Sunday 30 July, 2006

Paediatric resuscitation on a card

Posted in Emergency, Emergency Dept., General Practice, Michael Tam, Paediatrics, Resources, Wards at 23:27 by Michael Tam

Original article by: Michael Tam :: Printer friendly


Paediatric Resuscitation Card

High resolution scan (600 DPI) of the paediatric resuscitation card given to medical officers commencing a paediatrics rotation at The Sydney Children’s Hospital. [2.71 Mb]

One of the best resources I received when I worked at The Sydney Children’s Hospital, Randwick, was a laminated card (the size of a business card) attached to my ID badge lanyard. On this card included normal values for weight, heart rate, respiratory rate for infants and children, the correct dosage for a variety of emergency drugs as well as the recommended sizes for endotracheal tubes, nasogastric tubes and indwelling catheters by age.

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Saturday 29 July, 2006

How to manage workplace conflict

Posted in Emergency Dept., General Practice, May Su, Wards, Workplace at 20:44 by May Su

Original article by: May Su :: Printer friendly

Bullying and other workplace conflict is a common scenario as a medico – from patients, from nurses and from other colleagues. There has been increasing media coverage on this regarding in particular the NHS medical system in the UK, and our own more close to home situation in Queensland (1). In a study of the National Health System (NHS) in Britain released in 2002 specifically of junior doctors, 37% of respondents identified as being bullied in the past year and 84% had experienced one or more bullying behaviours (2).

Bullying should not be accepted passively

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Friday 28 July, 2006

How to treat hypoglycaemia on the ward

Posted in Emergency, Medicine, Michael Tam, Wards at 19:57 by Michael Tam

Original article by: Michael Tam :: Printer friendly

Hypoglycaemia (US: hypoglycemia) or a “low BSL” is a common call on the ward. Unless you have a good story that the patient is alert, oriented and able to immediately take some form of oral carbohydrate, it must be treated as a medical emergency.

Hypoglycaemia is a potentially life-threatening medical emergency. Go assess the patient as a matter of urgency.

If the ward nurses are experienced, it is usual that resuscitation equipment and the resuscitation trolley will already be next to the bed. Before you dive into reversing the hypoglycaemia, remember the “ABCs” of resuscitation. The patient will die from airway, breathing and circulatory problems quicker than from hypoglycaemia.

In the emergency situation for adults:

50 mL of 50% dextrose intravenous as a bolus


glucagon hydrochloride 1 mg intravenous (or IM or S/C)

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Tuesday 25 July, 2006

How to stop warfarin for surgery

Posted in General Practice, Medicine, Michael Tam, Surgery, Wards at 20:14 by Michael Tam

Index: Anticoagulation :: Printer friendly

Original article by: Michael Tam

One would think that there would be guidelines on how, when or if warfarin should be ceased before surgery but the reality is that this is often not the case. I remember working as a surgical resident in the pre-operative clinic and having to make this decision on the fly. I can only hope that the anaesthetic registrar who conducted the (parallel) anaesthetic clinic knew what he or she was doing.

In a nutshell:

Low thromboembolic risk:

  • stop warfarin 5 days pre-op;
  • restart warfarin post-op as soon as oral fluids are tolerated.

High thromboembolic risk:

  • stop warfarin 4 days pre-op and start low molecular weight heparin (LMWH) at therapeutic dose;
  • stop the LMWH 12-18 pre-op;
  • restart LMWH 6 hours post-op (assuming haemostasis achieved);
  • restart warfarin when oral fluids are tolerated;
  • stop LMWH when INR = 2.0.

See below for details

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Friday 21 July, 2006

Will soon be back in action…

Posted in Michael Tam, Site News at 1:17 by Michael Tam

I have just returned from an overseas trip to China and Hong Kong and will be moving to Gilgandra in the next 2 days. I have responded to a comment or two since my return.

Expect a few new articles in the coming week!

“The Medicine Box” has done pretty well in the past two months averaging over 2000 hits per month! Thanks to everyone for their interest and support.

Best regards,
Michael Tam

Tuesday 4 July, 2006

Moving to Gilgandra

Posted in Michael Tam, Site News at 12:09 by Michael Tam

I am posted to the town of Gilgandra in rural NSW for the next six months for my Advanced General Practice term. As such, I am taking a short break from The Medicine Box for the next 3 weeks.

New articles will appear once internet access in the registrar house in Gilgandra has been set up.

In the interim, please enjoy the articles already posted on “The Medicine Box”. Please post comments in the individual articles or in the feedback page.

Best regards,
Michael Tam