Mx Pearls

What are the SHAVED conditions that require rapid treatment in a deteriorating patient?
Haemorrhage / hypovolaemia
Epilepsy / seizures
Drugs / toxins
Intraosseous infusion is painful. What can be done to reduce this pain?
Inject a small amount of lignocaine before commencing the infusion.
In a rural emergency, what is the formula for estimating a child's ETT size from their age?
ETT = age / 4 + 4
In an emergency, if there is no Broselow tape, what is the formula for estimating a child's weight from their age?
Weight = (age + 4) x 2
In airway management, when should head tilt not be done?
If c-spine injury is suspected (do jaw thrust and manual in-line stabilisation) or in an infant (neutral head position is required, consider a towel under shoulders as their head is proportionally large).
In a paediatric anaphylaxis, what is the dose of adrenaline?
Adrenaline 0.01 ml/kg, using a 1mL syringe to draw it up straight from the vial that usually contains 1mg in 1 mL (1:1000).
e.g. 10kg child = 0.1 mL.
40kg child = 0.4 mL
In a paediatric emergency, why is a surgical airway contraindicated? What is the alternative?
Children's airways are anatomically different shapes and vital structures could be damaged by a scalpel cricothyroidotomy. The alternative is a needle cricothyrodotomy and jet insufflation (you can oxygenate but not ventilate through this).
In a paediatric arrest, what is the formula for manual defibrillator joules?
Defibrillation = 4 joules / kg
In an emergency, what is ear-to-sternal-notch positioning?

Ear to sternal notch position optimises ventilation. This simple repositioning manoeuvre can make a large difference to the success of ventilating a patient in an emergency. There are many more useful tips for rural GPs on emDOCs.
If an AED is available immediately, when should the first shock be given? a) immediately b) after 30 sec CPR c) after 2 min CPR
Immediately. Defibrillation should be performed as soon as possible. 2 min cycles of resus only start AFTER this.
Where should you insert an intraosseous needle?
Proximal tibia: Anteromedial surface, 2-3 cm below the tibial tuberosity
Distal tibia: Proximal to the medial malleolus
Distal femur: Midline, 2-3 cm above the external condyle
Study Topic Ideas

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For investigations, consider the indications for ordering the test and the key findings for common or critical conditions.
In addition to managing the key diagnoses related to each of the presenting problems above, here are some examples of key management issues to think about.
  • Acute analgesia edit
  • Advanced Life Support edit
  • AED edit
  • Basic Life Support edit
  • Burn dressings edit
  • C-spine immobilisation edit
  • Child rehydration edit
  • Digital nerve block edit
  • Doctor’s bag medications edit
  • Ear-to-sternal-notch edit
  • Emergency sedation of acute psychosis edit
  • Epipens edit
  • Estimating weight from age edit
  • ETT size formula edit
  • Head tilt / jaw thrust edit
  • IM injection edit
  • IO sites edit
  • Laceration repair edit
  • Medical Alerts edit
  • Needle cricothyroidotomy edit
  • Paediatric adrenaline dose edit
  • Paediatric defibrillation edit
  • Recognition of sick child edit
  • Reducing the pain of IO edit
  • Safe paralysis tick removal: Squeeze don’t Freeze, and Dab don’t Grab! edit
  • SHAVED edit
  • Venepuncture edit
For each diagnosis that arises from your differentials, you can then consider the key signs, investigations and management. This list is by no means exhaustive, but here are a few assorted diagnoses to consider.
  • Acute myocardial infarction edit
  • Acute pulmonary oedema edit
  • Anaphylaxis edit
  • Aortic dissection edit
  • Epiglottitis edit
  • Meningococcal infection edit
  • Pericardial tamponade edit
  • Pneumothorax edit
  • Pulmonary embolism edit
Foundation topics like anatomy, physiology and embryology are not the main focus of GP fellowship exams. The following are examples of topics that may be useful for quizzing any medical students you are supervising:
  • Australian spiders edit
  • Australian venomous snakes edit
  • AVPU edit
  • Femoral artery anatomy edit
  • GCS edit
  • Reversible causes of arrest: 4 Hs and 4 Ts edit
  • Shockable arrest rhythms edit
  • Types of shock edit
Medical students may be more focused on learning basic definitions, aetiology and pathophysiology of specific diagnoses, but registrars need to focus more on clinical problem solving. For each common presenting problem, consider what would be the red flag features, the most common differentials, as well as the most dangerous and most often missed (see Murtagh for more information on this model). For each diagnosis that arises from your differentials, you can then consider the key signs, investigations and management.
Medicine is nebulous with many conditions that arise infrequently in General Practice. These topics are not the main focus of college exams but nonetheless might occasionally appear - just as they can appear in your consultation room on a Friday afternoon. Other topics are so controversial that they are very difficult to examine. Here are some examples of topics that should not be the main focus of your study.

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