Comments for Broome Docs

Comment on Clinical Case 086: from Hell’s heart I stab at thee by Taylor

Taylor — Thu, 23 May 2013 13:18:19 +0000

Q1) No. Must be done in OR with full preparation for thoractomy/sternotomy. Major point is ECG changes and transient drop in BP. Many reasons for this… could’ve picked off a coronary vessel, myocardial injury, small amount of blood may not be seen on echo…

Q2) this is an emergency situation and I would go and assess this pt right away. I would prepare the OR for double setup, and would prefer to remove knife with pt asleep to prevent movement during removal, and also have a secured airway in case of catastrophe. Blood should be cross matched and readily available in the fridge. If I were really worried, would want if prechecked and in the room. Would transport of up to OR without tubing in ED.

Q3) quickly assess ABCs and confirm pulselessness. She may have developed tamponade or arrested from myocardial/coronary injury. Either way, would perform thoracotomy and see if pericardium is tense. If tense, open pericardium and look for source of bleeding. Have foley available to tamponade ventricular tear if present.

Q4) Macbeth?

Comment on Infertility: GP management with Dr Penny Wilson by Casey Parker

Casey Parker — Sun, 19 May 2013 14:11:12 +0000

Ah -- yes. The true nature of GP -- it is not all about hard facts, tests and the medicine. The great GP understands the impact health has on a patient, family and couple -- they are all intrinsically interwoven in a wonderful web of wellness -- or not.
We cannot fix one without the other -- especially with a problem as inherently personal as fertility. it doesn’t get more personal, it is a potential relationship breaker -- we need to be really careful when stepping into the bedrooms of our patients.
The fertility, stress, relationship-strain then sexual dysfunction cycle is a difficult one
Thanks for that Penny

Comment on Infertility: GP management with Dr Penny Wilson by Penny Wilson

Penny Wilson — Sun, 19 May 2013 13:46:04 +0000

Of course the purge thing I forgot to mention is that stress an anxiety is a sure fire way to knock off the fertility too. How often do you see couples getting super stressed out about not being able to fall pregnant only to take a break from trying and… Voila! Telling a trying to conceive couple to “relaaaaax” is easier said than done but is also an important part of the counselling process.

Comment on Sexual Assault Management in the Rural ED by Tim Leeuwenburg

Tim Leeuwenburg — Sat, 18 May 2013 22:45:07 +0000

There’s an excellent resource guide from RANZCOG which I will try to find a link to

Paperbags,, not plastic

Swab everything -- good point on the neck

And if you get the chance, practice Court appearance -- inevitably will be called to present evidence and practice helps. I did an excellent two day session with the sexual assault team in Tasmania a few years ago (actually, I think they flew down from Melbourne) -- inc practical tips on forensic medical exam plus mock court appearance

Comment on Sexual Assault Management in the Rural ED by Clint Kalan

Clint Kalan — Sat, 18 May 2013 04:46:05 +0000

Great post, Casey. A couple of things have been drilled into my head by my mum (proper oz usage?), who is an adult and peds Sexual Assault Nurse Examiner with over 100 cases and some court time: 1) Make sure your patient isn’t intoxicated when you get consent, or, if you’re in a big city, don’t call and wake the SANE nurse up at 2 am if the patient won’t be sober till morning. Don’t know how the laws work down there, but here not having that level of informed consent will get a case thrown out. 2) talk through your exam with the patient and tell them before anything happens. They have just lost all control over their bodies and you want to give them back as much as you can. 3) There always seems to be good evidence found by swabbing the neck. For whatever reason, salvia tends to live here. And finally 4) they generally use a colposcope with film capability for gential exam close ups. Don’t know if its available in ED’s anywhere or everywhere.
As a former cop before becoming a PA, I think you we’re spot on with chain of custody. It’s also one of the more likely notes you’ll have to end up in court, so make it your best work. Finally, just publicly recognizing how big of a problem this is, and not being uncomfortable to talk about it does a great service to survivors and our colleagues.