in many cases will be sufficient to justify not pursuing an LP or CTA. When ordering a CT scan for a patient, the Ottawa SAH rules may be occasionally helpful in identifying a patient that you don’t actually need to scan. Interlude Segment:Presenter - Dr Pramod Chandru.References: Kahneman, D., & Egan, P. (2011). Thinking, fast and slow. Random House Audio.Other References: Chu KH, Keijzers G, Furyk JS, et al. Applying the Ottawa subarachnoid haemorrhage rule on a cohort of emergency department patients with headache. Eur J Emerg Med. 2018;25(6):e29-e32. Dubosh NM, Bellolio MF, Rabinstein AA, Edlow JA. Sensitivity of Early Brain Computed Tomography to Exclude Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis. Stroke. 2016;47(3):750-755.  Morgenstern J. Subarachnoid Hemorrhage: What is the role of LP? - First10EM [Internet]. First10EM. 2021 [cited 20 August 2021]. Available from: https://first10em.com/subarachnoid-hemorrhage-lp/. Perry JJ, Stiell IG, Sivilotti ML, et al. High-risk clinical characteristics for subarachnoid haemorrhage in patients with acute headache: prospective cohort study. BMJ. 2010;341:c5204. Published 2010 Oct 28. Perry JJ, Stiell IG, Sivilotti ML, et al. Sensitivity of computed tomography performed within six hours of onset of headache for diagnosis of subarachnoid haemorrhage: prospective cohort study. BMJ. 2011;343:d4277. Published 2011 Jul 18. Credits:The discussions were mediated by ED consultant Dr Pramod Chandru. This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney and, Deepa Dasgupta. Music/Sound Effects Back To Me by Jay Someday | https://soundcloud.com/jaysomeday, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Birthday by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US Endless Summer by Loxbeats | https://soundcloud.com/loxbeats, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Feel Good by MBB | https://soundcloud.com/mbbofficial, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Instructions For Living A Life by Savfk | https://www.youtube.com/savfkmusic, Music promoted by https://www.free-stock-music.comAttribution 4.0 International (CC BY 4.0), https://creativecommons.org/licenses/by/4.0/. Medical Examination by MaxKoMusic | https://maxkomusic.com/, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.  Ocean by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Nightswim by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Pineapple by Roa Music | https://soundcloud.com/roa_music1031, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Sound effects from https://www.free-stock-music.com. Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

Theme: Medical Oncology. Participants: Professor Nicholas Wilcken, Sarah Rashid, Bratati Karmakar, Harry Hong, Dr Pramod Chandru, Shreyas Iyer, Caroline Tyers, and Kit Rowe. Discussion 1:Thomas, B., Lo, W., Nangati, Z., & Barclay, G. (2021). Dexmedetomidine for hyperactive delirium at the end of life: An open-label single-arm pilot study with dose escalation in adult patients admitted to an inpatient palliative care unit. Palliative Medicine, 35(4), 729-737. https://doi.org/10.1177/0269216321994440. Presenter -  Sarah Rashid, physician trainee at Westmead Hospital.  Summary: Terminal agitation and delirium are difficult to define and even harder to design studies around which to improve its management. The current treatment algorithm advises the use of neuroleptics, benzodiazepines, opiates, and barbiturates; often at the cost of wakefulness and interaction with loved ones. Dexmedetomidine can provide rousable sedation, a decreased severity of delirium, analgesia, a decrease in secretions, and potential anti-emetic effects.  The aim of this study was to describe a potential reduction in delirium and the presence of rousable sedation with dexmedetomidine in palliative care patients suffering terminal delirium, with a secondary aim to determine whether reduced opiate requirements were observed. There was a reduction in delirium (as measured by MDAS scores). Almost 50% of patients crossed over to routine care, with 27% of these due to family request for deeper sedation.  15 of the 22 patients required an increase in opiate dosing, however, there were no negative survival benefits and there was a notable reduction in the use of other PRN medications (such as, for secretions).  Ultimately, this pilot demonstrated promise for the use of dexmedetomidine in these patients (and prompts the need for further research in this area).  Take-Home Points: There is minimal evidence even behind our standard of care for these patients (midazolam, neuroleptics, and barbiturates).  This paper encourages us to think laterally about what medications can be used for these patients.  Terminal delirium is distressing for patients and their families, and at present, our treatments provide comfort but at the expense of wakefulness and interaction. More research needs to be done into agents such as dexmedetomidine which could allow for a better-sedated experience. More research also needs to be done into the experience of the dying process for patients and their families.  Families have large effects on the management of dying patients, and thus there is limited value in doing a study without measuring outcomes for both the patients and their families.  Discussion 2:Wang, D., Salem, J., Cohen, J., Chandra, S., Menzer, C., & Ye, F. et al. (2018). Fatal Toxic Effects Associated With Immune Checkpoint Inhibitors. JAMA Oncology, 4(12), 1721. https://doi.org/10.1001/jamaoncol.2018.3923.Presenter - Harry Hong - ED senior resident medical officer, at Westmead Hospital.Summary: This study looks at immune checkpoint inhibitors targeting cytotoxic T lymphocyte antigen-4 (CTLA-4) and programmed death-1/ligand-1 (PD-1/PD-L1).  There is increasing use of these agents individually and in combination for various cancers. This paper looks at multiple databases and analyzed data to characterize the rare but fatal side effects of these drugs.  613 fatal adverse effects were described: 193 associated with ipilimumab (anti-CTLA-4), 333 with anti-PD-1/PD-L1, and 87 in combination therapy (most commonly for the treatment of melanoma and lung cancer).   The type of fatal adverse events differed between the treatment groups; with ipilimumab monotherapy associated mostly with colitis (70% of adverse events) compared with anti-PD-1/PD-L1 monotherapy where adverse events were more varied (colitis, pneumonitis, hepatitis) and combination regimens where there were additionally increased rates of myocarditis and myositis.  The highest fatality rates were seen in myocarditis.  The multicentre analysis also revealed the median time to onset of disease following commencement on therapy was 40 days with monotherapy and 14.5 days for those on combination treatment.  Interestingly, the median time to steroid use for these patients was 5 days (suggested to be due to difficulty recognizing the diagnosis in these patients).  Take-Home Points: These drugs for some cancers have completely revolutionized treatment (they are not going away!).  It is important to remember that the rate of fatal adverse events with these agents is still very low (particularly when compared with other oncology treatments).  This data gives us information for what to be vigilant for when caring for these patients (particularly those presenting with non-specific symptoms and recent commencement on these agents).  Take colitis seriously; it can be fatal.  We are all learning; this is a new class of drugs with completely different toxicity to what we are used to – if in doubt ask the medical oncologist!  Discussion 3:Biganzoli, L., Mislang, A., Di Donato, S., Becheri, D., Biagioni, C., & Vitale, S. et al. (2017). Screening for Frailty in Older Patients With Early-Stage Solid Tumors: A Prospective Longitudinal Evaluation of Three Different Geriatric Tools. The Journals Of Gerontology: Series A, 72(7), 922-928. https://doi.org/10.1093/gerona/glw234.Presenter - Bratati Karmakar, physician trainee at Napean Hospital.  Summary: Frailty is a concept or syndrome which lacks a unified definition. It is broadly defined as a vulnerability to stressors such as illness or treatment, which may aid in patient prognostication.  Currently, there is no single standardized frailty assessment tool to guide our clinical practice.  The presence of frailty has been associated with increased mortality, increased frequency of hospitalizations, intolerance to treatments, and a reduction in quality of life. Data suggests that we as clinicians at the bedside are not accurate assessors of patient frailty. This study compares well-established (however cumbersome) frailty scores; the Balducci frailty criteria and the Fried frailty criteria, with the Vulnerable Elders Survey (VES-13) which may be easier to use and apply in the emergency setting (requiring only self-reported data from the patient).  The outcomes measured were functional decline (or loss of an ADL) and mortality. 17% of patients were classified as frail using the Fried frailty criteria, and 25% when looking at the Balducci criteria and the VES-13. The Fried frailty criteria and the VES-13 both showed that the probability of a functional event was higher in the frail group (with time to functional decline being 13 months in the frail and 36 months in the non-frail group using the VES-13).  Regarding mortality, all 3 tools demonstrated prognostic value for overall survival. Thus, according to this study, the VES-13 can be used to predict mortality and functional decline. However, there was poor concordance between the three tools, suggesting that no single tool can currently be utilized to establish frailty (only 9% of patients were frail in all 3 evaluations). Take-Home Points: Recognizing frailty is important and it can be conveniently assessed at the bedside with tools such as VES-13 (but standardized frailty assessment tools need to be developed).  Comorbid conditions do not indicate the presence or absence of frailty in isolation. Physical disability is not a reflection of frailty.  Whilst frailty increases with age, it is not a consequence of aging.  Shared language is important for information to be clinically relevant.  Interlude Segment:Presenter - Professor Nicholas Wilcken.Credits:The discussions were mediated by medical oncologist Professor Nicholas Wilcken and ED consultant Dr Pramod Chandru. This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney and, Deepa Dasgupta. Music/Sound Effects Cuba by ASHUTOSH | https://soundcloud.com/grandakt, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  I Feel Low by MAITTRE | https://www.youtube.com/c/maittreofficial, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Medical Examination by MaxKoMusic | https://maxkomusic.com/, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.  Mountain Trail by Vlad Gluschenko | https://soundcloud.com/vgl9, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Nightswim by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Sound effects from https://www.free-stock-music.com. Surfers Paradise by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  We’ve Got Time by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

Theme: Retrieval Medicine. Participants: Dr Ruby Hsu, Dr Ruth Parsell, Dr Pramod Chandru, Shannon Townsend, Yelise Foon, Shreyas Iyer and Samoda Wilegoda Mudalige.Discussion 1:Benoit, J., Stolz, U., McMullan, J., & Wang, H. (2021). Duration of exposure to a prehospital advanced airway and neurological outcome for out-of-hospital cardiac arrest: A retrospective cohort study. Resuscitation, 160, 59-65. https://doi.org/10.1016/j.resuscitation.2021.01.009.Presenter - Yelise Foon - ED senior resident medical officer. Summary: This study was a retrospective cohort study that looked at adult, non-traumatic OOHCA patients with an advanced airway (supraglottic or endotracheal). The timing of airway placement (intra-arrest versus post-ROSC) and patient outcomes (with respect to the cerebral performance category, or CPC) were analyzed.  They observed a higher CPC in the group that had the advanced airway placed post-ROSC (i.e. 21.7% in post-arrest group versus 7.5% in intra-arrest group). They concluded that the timing of the airway placement was not associated with poor neurological outcomes.  Discussion 2:Aziz, S., Foster, E., Lockey, D., & Christian, M. (2021). Emergency scalpel cricothyroidotomy use in a prehospital trauma service: a 20-year review. Emergency Medicine Journal, 38(5), 349-354. https://doi.org/10.1136/emermed-2020-210305.Presenter - Shannon Townsend, ED advanced trainee at Orange Health Service.Summary & Take-Home Points: This was a retrospective observational study conducted from 2000 to 2019 using clinical records and aimed to (1) ascertain the rate of scalpel cricothyroidotomy and (2) understand indications for and factors associated with this procedure. They observed that the main indication for scalpel cricothyroidotomy was as a rescue airway (for failed laryngoscopy due to a large volume of blood in the airway). They noted high levels of procedural success, but the overall mortality in patients receiving this procedure was high (due to a number of factors).  The rate of scalpel cricothyroidotomy has decreased over the years due to factors such as the introduction of supraglottic airways and longer-acting muscle relaxants (rocuronium versus suxamethonium).  It is important to remember that, if we optimize our intubation conditions (e.g. improving patient position, carefully choosing drugs and equipment according to patient's clinical situation), we are likely to increase our first pass success with laryngoscopy.  It is important to (1) recognize the indications for scalpel cricothyroidotomy, (2) be familiar with the procedure itself, (3) overcome the mental barriers against performing it, and (4) perform it confidently and competently. Discussion 3:Sperry, J., Guyette, F., Brown, J., Yazer, M., Triulzi, D., & Early-Young, B. et al. (2018). Prehospital Plasma during Air Medical Transport in Trauma Patients at Risk for Hemorrhagic Shock. New England Journal Of Medicine, 379(4), 315-326. https://doi.org/10.1056/nejmoa1802345.Presenter - Dr Ruth Parsell. Summary: In this pragmatic, multi-center, cluster-randomized, phase 3 superiority trial, the efficacy of administering thawed plasma to patients at risk of haemorrhagic shock was studied.  The comparative arm was standard-care resuscitation (with crystalloid fluids). The primary outcome was mortality at the 30-day mark.  They concluded that administration of thawed plasma to patients at risk of haemorrhagic shock resulted in (1) lower 30-day mortality and (2) lower median prothrombin-time ratio.  Interlude Segment 1:Presenter - Dr Ruth Parsell. Interlude Segment 2:Presenter - Dr Ruby Hsu.Credits:The discussions were mediated by retrieval specialists and ED consultants, Dr Ruby Hsu and Dr Ruth Parsell and ED consultant Dr Pramod Chandru. This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney, Deepa Dasgupta, Cynthia De Macedo Franco, and Paul Scott.Music/Sound Effects Beach Volley by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Hands High by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Lose My Mind by ASHUTOSH | https://soundcloud.com/grandakt, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Medical Examination by MaxKoMusic | https://maxkomusic.com/, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.  Nightswim by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Sol by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Sound effects from https://www.free-stock-music.com. Sunrise by Roa Music | https://soundcloud.com/roa_music1031, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. The Leap by Sapajou | https://soundcloud.com/sapajoubeats, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Thinking Of You by Ron Gelinas Chillout Lounge | https://soundcloud.com/atmospheric-music-portal, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  ~Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.

Theme: Paediatrics. Participants: Dr Surbhi Rikhi, Dr Kerf Tan, Dr Pramod Chandru, Johann De Alwis (PEM trainee) Omal Fernando (PEM trainee), Min Park (EM trainee), Shreyas Iyer, Kit Rowe, Caroline Tyers and Samoda Wilegoda Mudalige.Discussion 1:Kuppermann, N., Dayan, P., Levine, D., Vitale, M., Tzimenatos, L., & Tunik, M. et al. (2019). A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections. JAMA Pediatrics, 173(4), 342. https://doi.org/10.1001/jamapediatrics.2018.5501. Presenter - Johann De Alwis.Summary: Serious bacterial infections (SBIs); which include UTI, meningitis, and bacteraemia, lead to dangerous complications in infants. This was a prospective observational study between 2011 and 2013, looking at previously healthy febrile infants aged 60 days or younger, who were evaluated for SBIs. The clinical rule considered the urinalysis, absolute neutrophil count (ANC), and serum procalcitonin, and had a sensitivity of 97.7%, with a specificity of 60%, and a negative predictive value of 99.6%. One infant with bacteraemia and two with UTI who were misclassified.  This tool decreased the number of lumbar punctures performed, antibiotics administered, and infants admitted to the hospital.  Take-Home Points: Remember that these infants are the most at-risk population; do more rather than less. Safety net: no matter what you do or what investigations reveal, always have a safety net!  Discussion 2:Pan, P. (2020). Validation of the Testicular Workup for Ischemia and Suspected Torsion (TWIST) Score in the Diagnosis of Testicular Torsion in Children With Acute Scrotum. Indian Pediatrics, 57(10), 926-928. https://doi.org/10.1007/s13312-020-1992-6.Presenter - Omal Fernando.Summary: The TWIST score includes - testicular swelling (2), hard testicle (2), absent cremasteric reflex (1), nausea or vomiting (1), a high-riding testicle (1).  Low risk was a score of 0-2, intermediate risk was a score of 3-4 and high risk was a score 5-7. Of those with testicular torsion, the mean TWIST score was 5.7 (none in low-risk category, 13 in intermediate-risk group, and 55 in high-risk group).  Of those without testicular torsion, the mean TWIST score was 1.46 (21 in low-risk group, 7 in the intermediate-risk group, and 0 in the high-risk group). All patients with a high-riding testis or absent cremasteric reflex were found to have testicular torsion. Take-Home Points: This score reminds us what we should be looking for when assessing a patient with acute testicular pain and thus help to build clinical gestalt, however, there is not enough evidence at present to rely on this tool alone (although this may change in the years to come).  It is important to involve the urologist/general surgeon if there is any suspicion of torsion. Given the time-critical nature of this presentation, patients should be taken to the theatre (rather than further investigated with ultrasound) if testicular torsion is suspected. Discussion 3:Iramain, R., Castro‐Rodriguez, J., Jara, A., Cardozo, L., Bogado, N., Morinigo, R., & De Jesús, R. (2019). Salbutamol and ipratropium by inhaler is superior to nebulizer in children with severe acute asthma exacerbation: Randomized clinical trial. Pediatric Pulmonology, 54(4), 372-377. https://doi.org/10.1002/ppul.24244.Presenter - Min Park. Take-Home Points: 103 children between the age of 2 and 14 years with severe asthma exacerbations (pulmonary score 7) were randomly allocated to a nebulizer or metred dose inhaler (MDI) and spacer with nasal prong oxygen. The primary outcome was the rate of hospitalization with the secondary outcome being oxygen saturations at 60 and 90 minutes. Children in the MDI group had significantly improved oxygen saturation from 60 minutes compared with the nebulizer group, with significantly lower rates of admission to hospital (5.8% vs. 27.5%).  Summary: MDIs may be at least equally effective if not more effective than nebulizers. MDIs are also cheaper and provide an opportunity to educate patients regarding their use. It is important to re-assess your patients following initial treatment. There may be variability in the way you approach each patient to meet their individual needs.  Always refer to your local guidelines.  Interlude Segment 1:Presenter - Dr Surbhi Rikhi.Interlude Segment 2:Presenter - Dr Kerf Tan.Resources (to support doctor well-being) -  Applications: Shift (Black Dog Institute app for healthcare workers), Calm, Headspace, Feeling Good, Smiling Minds, Insight Timer.   JMO support line (NSW): 1300 566 321. Access EAP (free confidential service for all NSW Health employees). Doctors for doctors: www.drs4drs.com.au. Beyond Blue: 1300 224 636. Lifeline: 13 11 14.  Suicide call-back service: 1300 659 467.  Other References:“Step by step” approach to the febrile infant -  Mintegi, S., Bressan, S., Gomez, B., Da Dalt, L., Blázquez, D., & Olaciregui, I. et al. (2013). Accuracy of a sequential approach to identify young febrile infants at low risk for invasive bacterial infection. Emergency Medicine Journal, 31(e1), e19-e24. https://doi.org/10.1136/emermed-2013-202449.Original study validating the TWIST score - Barbosa, J., Tiseo, B., Barayan, G., Rosman, B., Torricelli, F., & Passerotti, C. et al. (2013). Development and Initial Validation of a Scoring System to Diagnose Testicular Torsion in Children. Journal Of Urology, 189(5), 1859-1864. https://doi.org/10.1016/j.juro.2012.10.056.Starship Hospital (NZ) study examining nebuliser vs. MDI delivery for asthma - Klassen, T. (2001). Spacers were better and less expensive than nebulisers for giving albuterol to children with moderate to severe acute asthma. Evidence-Based Medicine, 6(1), 31-31. https://doi.org/10.1136/ebm.6.1.31.Further evidence regarding female ACS presentations (as covered in our previous episode) -van Oosterhout, R., de Boer, A., Maas, A., Rutten, F., Bots, M., & Peters, S. (2020). Sex Differences in Symptom Presentation in Acute Coronary Syndromes: A Systematic Review and Meta‐analysis. Journal Of The American Heart Association, 9(9). https://doi.org/10.1161/jaha.119.014733.Sederholm Lawesson, S., Isaksson, R., Thylén, I., Ericsson, M., Ängerud, K., & Swahn, E. (2018). Gender differences in symptom presentation of ST-elevation myocardial infarction – An observational multicenter survey study. International Journal Of Cardiology, 264, 7-11. https://doi.org/10.1016/j.ijcard.2018.03.084.Credits:The discussions were mediated by PEM consultant Dr Surbhi Rikhi, ED consultant Dr Kerf Tan and, ED consultant Dr Pramod Chandru. This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney, Deepa Dasgupta, Cynthia De Macedo Franco, and Paul Scott.Music/Sound Effects Fable by Free Music | https://soundcloud.com/fm_freemusic, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Medical Examination by MaxKoMusic | https://maxkomusic.com/, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.  Moments by Sarah Jansen Music | https://soundcloud.com/sarahjansenmusic, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  New Days by Roa Music | https://soundcloud.com/roa_music1031, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Nightswim by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Sound effects from https://www.free-stock-music.com. Sunset Beach by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.   Warm Duck Shuffle by arnebhus | https://soundcloud.com/arnebhus, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. ~Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.

Theme: Women In Medicine. Participants: Dr Danielle Unwin, Amanda De Silva (ED advanced trainee) Jessica Stabler (neurology advanced trainee), Istabraq Raashed (ED advanced trainee), Harry Hong (ED SRMO), Shreyas Iyer, Caroline Tyers and Samoda Wilegoda Mudalige.Discussion 1:Stehli, J., Martin, C., Brennan, A., Dinh, D., Lefkovits, J., & Zaman, S. (2019). Sex Differences Persist in Time to Presentation, Revascularization, and Mortality in Myocardial Infarction Treated With Percutaneous Coronary Intervention. Journal Of The American Heart Association, 8(10). https://doi.org/10.1161/jaha.119.012161. Presenter - Amanda De Silva.Starting - 02:30. Take-Home Points: Women with STEMI had longer times to presentation and door to balloon times, compared with their male counterparts, with a higher rate of mortality.  Such data has been produced before, however, the underlying reason for these discrepancies is unclear. Possible reasons behind delayed presentation to the emergency department include atypical symptoms, competing priorities (with homelife, children, or careers), and sick behaviours.  This is a reminder to broaden our differentials for women with chest pain - could this be a STEMI? Remember time is myocardium: the outcomes are significantly different between men and women in the context of this delay to PCI.  This is an issue that we need to make the public and our patients more aware of.   Discussion 2:Hoffman, R., Mullan, J., Nguyen, M., & Bonney, A. (2020). Motherhood and medicine: a systematic review of the experiences of mothers who are doctors. Medical Journal Of Australia, 213(7), 329-334. https://doi.org/10.5694/mja2.50747.Presenter -Jessica Stabler.Starting - 24:55.  Three main themes raised in this review:1. Motherhood: the impact of being a doctor on raising children. Women found decisions around balancing children and career progression difficult. Women defer having children for career reasons. Decisions about career progression are likely to influence family size (most women reported having smaller families as a consequence of prioritizing career advancement or starting families later in life). 2. Medicine: the impact of being a mother on a medical career. Motivation to return to work was not lessened by motherhood. There are significant systemic barriers that women face on returning to work. 3. Combining motherhood and medicine: strategies and policies to aid women in medicine. Maternity leave policies. Access to lactation rooms and childcare, as well as flexible working options. Take-Home Points: It is important to acknowledge that medicine has a significant impact on the experience of motherhood (both in terms of the number and timing of children you have) and can contribute to the family strain.  Equally, medical careers offer financial freedom and great job satisfaction for women. Mothers are not less motivated to make career advancements, but there are very real systemic factors and prejudice that can make this challenging. There is a mental load that is associated strongly with motherhood; women do bear the greater parenting and domestic load.   Discussion 3:Ju, M., & van Schaik, S. (2019). Effect of Professional Background and Gender on Residents’ Perceptions of Leadership. Academic Medicine, 94, S42-S47. https://doi.org/10.1097/acm.0000000000002925. Presenter - Istabraq Raashed.Starting - 01:12:05.Take-Home Points: This study asked residents (in the US) to rate male and female leaders in an identically scripted video of a resuscitation, on overall performance, leadership, communication, problem-solving, situational awareness, and resource utilization skills. Women were given statistically significant lower scores in both leadership skills and communication domains. This study raises the concept of a ‘backlash effect’: where women who do not display characteristics typical of a female stereotype are at increased risk of prejudice or discrimination. It is important for everyone to check their bias in the workplace. Reflect on your interactions (good and bad) and be careful with what you take personally. Empathise with your colleagues and consider what other things may be going on in their lives  Interlude Segment:Presenter - Dr Danielle Unwin Starting - 01:05:40. Other References:Mnatzaganian, G., Hiller, J., Braitberg, G., Kingsley, M., Putland, M., & Bish, M. et al. (2019). Sex disparities in the assessment and outcomes of chest pain presentations in emergency departments. Heart, 106(2), 111-118. https://doi.org/10.1136/heartjnl-2019-315667.Credits:The discussions were mediated by ED consultant Dr Danielle Unwin.This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney, Deepa Dasgupta, Cynthia De Macedo Franco, and Paul Scott.Music/Sound Effects Coastline by Roa Music | https://soundcloud.com/roa_music1031, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Fluorescent Color by Punch Deck | https://soundcloud.com/punch-deck, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Fashion Future Bass | FASHION by Alex-Productions | https://www.youtube.com/channel/UCx0_M61F81Nfb-BRXE-SeVA, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Medical Examination by MaxKoMusic | https://maxkomusic.com/, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.  Moonlight by Roa Music | https://soundcloud.com/roa_music1031, Music promoted by https://www.free-stock-music.com,Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Nightswim by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Sound effects from https://www.free-stock-music.com. Sunset Beach by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Sweet by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  ~Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.

Theme: Bonus Episode. Participants: Dr Pramod Chandru, Kit Rowe, Shreyas Iyer, Caroline Tyers and, Samoda Wilegoda Mudalige. Discussion 1:Chandru, P., Priyambada Mitra, T., Dutt Dhanekula, N., Dennis, M., Eslick, A., Kruit, N., & Coggins, A. Out of hospital cardiac arrest in Western Sydney: an analysis of outcomes and estimation of future eCPR eligibility - not yet available online. Take-Home Points: This paper was a prospective observational study of consecutive out-of-hospital of cardiac arrests (OOHCAs) at Westmead Hospital over a 3-year period. It looked at the feasibility of setting up an ECMO service for refractory OOHCAs (i.e. for patients who have received CPR for 20 minutes or longer, between the ages of 18 and 70 years, and had a VF arrest). This study had 17 patients who would have qualified as true refractory OOHCAs (none of whom survived to hospital discharge).   This proportion of patients was similar to other studies that have been undertaken on this topic, which also demonstrated a survival to hospital discharge with good neurological recovery of around 35-40% with the use of ECMO CPR.  The 2CHEER study performed out of Melbourne is also a good reference for this subject - this was one of the first RCTs for the use of ECMO CPR in a pre-hospital setting (see reference below). Westmead Hospital will be one of the centers involved in the upcoming RESET trial looking at the implementation of ECMO CPR.   Discussion 2:Bima, P., Pivetta, E., Nazerian, P., Toyofuku, M., Gorla, R., & Bossone, E. et al. (2020). Systematic Review of Aortic Dissection Detection Risk Score Plus D‐dimer for Diagnostic Rule‐out of Suspected Acute Aortic Syndromes. Academic Emergency Medicine, 27(10), 1013-1027. https://doi.org/10.1111/acem.13969. Take-Home Points: This meta-analysis suggested a sensitivity of 97.6-99.9% for an aortic dissection risk score of 0-1 and a negative D-dimer (<0.5) or age-adjusted D-dimer in the identification of acute aortic syndromes.  However, this meta-analysis only included 4 studies, only one of which was prospective.  This may be a useful clinical tool when used in the right context, while still using our clinical gestalt (it should not be used unless you have a clinical suspicion that your patient may have an acute aortic syndrome).  On the other hand, the use of this tool also has the potential to increase the number of CT scans performed to investigate the presence of acute aortic syndromes (particularly if wrongly applied).  Lastly, remember to make sure you are only using D-dimer to work up low-risk patients.  Discussion 3:Miraglia, D., Miguel, L., & Alonso, W. (2020). Double Defibrillation for Refractory In- and Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis. The Journal Of Emergency Medicine, 59(4), 521-541. https://doi.org/10.1016/j.jemermed.2020.06.024.Take-Home Points: This systematic review of RCTs looking at double defibrillation for refractory VT and VF demonstrated no significant effect on rates of return of spontaneous circulation (apart from one study, whose rates of ROSC actually favoured the control group), survival to hospital admission or survival to discharge (all with low-grade evidence).  This is likely to be reflective of the fact that the data on double defibrillation at this stage is insufficient (rather than demonstrating that it does not work).  Double defibrillation at this stage can be viewed as a rescue measure that can be attempted in refractory cases, provided it does not distract from the rest of the resuscitation effort.  Keep your eyes peeled for the DOSE VF study which is due to be released at the end of 2022!  Other References: Dennis, M., Buscher, H., Gattas, D., Burns, B., Habig, K., Bannon, P., Patel, S., Buhr, H., Reynolds, C., Scott, S., Nair, P., Hayman, J., Granger, E., Lovett, R., Forrest, P., Coles, J., Lowe, D.A.; Sydney ECMO Research Interest Group. (2020). Prospective observational study of mechanical cardiopulmonary resuscitation, extracorporeal membrane oxygenation and early reperfusion for refractory cardiac arrest in Sydney: the 2CHEER study. Crit Care Resusc. 22(1):26-34. PMID: 32102640. Drennan, I., Dorian, P., McLeod, S., Pinto, R., Scales, D., & Turner, L. et al. (2020). DOuble SEquential External Defibrillation for Refractory Ventricular Fibrillation (DOSE VF): study protocol for a randomized controlled trial. Trials, 21(1). https://doi.org/10.1186/s13063-020-04904-z. Credits:This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney, Deepa Dasgupta, Cynthia De Macedo Franco, and Paul Scott.Sound Effects Another Time by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Sound effects from https://www.free-stock-music.com. Nightswim by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Good Feeling by Roa Music | https://soundcloud.com/roa_music1031, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Medical Examination by MaxKoMusic | https://maxkomusic.com/, Music promoted by https://www.free-stock-music.comCreative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. St. Tropez by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.   ~Thank you for listening to our bonus episode!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.comSee you next time,Caroline, Kit, Pramod, Samoda and Shreyas.

Theme: POCUS. Participants: Oliver Archer (ED resident and previous cardiac sonographer), Hung Diep (ED advanced trainee), Dr Richard McNulty, Dr Kenny Yee, Dr Pramod Chandru, Kit Rowe, Shreyas Iyer, Caroline Tyers and Samoda Wilegoda Mudalige.Discussion 1:Presenter - Oliver Archer.Starting - 02:00. Atkinson, P., Beckett, N., French, J., Banerjee, A., Fraser, J., & Lewis, D. (2019). Does Point-of-care Ultrasound Use Impact Resuscitation Length, Rates of Intervention, and Clinical Outcomes During Cardiac Arrest? A Study from the Sonography in Hypotension and Cardiac Arrest in the Emergency Department (SHoC-ED) Investigators. Cureus. https://doi.org/10.7759/cureus.4456.Take-Home Points: This study showed that visualizing cardiac activity on ultrasound resulted in increased duration and effort of resuscitation, and was associated with improved clinical outcomes.  It is difficult to know whether the improved clinical outcomes were secondary to increased resuscitation efforts or due to identification (with ultrasound) of those with a better prognosis.  Ultimately, ultrasound should be used as an adjunct to your clinical decision-making, but should not get in the way of the established standard ALS protocol.  The COACHRED protocol (referenced below) assists in incorporating POCUS into the arrest algorithm. Discussion 2:Presenter - Hung Diep.Starting - 29:10.Daley, J., Dwyer, K., Grunwald, Z., Shaw, D., Stone, M., & Schick, A. et al. (2019). Increased Sensitivity of Focused Cardiac Ultrasound for Pulmonary Embolism in Emergency Department Patients With Abnormal Vital Signs. Academic Emergency Medicine, 26(11), 1211-1220. https://doi.org/10.1111/acem.13774.Take-Home Points: This study shows that focused cardiac ultrasound (FOCUS): involving right ventricular dilation, McConnell’s sign, septal flattening, tricuspid regurgitation, and tricuspid annular plane systolic excursion (TAPSE), maybe a useful adjunct in the workup of patients with a high pre-test probability of PE. The most sensitive component of the FOCUS was TAPSE.  The most specific components of the FOCUS were McConnell’s sign and septal flattening.  However, it is important to remember that illnesses associated with chronic right heart strain such as COPD would also yield a positive FOCUS. At this stage, there is not enough evidence for FOCUS in diagnosing PE to alter clinical decision-making.  Discussion 3:Presenter - Pramod Chandru.Starting - 01:03:35.  Chartier, L., Bosco, L., Lapointe-Shaw, L., & Chenkin, J. (2016). Use of point-of-care ultrasound in long bone fractures: a systematic review and meta-analysis. CJEM, 19(2), 131-142. https://doi.org/10.1017/cem.2016.397Take-Home Points: This study looked at the use of POCUS to assist with both the diagnosis and reduction of long bone fractures (radius, ulna, humerus, tibia, fibula, and femur).  POCUS use had reasonable sensitivity and specificity in the diagnosis of fractures, particularly paediatric forearm fractures and adult ankle fractures - however, it may not provide all the information required regarding a fracture once identified.  In the absence of fluoroscopy, using POCUS to delineate the satisfactory nature of a reduction in ED (such as of the wrist) may reduce the risks associated with recurrent reductions and the need for operative fixation, however, further research with randomized controlled trials is needed. All in all, it is hard to see how ultrasound would replace x-ray as the imaging modality of choice for fractures, but there is an argument to be made for the use of ultrasound in assessing for the adequacy of reduction particularly in specific populations and this would be an interesting area for future studies.  Interlude Segment:Starting - 56:10.Ioannidis, J. (2005). Why Most Published Research Findings Are False. PLoS Medicine, 2(8), e124. https://doi.org/10.1371/journal.pmed.0020124.Other References:Finn, T., Ward, J., Wu, C., Giles, A., & Manivel, V. (2019). COACHRED: A protocol for the safe and timely incorporation of focused echocardiography into the rhythm check during cardiopulmonary resuscitation. Emergency Medicine Australasia, 31(6), 1115-1118. https://doi.org/10.1111/1742-6723.13374.Credits:The discussions were mediated by ED consultant and ultrasound guru Dr Kenny Yee, ED consultant and clinical toxicologist Dr Richard Mc Nulty, and ED consultant Dr Pramod Chandru.This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney, Deepa Dasgupta, Cynthia De Macedo Franco, and Paul Scott.Music/Sound Effects Another Time by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Cross Over by Sapajou | https://soundcloud.com/sapajoubeats, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US Esperanza by Roa Music | https://soundcloud.com/roa_music1031, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US Medical Examination by MaxKoMusic | https://maxkomusic.com/, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.  Mega Epic by Alexander Nakarada | https://www.serpentsoundstudios.com, Music promoted by https://www.free-stock-music.com, Attribution 4.0 International (CC BY 4.0), https://creativecommons.org/licenses/by/4.0/ Nightswim by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Piano Rock Instrumental by Hyde - Free Instrumentals | https://soundcloud.com/davidhydemusic, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Ragga Groove by Peyruis | https://soundcloud.com/peyruis, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Sea Current by Vlad Gluschenko | https://soundcloud.com/vgl9, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US Smile by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Sound effects from https://www.free-stock-music.com. Wasting Time by Sapajou & Yorgo H | https://soundcloud.com/sapajoubeats, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  ~Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.

Theme: Cardiology. Participants: Dr Aaisha Ferkh (cardiology fellow), Dr Samia Kazi (cardiology fellow), Dr Khanh Nguyen, Dr Pramod Chandru, Kit Rowe, Shreyas Iyer, Caroline Tyers and Samoda Wilegoda Mudalige.Discussion 1:Lemkes, J., Janssens, G., van der Hoeven, N., Jewbali, L., Dubois, E., & Meuwissen, M. et al. (2019). Coronary Angiography after Cardiac Arrest without ST-Segment Elevation. New England Journal Of Medicine, 380(15), 1397-1407. https://doi.org/10.1056/nejmoa1816897.  Take-Home Points: This study showed that in patients successfully resuscitated from out-of-hospital cardiac arrest, who did not have STEMI, immediate coronary angiography and revascularisation did not improve survival at 90 days. It may be reasonable to consider early coronary angiography in certain patients after discussion with the interventional cardiologist (e.g. if there is a good history of ischemic symptoms prior to the arrest or if the patient has a significant cardiac background). It is also important to focus on other aspects of post-resuscitation care e.g. targeted temperature management, vital organ support, and treating the underlying aetiology of the cardiac arrest. Discussion 2:Aslanger, E., Yıldırımtürk, Ö., Şimşek, B., Sungur, A., Türer Cabbar, A., & Bozbeyoğlu, E. et al. (2020). A new electrocardiographic pattern indicating inferior myocardial infarction. Journal Of Electrocardiology, 61, 41-46. https://doi.org/10.1016/j.jelectrocard.2020.04.008. Take-Home Points: ECG criteria for this pattern (or "Aslanger’s pattern"): ST-segment elevation isolated to lead III, concomitant ST depression in any of V4 to V6 (with a positive/terminally positive T-wave), and ST-segment in V1 > V2. This pattern may indicate inferior MI in patients “with concomitant critical lesion/s in coronary arteries other than the infarct-related artery”. This study shows that patients with this particular ECG pattern have a higher risk of short- and long-term mortality than other NSTEMI patients; however, more research is required to corroborate these findings.  If the patient has ongoing chest pain (without any other obvious cause), it is important to do serial ECGs and escalate concerns to the cardiology team (regardless of what their ECG might show).  ECG example (from Life In The Fast Lane):https://litfl.com/wp-content/uploads/2020/12/Aslanger-pattern-of-ECG-chages-in-inferior-myocardial-infarction-2020.png. Discussion 3:Schüpke, S., Neumann, F., Menichelli, M., Mayer, K., Bernlochner, I., & Wöhrle, J. et al. (2019). Ticagrelor or Prasugrel in Patients with Acute Coronary Syndromes. New England Journal Of Medicine, 381(16), 1524-1534. https://doi.org/10.1056/nejmoa1908973. Take-Home Points: This study demonstrated that, in patients with ACS (with or without ST-segment elevation), the incidence of death, MI, and stroke was significantly lower among patients who were treated with Prasugrel than among patients who were treated with Ticagrelor.  The incidence of major bleeding was similar between the two treatment groups. Prasugrel is currently unavailable in the Australian market and in this context, the preferred agent is Ticagrelor (unless it is contraindicated). However, prior to choosing an agent, it is worth discussing with the cardiology team due to variations in individual practice, local protocols, and time of administration.  When choosing DAPT, always consider the drug's contraindications and risk of potential complications (e.g. bleeding). If a patient has a higher risk of bleeding and is above the age of 70 years, it might be safer to use Clopidogrel. The main contraindications for use of Ticagrelor are increased risk of bleeding and higher degrees of conduction block. With Prasugrel, watch out for history of stroke as that increases the risk of intracranial bleeding.  Credits:The discussions were mediated by ED consultants,  Dr Khanh Nguyen and Dr Pramod Chandru.This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney, Deepa Dasgupta, Cynthia De Macedo Franco, and Paul Scott.Music/Sound Effects Sound effects from https://www.free-stock-music.com. Good Day by Roa Music | https://soundcloud.com/roa_music1031, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Happy by Mike Leite | https://soundcloud.com/mikeleite, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Love Trip by Sarah Jansen Music | https://soundcloud.com/sarahjansenmusic, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Medical Examination by MaxKoMusic | https://maxkomusic.com/, Music promoted by https://www.free-stock-music.comCreative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Nothing Better by Vendredi ft. ELLE | https://soundcloud.com/vendrediduo, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Roadtrip by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Sax by MBB | https://soundcloud.com/mbbofficial, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licens.  Waterfall by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. ~Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.comSee you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.

Theme: Toxicology. Participants: Dr Satish Mitter, Pramod Chandru, Samoda Wilegoda Mudalige, Kit Rowe, Rachel Ng, Shreyas Iyer, and Caroline Tyers.Discussion 1:“Clinical outcomes from early use of digoxin specific antibodies versus observation in chronic digoxin poisoning (ATOM-4)”Betty S. Chan, Geoffrey K. Isbister, Colin B. Page, Katherine Z. Isoardi, Angela L. Chiew, Katharine A. Kirby & Nicholas A. Buckleyhttps://doi.org/10.1080/15563650.2018.1546010.Take-Home Points: The results from this study suggest no benefit from routine use of DigiFab for chronic digoxin toxicity.  Clinical indications for DigiFab use include - cardiac arrest, ventricular arrhythmias or runs of ventricular ectopic complexes and bradyarrhythmias associated with hypotension.  Digoxin levels should only be performed under specific circumstances (not routinely for all patients on digoxin but rather in the context of an AKI or when there is a clinical suspicion of potential toxicity).  When managing chronic digoxin toxicity, correcting any precipitating factors such as volume depletion and electrolyte abnormalities is critically important. Identifying patients at risk of digoxin toxicity (the typical patient is the elderly patient with multiple comorbidities) and drugs that impair digoxin toxicity (NSAIDs and diuretics) is also vital to your overall assessment.  Discussion 2:Case of malathion (organophosphate) poisoning.  55-year-old male found unconscious surrounded by chemicals at home.  Developed clear cholinergic toxidrome, tachycardia, and hypotension in ICU. Received atropine on a doubling regimen every 5 minutes: reaching 16mg (and then a continuous infusion) with improvement in his symptoms (including this tachycardia). Infusion weaned after 24 hours with recurrence of hemodynamic instability requiring inotropic support and recommencement of atropine on day 3. Required atropine for 31 days in total.   Take-Home Points: The standard, routinely taught presentations for cases do not always apply: this patient was tachycardic rather than bradycardic with his organophosphate toxicity (and this tachycardia responded to atropine).  Atropine for organophosphate toxicity is vital.  Oximes (such as pralidoxime) are occasionally used in the treatment of organophosphate toxicity but should be discussed with toxicology specialists prior to use.  Discussion 3:“Use of antipsychotics and risk of myocardial infarction: a systematic review and meta‐analysis”Zheng-he Yu, Hai-yin Jiang, Li Shao, Yuan-yue Zhou, Hai-yan Shi and Bing Ruan                            https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5338104/.Take-Home Points: This study suggests an association between antipsychotic use and an increased risk of MI (OR 1.88).  This risk appeared to be greater within the first 30 days of use (when taking daily doses); with the risk decreasing over time.  There was however significant heterogeneity in the data studied.  The recent commencement of an antipsychotic may be worth considering as an added risk factor for ischaemic heart disease in a patient presenting with chest pain. Credits:The discussions were mediated by ED consultant and toxicologist Dr Satish Mitter and ED consultant Dr Pramod Chandru.This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney, Deepa Dasgupta, Cynthia De Macedo Franco, and Paul Scott.Sound Effects Sound effects from https://www.free-stock-music.com. Machinery 909 by Glitch | https://soundcloud.com/glitch, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Sax by MBB | https://soundcloud.com/mbbofficial, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Piano Sad 2 (Piano & Strings Version) by PeriTune | http://peritune.com, Music promoted by https://www.free-stock-music.com, Attribution 4.0 International (CC BY 4.0), https://creativecommons.org/licenses/by/4.0/. Special Agent None by Alexander Nakarada | https://www.serpentsoundstudios.com, Music promoted by https://www.free-stock-music.com, Attribution 4.0 International (CC BY 4.0), https://creativecommons.org/licenses/by/4.0/. Good Feeling by Roa Music | https://soundcloud.com/roa_music1031, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Medical Examination by MaxKoMusic | https://maxkomusic.com/, Music promoted by https://www.free-stock-music.comCreative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.  ~Thank you for listening to our first podcast episode!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.comSee you next time,Caroline, Kit, Pramod, Samoda and Shreyas.