Sunday 22 October, 2006

Caffeine is not a substitute for sleep

Posted in Emergency Dept., Michael Tam, Rants, Wards, Workplace at 21:53 by Michael Tam

Original article by: Michael Tam :: Printer friendly

Caffeine is the most widely used stimulant worldwide, and this is certainly true among Australian junior medical officers. Every morning, the wards are frequented by bleary-eyed junior doctors who do not become their cheery selves until the morning “cuppa”.

Juliano and Griffiths (2004) categorised and described a “caffeine-withdrawal syndrome” in a comprehensive review, and even concluded that “there is sufficient empiracal evidence to warrant inclusion of caffeine withdrawal as a disorder in the DSM [Diagnostic and Satistical Manual of Mental Disorders]” (1).

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Monday 16 October, 2006

DMARDs for rheumatoid arthritis

Posted in General Practice, Medicine, Michael Tam, Resources, Wards at 23:33 by Michael Tam

Original article by: Michael Tam :: Printer friendly


Disease-modifying antirheumatic drugs (DMARDs) for rheumatoid arthritis

An excellent two page summary from the National Prescriber Service [65 Kb]

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Sunday 15 October, 2006

How to start an intravenous glyceryl trinitrate (GTN) infusion

Posted in Emergency, Emergency Dept., Medicine, Michael Tam at 20:20 by Michael Tam

Original article: Michael Tam :: Printer friendly

An understanding of how to start and setup an intravenous infusion of glyceryl trinitrate (GTN) is a rather useful skill. Unfortunately, setting up a GTN infusion is sufficiently complicated that it can’t be worked out in an emergency situation. In a nutshell:

Start with glyceryl trinitrate 5 mcg/min


increase infusion rate by 5 mcg/min every 3-5 minutes if needed

when infusion rate is GTN 20 mcg/min or more

increase infusion rate by 10 mcg/min every 3-5 minutes if needed

GTN infusions are not trivial. Call for help. It should best be performed under the supervision of someone who has experience with them (e.g., a medical registrar or emergency medicine registrar).

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Sunday 8 October, 2006

Dealing with borderline personality disorder

Posted in Emergency Dept., General Practice, In The Field, May Su, Psychiatry at 21:31 by May Su

Original article: May Su :: Printer friendly

There is the hypothesis that borderline personality disorder may not be a true personality disorders but rather a form of post traumatic stress disorder. Regardless, a person with borderline personality disorder will present with particular characteristic traits which can be difficult to manage.

Borderline personality disorder

Characterized by: instability of mood, poor self-esteem and self-image, and poor impulse control (1). These mood fluctuations may occur over the space of hours or days, as opposed to the mood fluctuations that occur in bipolar affective disorder. There is often a great fear of abandonment, and higher sensitivity to rejection (or perceived rejection). This can manifest as more unstable interpersonal relationships. The term “splitting” refers to these intense by transient relationships, which can suddenly switch from idealization to contempt.

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How to give thrombolysis in acute myocardial infarction

Posted in Emergency, Emergency Dept., Medicine, Michael Tam at 17:42 by Michael Tam

Original article: Michael Tam :: Printer friendly

In the major urban hospitals, there will be little place for thrombolysis in acute STEMI (ST-elevation myocardial infarction). Primary PCI (percutaneous coronary intervention) is clearly the treatment of choice (1).

Don’t forget to take documented informed consent prior to giving thrombolysis. It is a commonly forgotten step.

However, if you work in a rural or remote setting where the local hospital does not have a cardiologist who can offer primary PCI, then thrombolysis makes a difference. The 30-day mortality in newly diagnosed acute coronary syndrome from 1987-2000 decreased by 47%. This has been attributed to aspirin and coronary revascularisation procedures (e.g., thrombolysis and PCI) (2).

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“The Creation of The Medicine Box” published

Posted in May Su, Michael Tam, Site News at 14:19 by Michael Tam

This book, “The Creation of The Medicine Box” is a comprehensive documentation of the design, goals, development and construction of this website. It contains a review and analysis of the state of the project after six months from its launch in April 2006.

This report was in addition written and designed as a guidebook to the development of online medical education resources.

“The Medicine Box” represents a significant body of work. We hope that you find both this book and the website worthwhile.

“The Creation of The Medicine Box” has been published as a hard cover publication through It can be purchased here for $US 17.95.

It can also be downloaded as a PDF ebook [4.2 MB].