Global Medics is pleased to be in partnership with www.resus.com.au with providing a series of fortnightly teaching materials and video blogs. Here at Global Medics we value the importance of continuing professional development for doctors at all levels, we hope that these blogs will be informative and of interest to you.
Associate Professor Peter Kas is a leading Emergency Specialist in Australia, conference guest speaker and owner of www.resus.com.au which publishes teaching materials, training videos and event/conference information.
We would like to launch the first blog with two interesting topics below (training video and teaching module) provided by Associate Professor Peter Kas.
Hip Relocation Made Easy
Here is a short video on the Whistler technique for putting in hips. It’s quick, easy and really doesn’t allow you to hurt yourself. You use your legs to give you the traction, just watch and see.
I call it the under-over technique: I put my arm under the knee of the affected side and rest my hand over the good knee. I will use this a fulcrum. Both ankles are stabilised and all I do is straighten my legs and lift up, putting traction on the dislocated hip.
Pseudo vs Real Seizure
If you have worked in an emergency department for a few years you will have seen a pseudo-seizure and hopefully have picked it. In those early days, I had trouble making the diagnosis and I had seen neurologists get it wrong. Now they are a little easier to pick. I’m not one to do prolactin levels and blood gases in this group, although I do look at pulse oximetry, which should show a decreased oxygen saturation, during a real seizure. Here are some other tips that might help you. Be careful as there are always exceptions and always err on the side of giving your patient the benefit of the doubt.
I look for seven things. Sure the history and everything that has occurred around the event has to make sense but if I’m unsure this is what I use.
- The seizure lasts longer than most normal seizures, for example five minutes verses one to two minutes.
- There is a very brief one to five minutes post ictal period.
- The patient may be awake post seizure but not communicating (beware ‘Locked-in’ syndrome).
- The patient remembers all events that occurred during a generalised tonic colonic seizure.
- There is forward pelvic thrusting during the seizure, very indicative.
- There is turning of the head from side to side during the seizure.
- There are asynchronous limb movements during the seizure.
So you have made the diagnosis, now the way you handle it with the patient is important. Some patients need to simply be asked to stop. Whatever approach you take, it shouldn’t be threatening, but one that tells the patient you realise they are under great stress and to invite an open discussion, so you can assist them. Psychiatric review will of course be required.
We hope you enjoyed these two topics in our first training blog.
Global Medics Australia will be holding a half day ECG and ACLS re-cap session at our Sydney office, further information regarding this event will be posted in the coming weeks.