Tasty Morsels of EM 045 – Parvovirus B19

As always, this is from the ever expanding google doc on bits and bobs I read and learn from and transfer here for all our learning pleasure.

Everyone knows the slapped cheek syndrome that runs in epidemics in kids. Hopefully you’ll be aware of the risk to pregant mothers with this infection.

There are however other complications that you need to know about that just might appear in your ED or in your FCEM

Arthralgia/arthritis

  • keep parvovirus in your differential for someone presenting with an acute poly arthritis, especially if there’s a recent flu like illness in the back ground
  • usually symmetric and in the small joints (something that might make you think rheumatoid but you probably shouldn’t head that direction until symptoms have been present for more than 6 weeks)
  • most will have a rash but in adults don’t expect the classic slapped cheek
  • should resolve within 3 weeks and there shouldn’t be any joint destruction

Transient Aplastic crisis

  • typically someone with some kind of haematologic problems eg sickle or iron def anaemia
  • the scenario you should think of this is when you get the FBC back and there an unexpected anaemia
  • usually it’s only red cells involved. If checked reticulocytes should be low

References:

  • UpToDate
  • Rosen’s 8th Chapter 116

[Featured image CC license, via Wikipedia]

 

Work as an emergency fellow in Ireland

I posted on this last year but the department I work in as a few upcoming vacancies in July so I thought I would update things for those who might want to come work.

MMUH resus

Are you an emigrated Irish doc in training in Oz or NZ and fancy coming home for 6 months as part of your training? Are you a kiwi or Aussie and fancy some time in Europe as part of your training?* Do you simply want to come and work in a different system and advance your practice. Then these might be the jobs for you. Are you an Irish trainee between basic and advanced training? If you’re working in Ireland and fancy a career development opportunity in one of the big Dublin hospitals then read on. 

[* the Mater is accredited for training in Ireland through the (recently Royal) college of emergency medicine which is the specialist college for emergency medicine in the UK and Ireland. From communication with the Australasian College in Emergency Medicine (ACEM) we have been told that any trainee wishing to undertake training overseas and have that time accredited toward their ACEM training can apply to ACEM prior to beginning the post and obtain prior approval to have the training added toward their ACEM training. So as far as we know we are eligible for training by ACEM too]

The Mater Misericordiae University Hospital (The Mater) in north Dublin is one of the main tertiary centres in the country. It has the national spinal injuries centre and all major specialities apart from neurosurgery and as far as I’m aware it’s the only place doing ECMO in the country. The hospital recently (2013) moved to brand new facilities including a new Emergency Dept, theatres and ICU.

The ED encompasses a large ‘acute floor’ model with acute medicine working out of the same department.  There is a 5 bed resus with CT scanning within the resus bay. There are 2 dedicated ED ultrasound machines.

The hospital serves one of the more deprived areas of Dublin with the obvious result that it sees a fascinating range of pathology from stab wounds, pedestrian trauma to complications of alcohol and  intravenous drug use and all the interesting infectious disease complications that come with it. One of the emergency medicine trainees is a lead for an international HIV screening project in the department.

The ED has created several posts at registrar level to attract new staff and facilitate career development. All posts have protected non clinical time to pursue the appropriate sub specialty. Clinical work will be on the registrar rota in the ED.

Link to official job advert [search for mater misericordiae]

Video ad from Dr Tomas Breslin, Consultant in EM, Mater Hospital

Feel free to contact myself [emergencymedicineireland [at] gmail.com] or Tomas Breslin [tbreslin [at] mater.ie] if interested.

Fellow in imaging

  • 20% protected non clinical time
  • 2 machines in ED
  • Weekly USS teaching (led by fellows)
  • Liaison with emergency radiology (fellowship trained)
  • Echo Module
    • 6 months
    • 2 hrs/wk in ICU with echo tech supervised scanning
    • 1hr/wk with ED/CCU patients with echo tech supervised scanning
    • Formal lectures
    • Examination
  • Early Pregnancy Module
    • based in local maternity hospital
    • this years fellows just starting
  • Suitable for (but not limited to)
    • post basic EM training, able to work clinically as registrar/advanced trainee in ED
    • prior to entry to formal higher training scheme, allows clinical development and level 1 USS skills with space to develop CV prior to application to higher training OR
    • post training as a fellowship to acquire higher level ultrasound skills
    • particularly well suited to UK/Australasian/South African trainees as registration recognised

Education fellow

  • University hospital with huge opportunities for educational development
  • Already happening in ED
    • weekly Registrar/consultant teaching (focused on FCEM exams)
    • weekly SHO teaching (focused on basic approaches to EM)
    • monthly radiology/EM/Acute medicine meeting
    • weekly ultrasound teaching
    • monthly joint EM/ICU meeting
    • Regular student placements as elective students throughout year or 4th year students for weekly placement jan-march
    • Online education induction package for SHOs and student placement
  • 30% protected time for non clinical activities to coordinate and develop education in emergency medicine
  • Suitable for (but not limited to)
    •  post basic training in EM,
    • able to work clinically as registrar/advanced trainee in ED

Conflict of interest statement

  • I work in the ED and really quite enjoy it there but no favours, cash or back rubs were exchanged for this post. I am happy to promote (on the same “no favours, cash or back rubs” terms) other interesting/innovative Irish emergency medicine jobs if people see the need.
  • My opinions are of course my own and do not necessarily represent that of the hospital.

Anatomy for Emergency Medicine 030: CFN Eye Anatomy Part 1

This is the first of a series of podcasts I’m doing on basic eye anatomy for the CEM FOAMed Network. This is a developing resource which aims to provide a fully mapped college curriculum with FOAMed resources. Be sure and check it out and get the podcast. This podcast went out a while ago on the CFN and I’m just providing it for everyone else who hasn’t got it already.

The single most important resource you need is Ophthobook.com

[Direct Download] [8omb]

AFEM Podcast

Medical Complications of Pregnancy

This is a talk I gave recently for our registrar teaching morning. Not the sexiest presentation (forgive the bullets) but hopefully will give you the basic, textbook level info a al foamcast style

 

Direct Download [60mb]

References:

 

 

SMACC Gold Neuroanatomy Talk

Back in March 2014 I had the pleasure of speaking at SMACC Gold in Australia. The whole thing was great fun and I’m sure you’re all aware it’s going to Chicago in May 2015 so be sure to be there. Indeed Registration opens tonight (in the UK at least) so check it out!!!

Every talk from the conference is coming out via the SMACC podcast so make sure you subscribe.

As my talk is so predominantly visual, it really needs the slides for it to make sense so I’ve included the slideset here and put the audio over the slides so you can get the feel of the talk.

Direct Download [SD 41mb]

For people interested in learning some more detailed neuroanatomy I’d strongly recommend headneckbrainspine.com

They’ve done what I’ve always wanted to do and have created scrolling, labelled radiology images that wonderfully demonstrate the anatomy in 3 dimensions. Really invaluable stuff.

Here’s a list of previous neuro related podcasts I’ve done:

And if you’re interested in working where I work as an ultrasound or education fellow then get in touch.