Network Five Emergency Medicine Journal Club

Theme: Mycoplasma - To Treat Vs Not Treat?Participants: Dr Chetan Pandit (Paediatric Respiratory & Sleep Specialist), Dr Pramod Chandru (FACEM), Dr Shreyas Iyer (FACEM), and Dr Sunny Rajput (ED trainee)Article: Liu, X., Wang, Y., Chen, C., & Liu, K. (2021). Mycoplasma pneumoniae infection and risk of childhood asthma: A systematic review and meta-analysis. Microbial pathogenesis, 155, 104893. https://doi.org/10.1016/j.micpath.2021.104893.Presenter: Sunny RajputMusic/Sound Effects:Sunset by Alex-Productions | https://onsound.eu/Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US. Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. The therapies discussed are general and should not be a substitute for an individualized assessment by a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at hello@n5em.com!You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme:  Practice Changes In Paediatric Wheeze ManagementParticipants: Dr Chetan Pandit (Paediatric Respiratory & Sleep Specialist), Dr Pramod Chandru (FACEM), Dr Shreyas Iyer (FACEM), and Dr Sunny Rajput (ED trainee)Presenter: Shreyas IyerMusic/Sound Effects:Hard As Steel by Alex-Productions | https://onsound.eu/, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US.Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. The therapies discussed are general and should not be a substitute for an individualized assessment by a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at hello@n5em.com!You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme:  Practice Changes In Paediatric Wheeze ManagementParticipants: Dr Chethan Pandit (Paediatric Respiratory & Sleep Specialist), Dr Pramod Chandru (FACEM), Dr Shreyas Iyer (FACEM), and Dr Sunny Rajput (ED trainee)Presenter: Pramod ChandruInterlude: Dr Chethan PanditMusic/Sound Effects:Energetic Electronic Vlog | Breeze by Alex-Productions |, https://youtu.be/6yAkEyzPKOw, Music promoted by http://onsound.eu/. Walk Around by Roa Music | https://soundcloud.com/roa_music1031, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US.Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at hello@n5em.com!You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme:  Practice Changes In Paediatric Wheeze ManagementParticipants: Dr Chethan Pandit (Paediatric Respiratory & Sleep Specialist), Dr Pramod Chandru (FACEM), Dr Shreyas Iyer (FACEM), and Dr Sunny Rajput (ED trainee)Presenter: Shreyas IyerMusic/Sound Effects:Sunrise by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US.Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at hello@n5em.com!You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Guest Speaker:Dr Setthy Ung, BSc(Med) MBBS FACEM - Senior Staff Specialist, Cambelltown Hospital.Interviewed By:Shreyas Iyer, FACEM.Music/Sound Effects:Another Time by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons/ Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US.Nostalgic Marshmallows by Arthur Vyncke | https://soundcloud.com/arthurvost, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution-ShareAlike 3.0 Unported (CC BY-SA 3.0), https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. The therapies discussed are general and should not be a substitute for an individualized assessment by a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme:  LGBTQIA+ Identity, Experiences & Challenges In Healthcare.Participants: Dr Dervla McGrann (FACEM), Dr Bhushan Joshi (FACEM), Dr Ashleigh Pitcher (advanced trainee in paediatrics), Dr Kit Rowe, Dr Shreyas Iyer, and Dr Caroline Tyers.Presenter: Shreyas IyerDiscussion:Luetkemeyer, A.F. et al. (2023) ‘Postexposure doxycycline to prevent bacterial sexually transmitted infections', New England Journal of Medicine, 388(14), pp. 1296–1306. doi:10.1056/nejmoa2211934.Music/Sound Effects:Ascension by Keys of Moon | https://soundcloud.com/keysofmoon, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 4.0 International (CC BY 4.0), https://creativecommons.org/licenses/by/4.0/.Chill Vibes by Alex-Productions | https://onsound.eu/, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US.Colorful by Roa Music | https://soundcloud.com/roa_music1031, Music promoted by https://www.free-stock-music.com, Creative Commons/ Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US.Stay by Thomas Gresen | https://soundcloud.com/thomasgresen, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US.Te Quero by Jay Someday | https://soundcloud.com/jaysomeday, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US.Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme:  LGBTQIA+ Identity, Experiences & Challenges In Healthcare.Participants: Dr Dervla McGrann (FACEM), Dr Bhushan Joshi (FACEM), Dr Ashleigh Pitcher (advanced trainee in paediatrics), Dr Kit Rowe, Dr Shreyas Iyer, and Dr Caroline Tyers. Presenter: Dr Caroline Tyers.Discussion:Toman L. (2019). Navigating medical culture and LGBTQ identity. The clinical teacher, 16(4), 335–338. https://doi.org/10.1111/tct.13078. Summary:This was a qualitative study which focused on the experience of lesbian, gay, bisexual, transgender, and queer medical students as trainees within the medical profession. This study aimed to investigate how LGBTQIA+ medical students navigate medical school as minorities and sociocultural behaviours within medical culture contribute to their overall well-being and mental health. 12 LGBTQ medical students from 4 different medical schools in Michigan were placed into focus groups in 2018. The prominent themes that emerged from this study were: 1) fears of repercussions of identifying as part of the LGBTQIA+ community, 2) a lack of mentorship for these students, and 3) the added burden of being from a non-white background. The conclusion of this study highlighted the importance of implementing programs to support diversity and welcome differences among students and employees alike. It raised the need for deliberate support of LGBTQIA+ students through advocacy and conditions that encourage affirmation and promote positive mental health outcomes. Take-Home Points:Not only are our LGBTQIA+ patients important but our colleagues are also incredibly important too. Our LGBTQIA+ colleagues may face different challenges, and it is something that we as a medical community need to work together toward improving.Resources:https://www.facebook.com/GLADDAUS https://amsa.org.au/representative-groups/queer/  Music/Sound Effects:Paradise by Spiring | https://soundcloud.com/user-57630131, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US.Traveling Around The World by Alex-Productions | https://onsound.eu/, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US. Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme:  LGBTQIA+ Identity, Experiences & Challenges In Healthcare.Participants: Dr Dervla McGrann (FACEM), Dr Bhushan Joshi (FACEM), Dr Ashleigh Pitcher (advanced trainee in paediatrics), Dr Kit Rowe, Dr Shreyas Iyer, and Dr Caroline Tyers. Discussion: Chisolm-Straker M, Jardine L, Bennouna C, Morency-Brassard N, Coy L, Egemba MO, Shearer PL. Transgender and Gender Nonconforming in Emergency Departments: A Qualitative Report of Patient Experiences. Transgend Health. 2017 Feb 1;2(1):8-16. doi: 10.1089/trgh.2016.0026. PMID: 28861544; PMCID: PMC5367487. Presenter: Dr Ashleigh Pitcher. Interlude: Dr Dervla McGrann.Music/Sound Effects:Get Away by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US. Smile by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US.Sweet by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US.Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Guest Speaker:Dr Indika De Lanerolle (MBBS, MD, MRCEM) is a Consultant Emergency Physician at the National Hospital of Sri Lanka in Colombo. He is also the first emergency physician in Sri Lanka.Interviewed By:Samoda Wilegoda - ED trainee at Westmead Hospital. Music/Sound Effects: Awakening by Vlad Gluschenko | https://soundcloud.com/vgl9, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US. Denna Dena Na (Papara Song).  Electronic Rock (King Around Here) by Alex Grohl, available via https://pixabay.com/music/beats-electronic-rock-king-around-here-15045/.  Tropical Evening by Vlad Gluschenko | https://soundcloud.com/vgl9, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US. Promotional VideoMusic - Tropical Evening by Vlad Gluschenko | https://soundcloud.com/vgl9, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US.Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Panel:Pramod Chandru and Shreyas Iyer.Music/Sound Effects: Bullet Train by tubebackr | https://www.tubebackrmusic.com/Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution-NoDerivs 3.0 Unported (CC BY-ND 3.0), https://creativecommons.org/licenses/by-nd/3.0/. Hands High by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US. Love Trip by Sarah Jansen Music | https://soundcloud.com/sarahjansenmusic, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US. Stay by Thomas Gresen | https://soundcloud.com/thomasgresen, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US. References: Carne B, Kennedy M, Gray T. Review article: Crisis resource management in emergency medicine. Emerg Med Australas. 2012 Feb;24(1):7-13. doi: 10.1111/j.1742-6723.2011.01495.x. Epub 2011 Oct 13. Review. PubMed PMID: 22313554. St Pierre M, Hofinger G, Buerschaper C, Simon R. Crisis Management in Acute Care Settings: Human Factors, Team Psychology, and Patient Safety in a High Stakes Environment. (2nd edn) Springer, 2011. Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Special Episode: The Indigenous Voice To The Australian ParliamentPresenter: Shreyas Iyer.Summary: There is a toxic amount of lies and misinformation regarding what is a very simple proposal for providing dignity to the First Nations people and helping our government make good decisions.  Polls show that the overwhelming majority of First Nations people are in favour of this proposal.  Better government policy and better use of government resources benefit all of us.  Listening to First Nations people and learning from their knowledge of the land also benefits all of us.  We shouldn't expect this to be a panacea, but the status quo of wasting money and allowing our First Nations communities to languish is not tenable.  The 'No' campaign has not actually offered any alternative viable solutions. Our community is a melting pot of different peoples, but we all love this country and want to play our part in it.  We have provided our references, and also some useful resources for information regarding the Voice below. If you found this video helpful, please feel free to share and spread the word. If you would like to discuss this topic further or have any questions please feel free to reach out to us on social media.  On 14th October we have a chance to make a good decision for the future of this country, we have a chance to vote YES to the Aboriginal and Torres Strait Islander Voice to Parliament.  References https://www.wslhd.health.nsw.gov.au/ArticleDocuments/1232/WSLHD%20Year%20in%20Review%202021-22.pdf.aspx  https://www.abs.gov.au/articles/new-south-wales-aboriginal-and-torres-strait-islander-population-summary#where-aboriginal-and-torres-strait-islander-people-live https://www.abs.gov.au/statistics/people/aboriginal-and-torres-strait-islander-peoples/census-population-and-housing-counts-aboriginal-and-torres-strait-islander-australians/2021#new-south-wales  https://ulurustatement.org/history/the-journey-so-far/  https://aci.health.nsw.gov.au/projects/co-design  https://www.aph.gov.au/About_Parliament/Senate/Powers_practice_n_procedures/Constitution.aspx  https://theconversation.com/indigenous-recognition-in-our-constitution-matters-and-will-need-greater-political-will-to-achieve-90296  https://about.abc.net.au/speeches/noel-pearson-boyer-lecture-series-who-we-were-and-who-we-can-be/  https://www.survivalinternational.org/tribes/aboriginals#:~:text=There%20are%20about%20500%20different,large%20number%20of%20separate%20clans.&text=Archaeologists%20believe%20that%20the%20Aboriginals,continent%20around%2045%2C000%20years%20ago  https://www.indigenoushpf.gov.au/Measures/1-19-Life-expectancy-birth  https://www.indigenoushpf.gov.au/Measures/2-11-Contact-criminal-justice-system#keymessages  https://www.abc.net.au/news/2015-12-03/fact-check-aboriginal-men-in-jail-and-university/6907540  https://www.aihw.gov.au/reports/australias-health/indigenous-health-andwellbeing#Suicide%20and%20self-harm      https://www.abc.net.au/news/2022-11-30/closing-the-gap-report-released/101713892  https://www.pc.gov.au/closing-the-gap-data/annual-data-report/report/snapshot-socioeconomic#seo10  https://www.abc.net.au/news/2023-10-02/preventable-blindness-rates-have-been-halved/102916184   https://theconversation.com/governments-are-failing-to-share-decision-making-with-indigenous-people-productivity-commission-finds-210392#:~:text=The%20commission%20says%20too%20many,Agreement%20on%20Closing%20the%20Gap”  https://theconversation.com/many-claim-australias-longest-running-indigenous-body-failed-heres-why-thats-wrong-209511  Useful Resources https://voice.gov.au  https://ulurustatement.org  https://www.reconciliation.org.au/reconciliation/support-a-voice-to-parliament/  https://theconversation.com/the-voice-what-is-it-where-did-it-come-from-and-what-can-it-achieve-202138  https://theconversation.com/au/voice  https://www.abc.net.au/listen/programs/the-voice-referendum-explained  https://www.abc.net.au/news/2023-09-29/fact-check-voice-to-parliament-misinformation/102913680  https://www.amnesty.org.au/the-voice-to-parliamentfaqs/#:~:text=The%20Voice%20will%20give%20independent,gender%20balanced%20and%20include%20youth 

Guest Speaker: Dr Kavita Varshney (MBBS EMDM FACEM FCEM) is an emergency physician with a special interest in disaster medicine and clinical education. She is also the deputy director of Emergency Medicine at Westmead Hospital.Interviewed By:Dr Pramod Chandru (FACEM). Music/Sound Effects: Adventure by Roa Music | https://soundcloud.com/roa_music1031, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US. Lagoon by LiQWYD & Luke Bergs | https://www.liqwydmusic.com, https://soundcloud.com/bergscloud, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US. Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Guest Speaker: Dr Amith Shetty (FACEM, PhD) - Clinical Director, Patient Experience and System Performance Support Division, NSW Health, Australia. Interviewed By:Dr Pramod Chandru (FACEM). Music/Sound Effects: Ascension by Keys of Moon | https://soundcloud.com/keysofmoon, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 4.0 International (CC BY 4.0), https://creativecommons.org/licenses/by/4.0/. Eternal Sunshine by LiQWYD & Luke Bergs | https://www.liqwydmusic.com, https://www.lukebergsmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution-ShareAlike 3.0 Unported (CC BY-SA 3.0), https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Somebody by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US.  Promotional Video (Soundtrack):Somebody by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US. Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Panel: Pramod Chandru and Shreyas Iyer.Case Summary: 61-year-old male presenting with 2 distinct episodes of shortness of breath, chest pain, and associated presyncope.   Asymptomatic by the time of arrival to the emergency department.   ECG and observations at triage were unremarkable.  No recent travel or recent major surgeries.  Initial troponin and serial troponin were 80ng/L.   D-dimer was ordered given static troponin and the nature of symptoms: 0.58.  Although this D-dimer was negative when age-adjusted, a V/Q scan was pursued as the patient was not felt to fit a ‘low risk' pre-test probability for PE (IV contrast shortage dictated V/Q over CTPA).  Bilateral segmental pulmonary PE identified on V/Q scan with mild right heart strain evident on subsequent CTPA and TTE.   Key Discussion Points: If a case does not follow the usual ‘pattern' of your initial diagnosis, consider alternate aetiologies.  There are many tools available for risk-stratifying PE including PERC, age-adjusted D-dimer, and the YEARS diagnostic pathway. However, the way in which to appropriately utilize these tools is nuanced.   A paper published in JAMA in December 2021 demonstrates some ways in which these tools can be used together (see first reference below).   The PESI score (even prior to definitive diagnosis) can be useful to risk stratify patients with possible PE and help determine their disposition.   Take-Home Points: Pre-test probability is incredibly important, particularly in entities such as PE where only highly invasive imaging modalities are diagnostic.  Having a structured approach to protect yourself from your own mistakes is extremely important (such as a hypothesis and hypothesis testing approach).  References & Background Reading:  Effect of a Diagnostic Strategy Using an Elevated and Age-Adjusted D-Dimer Threshold on Thromboembolic Events in Emergency Department Patients With Suspected Pulmonary Embolism: A Randomized Clinical Trial. JAMA. 2021 Dec 7;326(21):2141-2149. doi: 10.1001/jama.2021.20750.  Thiruganasambandamoorthy, V., Stiell, I.G., Sivilotti, M.L. et al. Risk stratification of adult emergency department syncope patients to predict short-term serious outcomes after discharge (RiSEDS) study. BMC Emerg Med 14, 8 (2014). https://doi.org/10.1186/1471-227X-14-8. Crane SD, Risk stratification of patients with syncope in an accident and emergency department Emergency Medicine Journal 2002;19:23-27. Almulhim KN. The Characteristics of Syncope-Related Emergency Department Visits: Resource Utilization and Admission Rate Patterns in Emergency Departments. Cureus. 2022 Feb 8;14(2):e22039. doi: 10.7759/cureus.22039. PMID: 35340474; PMCID: PMC8913182.  Iwuji K, Almekdash H, Nugent KM, Islam E, Hyde B, Kopel J, Opiegbe A, Appiah D. Age-Adjusted D-Dimer in the Prediction of Pulmonary Embolism: Systematic Review and Meta-analysis. J Prim Care Community Health. 2021 Jan-Dec;12:21501327211054996. doi: 10.1177/21501327211054996. PMID: 34814782; PMCID: PMC8640977.  Schouten HJ, Geersing GJ, Koek HL, et al. Diagnostic accuracy of conventional or age-adjusted D-dimer cut-off values in older patients with suspected venous thromboembolism: systematic review and meta-analysis. 2012. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK133492/. Franco-Moreno AI, Bustamante-Fermosel A, Ruiz-Giardin JM, Muñoz-Rivas N, Torres-Macho J, Brown-Lavalle D. Utility of probability scores for the diagnosis of pulmonary embolism in patients with SARS-CoV-2 infection: A systematic review. Rev Clin Esp (Barc). 2023 Jan;223(1):40-49. doi: 10.1016/j.rceng.2022.07.004. Epub 2022 Sep 22. PMID: 36241500; PMCID: PMC9492501.  Christ M, Geier F, Popp S, Singler K, Smolarsky A, Bertsch T, Müller C, Greve Y. Diagnostic and prognostic value of high-sensitivity cardiac troponin T in patients with syncope. Am J Med. 2015 Feb;128(2):161-170.e1. doi: 10.1016/j.amjmed.2014.09.021. Epub 2014 Oct 15. PMID: 25447619.  Lindner G, Pfortmueller CA, Funk GC, Leichtle AB, Fiedler GM, Exadaktylos AK. High-Sensitive Troponin Measurement in Emergency Department Patients Presenting with Syncope: A Retrospective Analysis. PLoS One. 2013 Jun 18;8(6):e66470. doi: 10.1371/journal.pone.0066470. PMID: 23823330; PMCID: PMC3688899.  Music/Sound Effects: ENGINE by Alex-Productions | https://onsound.eu/, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US.  Feel It by MBB feat. JV Saxx | https://soundcloud.com/mbbofficial, https://www.instagram.com/JVSAXX/, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution-ShareAlike 3.0 Unported (CC BY-SA 3.0), https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Lakeside by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US.  Ocean Love by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US. Nostalgic Marshmallows by Arthur Vyncke | https://soundcloud.com/arthurvost, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution-ShareAlike 3.0 Unported (CC BY-SA 3.0), https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Sound effects from https://www.free-stock-music.com. Promotional Video (Soundtrack):Pina Colada by Scandinavianz | https://soundcloud.com/scandinavianz,Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US.Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Orthopaedics. Participants: Professor Herwig Drobetz (orthopaedic trauma surgeon at Lismore Base Hospital), Dr Anthony Wilson (orthopaedics registrar at Lismore Base Hospital), Pramod Chandru, Caroline Tyers, Mariez Gorgi and Kim Van Vu. Discussion:Gibson, P. D., Adams, M. R., Koury, K. L., Shaath, M. K., Sirkin, M. S., & Reilly, M. C. (2016). Inadvertent Reduction of Symphyseal Diastasis During Computed Tomography. Journal of orthopaedic trauma, 30(9), 474–478. https://doi.org/10.1097/BOT.0000000000000627.Presenter: Kim Van Vu - emergency medicine trainee at Westmead Hospital. Music/Sound Effects: Esta Noche by Vendredi & Shifumi | https://soundcloud.com/vendrediduo, Music promoted by https://www.free-stock-music.com,  Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US. Picasso by Ikson | https://youtube.com/ikson, Music promoted by https://www.free-stock-music.com. Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Orthopaedics. Participants: Professor Herwig Drobetz (orthopaedic trauma surgeon at Lismore Base Hospital), Dr Anthony Wilson (orthopaedics registrar at Lismore Base Hospital), Pramod Chandru, Caroline Tyers, Mariez Gorgi and Kim Van Vu. Discussion:Combined Randomised and Observational Study of Surgery for Fractures in the Distal Radius in the Elderly (CROSSFIRE) Study Group, Lawson, A., Naylor, J. M., Buchbinder, R., Ivers, R., Balogh, Z. J., Smith, P., Xuan, W., Howard, K., Vafa, A., Perriman, D., Mittal, R., Yates, P., Rieger, B., Smith, G., Adie, S., Elkinson, I., Kim, W., Sungaran, J., Latendresse, K., … Harris, I. A. (2021). Surgical Plating vs Closed Reduction for Fractures in the Distal Radius in Older Patients: A Randomized Clinical Trial. JAMA surgery, 156(3), 229–237. https://doi.org/10.1001/jamasurg.2020.5672. Presenter: Mariez Gorgi - emergency medicine advanced trainee at Westmead Hospital.Music/Sound Effects: Got My Love by LiQWYD & Markvard | https://www.liqwydmusic.com, https://soundcloud.com/markvard, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US. Sunset Beach by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.comCreative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US. Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Orthopaedics. Participants: Professor Herwig Drobetz (orthopaedic trauma surgeon at Lismore Base Hospital), Dr Anthony Wilson (orthopaedics registrar at Lismore Base Hospital), Pramod Chandru, Caroline Tyers, Mariez Gorgi and Kim Van Vu. Discussion:Weinberg, D. S., Scarcella, N. R., Napora, J. K., & Vallier, H. A. (2016). Can Vascular Injury be Appropriately Assessed With Physical Examination After Knee Dislocation?. Clinical orthopaedics and related research, 474(6), 1453–1458. https://doi.org/10.1007/s11999-016-4730-6.Presenter: Anthony Wilson - orthopaedics registrar at Lismore Base Hospital.References: Welling, D. R., Ryan, J. M., Burris, D. G., & Rich, N. M. (2010). Seven sins of humanitarian medicine. World journal of surgery, 34(3), 466–470. https://doi.org/10.1007/s00268-009-0373-z. Music/Sound Effects: Faces by RYYZN | https://soundcloud.com/ryyzn, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US. Get Away by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US. Slipz (audio logo) by tubebackr | https://www.tubebackrmusic.com/, Music promoted by https://www.free-stock-music.com. Swing by LiQWYD & Luke Bergs | https://www.liqwydmusic.com, https://soundcloud.com/bergscloud, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US. Thinking Of You by Ron Gelinas Chillout Lounge | https://open.spotify.com/artist/03JYfsI9Ke7JFuxHD239m2Music promoted by https://www.free-stock-music.com. Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Critical Care.Participants: Dr Alex Yartsev (intensivist at Westmead Hospital), Dr Mark Salter (emergency physician at Westmead Hospital), Maddy Jegatheeswaran (intensive care Fellow at Westmead Hospital), Gladis Kabil (registered nurse at Westmead Hospital), Kristian Adams, Pramod Chandru, Caroline Tyers, Amanda De Silva, Shreyas Iyer, and Samoda Wilegoda. Discussion:Sud, S., Friedrich, J. O., Adhikari, N. K. J., Fan, E., Ferguson, N. D., Guyatt, G., & Meade, M. O. (2021). Comparative Effectiveness of Protective Ventilation Strategies for Moderate and Severe Acute Respiratory Distress Syndrome. A Network Meta-Analysis. American journal of respiratory and critical care medicine, 203(11), 1366–1377. https://doi.org/10.1164/rccm.202008-3039OC. Presenter: Maddy Jegatheeswaran intensive care Fellow at Westmead Hospital.Music/Sound Effects: Blue Sweater by RYYZN | https://soundcloud.com/ryyzn, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Good Day by Ikson | https://youtube.com/ikson, Music promoted by https://www.free-stock-music.com. Slipz (audio logo) by tubebackr | https://soundcloud.com/tubebackr, Music promoted by https://www.free-stock-music.com. Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Critical Care.Participants: Dr Alex Yartsev (intensivist at Westmead Hospital), Dr Mark Salter (emergency physician at Westmead Hospital), Maddy Jegatheeswaran (intensive care Fellow at Westmead Hospital), Gladis Kabil (registered nurse at Westmead Hospital), Kristian Adams, Pramod Chandru, Caroline Tyers, Amanda De Silva, Shreyas Iyer, and Samoda Wilegoda. Discussion:Kabil, G., Liang, S., Delaney, A., Macdonald, S., Thompson, K., Saavedra, A., Suster, C., Moscova, M., McNally, S., Frost, S., Hatcher, D., & Shetty, A. (2021). Association between intravenous fluid resuscitation and outcome among patients with suspected infection and sepsis: A retrospective cohort study. Emergency Medicine Australasia, 34(3), 361–369. https://doi.org/10.1111/1742-6723.13893. Presenter: Gladis Kabil - registered nurse at Westmead Hospital and PhD candidate. Music/Sound Effects: Lagoon by LiQWYD & Luke Bergs | https://www.liqwydmusic.com, https://soundcloud.com/bergscloud, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. My Old East Coast by Vendredi feat. Melanie | https://soundcloud.com/vendrediduo, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Slipz (audio logo) by tubebackr | https://soundcloud.com/tubebackr, Music promoted by https://www.free-stock-music.com. Trick Or Treat by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. When The Lights Go On by Vlad Gluschenko | https://soundcloud.com/vgl9, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Critical Care.Participants: Dr Alex Yartsev (intensivist at Westmead Hospital), Dr Mark Salter (emergency physician at Westmead Hospital), Maddy Jegatheeswaran (intensive care Fellow at Westmead Hospital), Gladis Kabil (registered nurse at Westmead Hospital), Kristian Adams, Pramod Chandru, Caroline Tyers, Amanda De Silva, Shreyas Iyer, and Samoda Wilegoda. Discussion:Ameloot, K. et al. (2020) “Optimum blood pressure in patients with shock after acute myocardial infarction and cardiac arrest,” Journal of the American College of Cardiology, 76(7), pp. 812–824. Available at: https://doi.org/10.1016/j.jacc.2020.06.043. Presenter: Kristian Adams - intensive care trainee at Westmead Hospital.Music/Sound Effects: Alicante by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Dance by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Descriptions by RYYZN | https://soundcloud.com/ryyzn, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Get Away by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Healthcare Worker Well-Being.Participants: Dr Felicity Day (emergency physician), Dr Laura Brown (emergency physician), Natalie Harman (psychotherapist and counselor), Diane Premnath, Nasim Erfani, Caroline Tyers, Jack Ashley, Shreyas Iyer, and Mariez Gorgi. Discussion:Brand, S. L., Thompson Coon, J., Fleming, L. E., Carroll, L., Bethel, A., & Wyatt, K. (2017). Whole-system approaches to improving the health and wellbeing of healthcare workers: A systematic review. PloS one, 12(12), e0188418. https://doi.org/10.1371/journal.pone.0188418. Presenter: Diane Premnath - ED advanced trainee at Westmead Hospital.Music/Sound Effects: Adrenaline by Alex-Productions | https://onsound.eu/, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Down by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Emotional Piano Improvisation by Alexander Nakarada | https://www.serpentsoundstudios.com, Music promoted by https://www.free-stock-music.com, Attribution 4.0 International (CC BY 4.0), https://creativecommons.org/licenses/by/4.0/. Slipz (audio logo) by tubebackr | https://soundcloud.com/tubebackr, Music promoted by https://www.free-stock-music.com. Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Healthcare Worker Well-Being.Participants: Dr Felicity Day (emergency physician), Dr Laura Brown (emergency physician), Natalie Harman (psychotherapist and counsellor), Diane Premnath, Nasim Erfani, Caroline Tyers, Jack Ashley, Shreyas Iyer and Mariez Gorgi. Discussion:Kendrick, M., Kendrick, K., Morton, P., Taylor, N., & Leggat, S. (2020). Hospital Staff Report It Is Not Burnout, but a Normal Stress Reaction to an Uncongenial Work Environment: Findings from a Qualitative Study. International Journal Of Environmental Research And Public Health, 17(11), 4107. https://doi.org/10.3390/ijerph17114107. Presenter: Jack Ashley - ED trainee at Liverpool Hospital.Music/Sound Effects: Love Me Now by Vishmak | https://soundcloud.com/vishmak, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Motivational Piano Background Music by Nikita Lukyanov | https://soundcloud.com/lukyanovnikita, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Summer Mood by Roa Music | https://soundcloud.com/roa_music1031, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Healthcare Worker Well-Being.Participants: Dr Felicity Day (emergency physician), Dr Laura Brown (emergency physician), Natalie Harman (psychotherapist and counsellor), Diane Premnath, Nasim Erfani, Caroline Tyers, Jack Ashley, Shreyas Iyer and Mariez Gorgi. Discussion:Zhang Q, Mu M-c, He Y, Cai Z-l, Li Z-c. Burnout in emergency medicine physicians: a meta-analysis and systematic review. Medicine 2020; 99:32(e21462). Presenter: Nasin Erfani - ED advanced trainee at Westmead Hospital.Music/Sound Effects: Coastline by Ikson | https://youtube.com/ikson, Music promoted by https://www.free-stock-music.com. Gatekeeper by The Piano Says | https://soundcloud.com/thepianosays, https://spoti.fi/3uvxbRU, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Paradise by Ikson | https://youtube.com/ikson, Music promoted by https://www.free-stock-music.com. Piano Rock Instrumental by Hyde - Free Instrumentals | https://soundcloud.com/davidhydemusic, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Slipz (audio logo) by tubebackr | https://soundcloud.com/tubebackr, Music promoted by https://www.free-stock-music.com. Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Toxicology. Participants: A/Prof. Naren Gunja (clinical toxicologist), Pramod Chandru, Amanda De Silva, Mariez Gorgi, Tim Selvaraj and Kit Rowe. Discussion:Tokuda, Y., Kikuchi, M., Takahashi, O., & Stein, G. (2006). Prehospital management of sarin nerve gas terrorism in urban settings: 10 years of progress after the Tokyo subway sarin attack. Resuscitation, 68(2), 193-202. https://doi.org/10.1016/j.resuscitation.2005.05.023.Presenter: Mariez Gorgi - ED advanced trainee at Westmead Hospital.Music/Sound Effects: Eternal Sunshine by LiQWYD & Luke Bergs | https://www.liqwydmusic.com, https://www.lukebergsmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Legendary Epic Heroic Cinematic Music | Heroic by Alex-Productions | https://www.youtube.com/channel/UCx0_M61F81Nfb-BRXE-SeVA, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Nightswim by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Slipz (audio logo) by tubebackr | https://soundcloud.com/tubebackr, Music promoted by https://www.free-stock-music.com. Something 'bout July by RYYZN | https://soundcloud.com/ryyzn, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Vamos by MBB & LiQWYD | https://soundcloud.com/mbbofficial, https://soundcloud.com/liqwyd, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Toxicology. Participants: A/Prof. Naren Gunja (clinical toxicologist), Pramod Chandru, Amanda De Silva, Mariez Gorgi, Tim Selvaraj and Kit Rowe. Discussion:Salter MD, Chandru P, Rowe K, Smith P, Gunja N. Prevalence of Pregnancy in Drug Overdose Presenting to a Tertiary Toxicology Service. Clinical Audit. 2022;14:19-29, https://doi.org/10.2147/CA.S341432. Presenter: Tim Selvaraj - ED trainee at Westmead Hospital.Music/Sound Effects: Hands High by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Mamacita by Mike Leite | https://soundcloud.com/mikeleite, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Paradise by Ikson | https://youtube.com/ikson, Music promoted by https://www.free-stock-music.com. Slipz (audio logo) by tubebackr | https://soundcloud.com/tubebackr, Music promoted by https://www.free-stock-music.com. Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Toxicology. Participants: A/Prof. Naren Gunja (clinical toxicologist), Pramod Chandru, Amanda De Silva, Mariez Gorgi, Tim Selvaraj and Kit Rowe. Discussion:De Fazio, P., Gaetano, R., Caroleo, M., Cerminara, G., Maida, F., Bruno, A., Muscatello, M. R., Moreno, M. J., Russo, E., & Segura-García, C. (2015). Rare and very rare adverse effects of clozapine. Neuropsychiatric disease and treatment, 11, 1995–2003. https://doi.org/10.2147/NDT.S83989.Presenter: Pramod Chandru. Music/Sound Effects: Descriptions by RYYZN | https://soundcloud.com/ryyzn, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Get Away by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Last Summer by Ikson | https://youtube.com/ikson, Music promoted by https://www.free-stock-music.com. Slipz (audio logo) by tubebackr | https://soundcloud.com/tubebackr, Music promoted by https://www.free-stock-music.com. Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Environmental Medicine. Participants: Dr Scott Squires, A/Prof. Andrew Coggins, Tim Selvaraj, Shoahaib Karimi, Yelise Foon, Mariez Gorgi, Shreyas Iyer, Kit Rowe, and Harry Hong. Discussion:Yeh, R., Valsdottir, L., Yeh, M., Shen, C., Kramer, D., & Strom, J. et al. (2018). Parachute use to prevent death and major trauma when jumping from aircraft: randomized controlled trial. BMJ, k5094. https://doi.org/10.1136/bmj.k5094.Presenter: Harry Hong - critical care trainee at Ryde Hospital. Music/Sound Effects: Fire by Noise Badger | https://soundcloud.com/noisebadger, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Never Give Up by Jay Someday | https://soundcloud.com/jaysomeday, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Nightswim by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Slipz (audio logo) by tubebackr | https://soundcloud.com/tubebackr, Music promoted by https://www.free-stock-music.com. Thinking Of You by Ron Gelinas Chillout Lounge | https://open.spotify.com/artist/03JYfsI9Ke7JFuxHD239m2Music promoted by https://www.free-stock-music.com. Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Environmental Medicine. Participants: Dr Scott Squires, A/Prof. Andrew Coggins (emergency physician), Tim Selvaraj, Yelise Foon, Mariez Gorgi, Shreyas Iyer, Kit Rowe, and Harry Hong. Discussion:Livingstone, D., Smith, K., & Lange, B. (2017). Scuba diving and otology: a systematic review with recommendations on diagnosis, treatment and post-operative care. Diving And Hyperbaric Medicine Journal, 47(2), 97-109. https://doi.org/10.28920/dhm47.2.97-109.Presenter:  - Yelise Foon - emergency medicine trainee at Westmead Hospital.Music/Sound Effects: Ascension by Keys of Moon | https://soundcloud.com/keysofmoon, Music promoted by https://www.free-stock-music.comAttribution 4.0 International (CC BY 4.0), https://creativecommons.org/licenses/by/4.0/. Dance by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Keep Going by Jay Someday | https://soundcloud.com/jaysomeday, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Nostalgic Marshmallows by Arthur Vyncke | https://soundcloud.com/arthurvost, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Sound effects from https://www.free-stock-music.com.  The Times by Jay Someday | https://soundcloud.com/jaysomeday, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Environmental Medicine. Participants: Dr Scott Squires, A/Prof. Andrew Coggins, Tim Selvaraj, Yelise Foon, Mariez Gorgi, Shreyas Iyer, Kit Rowe, and Harry Hong. Discussion:Douma, M., Aves, T., Allan, K., Bendall, J., Berry, D., & Chang, W. et al. (2020). First aid cooling techniques for heat stroke and exertional hyperthermia: A systematic review and meta-analysis. Resuscitation, 148, 173-190. https://doi.org/10.1016/j.resuscitation.2020.01.007. Presenter: Tim Selvaraj - emergency medicine trainee at Westmead Hospital. Music/Sound Effects: Maximalism by Punch Deck | https://soundcloud.com/punch-deck, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Slipz (audio logo) by tubebackr | https://soundcloud.com/tubebackr, Music promoted by https://www.free-stock-music.com. Wanna by Ikson | https://youtube.com/ikson, Music promoted by https://www.free-stock-music.com. Waterfall by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Gastroenterology. Participants: Dr Tim O'Sullivan (gastroenterologist and endoscopy fellow), Dr Oksana Williamns (emergency physician), Varan Perananthan (gastroenterology advanced trainee), Maria Martino (emergency medicine advanced trainee), Amanda De Silva, Shreyas Iyer, Jack Ashley.Discussion:Sreedharan, A., Martin, J., Leontiadis, G., Dorward, S., Howden, C., Forman, D., & Moayyedi, P. (2010). Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding. Cochrane Database Of Systematic Reviews. https://doi.org/10.1002/14651858.cd005415.pub3.Presenter: Maria Martino - emergency medicine advanced trainee at Westmead Hospital.  Music/Sound Effects: Good Day by Ikson | https://youtube.com/ikson, Music promoted by https://www.free-stock-music.com.Bring Me The Sky by Scott Buckley | https://soundcloud.com/scottbuckley, Music promoted by https://www.free-stock-music.comAttribution 4.0 International (CC BY 4.0),https://creativecommons.org/licenses/by/4.0/. Night Sky by Leonell Cassio ft. Julia Mihevc | https://soundcloud.com/leonellcassio, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Nightswim by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Slipz (audio logo) by tubebackr | https://soundcloud.com/tubebackr, Music promoted by https://www.free-stock-music.com. Sound effects from https://www.free-stock-music.com.  Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Gastroenterology. Participants: Dr Tim O'Sullivan (gastroenterologist and endoscopy fellow), Dr Oksana Williamns (emergency physician), Varan Perananthan (gastroenterology advanced trainee), Maria Martino (emergency medicine advanced trainee), Amanda De Silva, Shreyas Iyer, Jack Ashley.Discussion:Rout, G., Shalimar, Gunjan, D., Mahapatra, S., Kedia, S., Garg, P., & Nayak, B. (2020). Thromboelastography-guided Blood Product Transfusion in Cirrhosis Patients With Variceal Bleeding. Journal Of Clinical Gastroenterology, 54(3), 255-262. https://doi.org/10.1097/mcg.0000000000001214.Presenter: Varan Perananthan - gastroenterology advanced trainee at Westmead Hospital.  Music/Sound Effects: Faces by RYYZN | https://soundcloud.com/ryyzn, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Help You Out by Leonell Cassio ft. Jonathon Robins | https://soundcloud.com/leonellcassio, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Picasso by Ikson | https://youtube.com/ikson, Music promoted by https://www.free-stock-music.com. Slipz (audio logo) by tubebackr | https://soundcloud.com/tubebackr, Music promoted by https://www.free-stock-music.com. Sound effects from https://www.free-stock-music.com.  Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Gastroenterology. Participants: Dr Tim O'Sullivan (gastroenterologist and endoscopy fellow), Dr Oksana Williamns (emergency physician), Varan Perananthan (gastroenterology advanced trainee), Maria Martino (emergency medicine advanced trainee), Amanda De Silva, Shreyas Iyer, Jack Ashley.Discussion:Horibe, M., Iwasaki, E., Matsuzaki, J., Bazerbachi, F., Kaneko, T., & Minami, K. et al. (2021). Superiority of urgent vs early endoscopic hemostasis in patients with upper gastrointestinal bleeding with high-risk stigmata. Gastroenterology Report, 9(6), 543-551. https://doi.org/10.1093/gastro/goab042. Presenter: Jack Ashley - emergency medicine trainee at Liverpool Hospital.  Music/Sound Effects: Blue Sweater by RYYZN | https://soundcloud.com/ryyzn, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Outside by Ikson | https://youtube.com/ikson, Music promoted by https://www.free-stock-music.com. Medical Examination by MaxKoMusic | https://maxkomusic.com/, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Slipz (audio logo) by tubebackr | https://soundcloud.com/tubebackr, Music promoted by https://www.free-stock-music.com. Sound effects from https://www.free-stock-music.com.  Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Neurology. Participants: Dr Hugo Morales (neurologist), Dr James Tadros (emergency physician), Jessica Stabler (epilepsy fellow), Kim Van Vu, Mariez Gorgi and Shreyas Iyer. Discussion:Chamberlain, J., Kapur, J., Shinnar, S., Elm, J., Holsti, M., & Babcock, L. et al. (2020). Efficacy of levetiracetam, fosphenytoin, and valproate for established status epilepticus by age group (ESETT): a double-blind, responsive-adaptive, randomised controlled trial. The Lancet, 395(10231), 1217-1224. https://doi.org/10.1016/s0140-6736(20)30611-5. Presenter: Jessica StablerMusic/Sound Effects: Help You Out by Leonell Cassio ft. Jonathon Robins | https://soundcloud.com/leonellcassio, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.  Nightswim by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Ocean Love by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. River by MusicbyAden | https://soundcloud.com/musicbyaden, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Slipz (audio logo) by tubebackr | https://soundcloud.com/tubebackr, Music promoted by https://www.free-stock-music.com. Sound effects from https://www.free-stock-music.com.  The Travelling Symphony by Savfk | https://www.youtube.com/savfkmusic, Music promoted by https://www.free-stock-music.comAttribution 4.0 International (CC BY 4.0), https://creativecommons.org/licenses/by/4.0/.  Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Neurology. Participants: Dr Hugo Morales (neurologist), Dr James Tadros (emergency physician), Jessica Stabler (epilepsy fellow), Kim Van Vu, Mariez Gorgi and Shreyas Iyer. Discussion:Keh, R., Scanlon, S., Datta-Nemdharry, P., Donegan, K., Cavanagh, S., & Foster, M. et al. (2022). COVID-19 vaccination and Guillain-Barré syndrome: analyses using the National Immunoglobulin Database. Brain. https://doi.org/10.1093/brain/awac067. Presenter: Kim Van Vu - ED Trainee at Westmead Hospital.Interude Reference: http://www.petervuust.dk/Credits:This episode is produced with help of HETI's Emergency Medicine Training Network 5.Music/Sound Effects: Open Arms by Jay Someday | https://soundcloud.com/jaysomeday, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Motivational Piano Background Music by Nikita Lukyanov | https://soundcloud.com/lukyanovnikita, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.  Second Goodbye by Sapajou | https://soundcloud.com/sapajoubeats, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Slipz (audio logo) by tubebackr | https://soundcloud.com/tubebackr, Music promoted by https://www.free-stock-music.com. Smile by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Sound effects from https://www.free-stock-music.com.  Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Neurology. Participants: Dr Hugo Morales (neurologist), Dr James Tadros (emergency physician), Jessica Stabler (epilepsy fellow), Sai Nagaratnam (neurology advanced trainee), Mariez Gorgi and Shreyas Iyer. Discussion:  Nham, B., Reid, N., Bein, K., Bradshaw, A., McGarvie, L., & Argaet, E. et al. (2021). Capturing vertigo in the emergency room: three tools to double the rate of diagnosis. Journal Of Neurology, 269(1), 294-306. https://doi.org/10.1007/s00415-021-10627-1.Presenter: Sai Nagaratnam. Resources:Emergency Care Institute: https://aci.health.nsw.gov.au/networks/eci. Credits:This episode is produced with help of HETI's Emergency Medicine Training Network 5.Music/Sound Effects: Energetic Electronic Vlog Music | Breeze by Alex-Productions | https://www.youtube.com/channel/UCx0_M61F81Nfb-BRXE-SeVA,Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Medical Examination by MaxKoMusic | https://maxkomusic.com/, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Miss You by RYYZN | https://soundcloud.com/ryyzn, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Sound effects from https://www.free-stock-music.com.  Vamos by MBB & LiQWYD | https://soundcloud.com/mbbofficial, https://soundcloud.com/liqwyd, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Why'd You Wanna End by Leonell Cassio ft. Alex Lippett | https://soundcloud.com/leonellcassio, Music promoted by https://www.free-stock-music.com, Attribution-ShareAlike 4.0 International (CC BY-SA 4.0), https://creativecommons.org/licenses/by-sa/4.0/.  Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

Theme: Paediatrics. Participants: Dr Kerf Tan (emergency physician), Dr Karl Pobre (paediatric emergency physician and paediatrician), Mariez Gorgi, Amanda De Silva, Shreyas Iyer, Harry Hong, and Samoda WilegodaDiscussion:Bourke, E., Say, D., Carison, A., Hill, A., Craig, S., & Hiscock, H. et al. (2021). Emergency mental health presentations in children with autism spectrum disorder and attention deficit hyperactivity disorder. Journal Of Paediatrics And Child Health, 57(10), 1572-1579. https://doi.org/10.1111/jpc.15535.Presenter: Shreyas Iyer.Summary: This was a retrospective cross-sectional study which aimed to explore the issues faced by young people with a known diagnosis of autism spectrum disorder (ASD) or attention deficit hyperactivity disorder (ADHD) presenting to the emergency department with a mental health complaint. This study found 374 mental health presentations to the Royal Children's Hospital in Melbourne in 2018 in which patients had a background of ASD and/or ADHD (in the age group of 7 to 17 years). This represented 28% of mental health presentations for this specified age group. Those with a diagnosis of both ADHD and ASD were more likely to require ambulance or police transport to hospital (RR 1.5).  Children with ADHD (with or without ASD) were at a higher risk of being brought to hospital under section.  The most common presentation for both the ADHD and ASD cohorts was acute severe behavioural disturbance.  Patients with ASD had a significantly increased risk of physical restraint (RR 2.8), chemical restraint (RR 2.8) and of seclusion (RR 3.3). It is important to understand what ASD and ADHD are and what the perspective of the child might be so that we can approach these patients with empathy and try and avoid potential triggers for behavioural escalation.    Take-Home Points: This study gives numbers to support what we already know; that patients with ASD and ADHD are both at structural risk of suffering secondary trauma in the emergency department because of the environment.  When assessing these patients, involve senior and experienced clinicians early to try and expedite their journey through the emergency department.  There needs to be systemic change with regards to the design of our emergency departments to better manage these patients; this will require input from an executive level.   Credits:This episode is produced with help of HETI's Emergency Medicine Training Network 5.Music/Sound Effects Energetic Electronic Vlog Music | Breeze by Alex-Productions | https://www.youtube.com/channel/UCx0_M61F81Nfb-BRXE-SeVA, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Jolly Way by Artegon | https://soundcloud.com/artegon, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Nightswim by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Second Goodbye by Sapajou | https://soundcloud.com/sapajoubeats, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Slipz (audio logo) by tubebackr | https://soundcloud.com/tubebackr, Music promoted by https://www.free-stock-music.com. Sound effects from https://www.free-stock-music.com.  Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

Theme: Paediatrics. Participants: Dr Kerf Tan (emergency physician), Dr Karl Pobre (paediatric emergency physician and paediatrician), Mariez Gorgi, Shreyas Iyer, Harry Hong, and Samoda WilegodaDiscussion:Dainty, K., Atkins, D., Breckwoldt, J., Maconochie, I., Schexnayder, S., & Skrifvars, M. et al. (2021). Family presence during resuscitation in paediatric and neonatal cardiac arrest: A systematic review. Resuscitation, 162, 20-34. https://doi.org/10.1016/j.resuscitation.2021.01.017.Presenter: Mariez Gorgi (emergency medicine advanced trainee).Summary: This systematic review set out to determine the impact of family presence during resuscitation (specifically in cardiac arrest) on patient outcomes, family-centered outcomes and healthcare-provider outcomes. A total of 38 papers were included in the review; consisting of observational studies, qualitative interviews or surveys, spanning from 1999 to 2019 in 11 different countries. No papers explored the impact of family presence on patient outcome. Most parents wished to be offered the opportunity to be present in the resuscitation in order to provide comfort to their child, as well as assisting in accepting the outcome and knowing that everything that could be done had been done for their child.  The opinion of healthcare providers was more widely varied, citing the concern of psychological trauma to the parents, interference with management of the patient and stress on the treating team (performance-related anxiety).  However, the more experienced a healthcare worker with having family presence in a resuscitation, the more agreeable they were to this.  However, the evidence provided in all papers was of very low quality, and there is an urgent need for better quality data surrounding this topic.  Important things to consider with family presence is to flag that you may need them to leave the room during the resuscitation, and having a dedicated support person for the family present.  Hot and cold debriefs involving all relevant staff (paramedics, nursing staff, allied health, doctors) are also incredibly important following a resuscitation such as this.   Take-Home Points:  It would be great to have better studies looking into family presence in resuscitation (looking into outcomes for the patients themselves as well as better qualitative data looking into what happens to families and healthcare workers afterwards).  If there is family around, they should be asked whether they want to be present in the resuscitation.  There should be a resource allocated to families to prevent their presence taking away from the resuscitation itself.  If you are struggling following a resuscitation, seek support.  Resources (to support doctor well-being) -  Applications: Shift (Black Dog Institute app for healthcare workers), Calm, Headspace, Feeling Good, Smiling Minds, Insight Timer.   JMO support line (NSW): 1300 566 321. Employee Assistance Program (free confidential service for all NSW Health employees) - 1300  687 327.  Doctors for doctors: www.drs4drs.com.au. Beyond Blue: 1300 224 636. Lifeline: 13 11 14.  Suicide call-back service: 1300 659 467.  Credits:This episode is produced with help of HETI's Emergency Medicine Training Network 5.Music/Sound Effects Breathe by Roa Music | https://soundcloud.com/roa_music1031, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Emotional Piano Improvisation by Alexander Nakarada | https://www.serpentsoundstudios.com, Music promoted by https://www.free-stock-music.com, Attribution 4.0 International (CC BY 4.0), https://creativecommons.org/licenses/by/4.0/. Inspiration by MaxKoMusic | https://maxkomusic.com/, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.  Sound effects from https://www.free-stock-music.com.  Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

Theme: Paediatrics. Participants: Dr Kerf Tan (emergency physician), Dr Karl Pobre (paediatric emergency physician and paediatrician), Yelise Foon, Mariez Gorgi, Shreyas Iyer, Harry Hong, and Samoda WilegodaDiscussion:Goyal, M., Chamberlain, J., Webb, M., Grundmeier, R., Johnson, T., & Lorch, S. et al. (2020). Racial and ethnic disparities in the delayed diagnosis of appendicitis among children. Academic Emergency Medicine, 28(9), 949-956. https://doi.org/10.1111/acem.14142.Presenter: Yelise Foon.Summary: Delay in the diagnosis of appendicitis is associated with perforation and significant subsequent morbidity.  Currently the pre-operative perforation rate for appendicitis is 30%.  Some known risk factors for a delayed diagnosis for appendicitis include a young age, female gender, African-American race, non-English speaking backgrounds and government insurance factors (predominantly in the US).  This was a multi-centre retrospective cohort study conducted over 3 years utilizing the PECARN registry, which aimed to compare the rate of appendiceal perforation, delayed diagnosis of appendicitis and diagnostic imaging use among different ethnicities. Of the 7298 children diagnosed with appendicitis where race/ethnicity data was collected, 34.9% of non-Hispanic white children had a perforated appendix, compared with 36.5% of non-Hispanic black children.  Non-Hispanic black children also had higher rates of delayed diagnosis (defined as having a relevant emergency visit in the week prior to diagnosis): at 4.7% compared with 2.0% for non-Hispanic white children.  Further non-Hispanic black children with a delayed diagnosis of appendicitis were less likely to undergo definite imaging (including MRI, ultrasound, or CT) compared with their non-Hispanic white counterparts (with 28.2% versus 46.2% undergoing imaging).  However, given that this study came out of the US, the generalisability of this study to Australian emergency departments is unclear.  Health literacy is likely to be a large contributor to delayed presentation of appendicitis and something to be carefully considered when treating any child (and their family).  There are tools such as the Paediatric Appendicitis Score (PAS) and the Alvarado Score which may assist in objectively quantifying the possibility of appendicitis (particularly for junior staff).   Take-Home Points:It is important for us to consider how we can minimise racial and ethnic disparities and make sure we are conscious of them. Credits:This episode is produced with help of HETI's Emergency Medicine Training Network 5.Music/Sound Effects Feel Me by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. In The Eyes by Peyruis | https://soundcloud.com/peyruis, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. It's All Good by Roa Music | https://soundcloud.com/roa_music1031, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Love Trip by Sarah Jansen Music | https://soundcloud.com/sarahjansenmusic, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Mamacita by Mike Leite | https://soundcloud.com/mikeleite, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Slipz (audio logo) by tubebackr | https://soundcloud.com/tubebackr, Music promoted by https://www.free-stock-music.com. Sound effects from https://www.free-stock-music.com.  Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

Theme: Cardiology.Participants: Dr Karan Rao (cardiologist), Dr Nick Moore (ED consultant), Dr Hao Tran (cardiology advanced trainee), David Emmerig (ED trainee), Aran Sandrasegaran, Amanda De Silva, Pramod Chandru, Shreyas Iyer, and Samoda WilegodaDiscussion:Stewart, J., Lu, J., Goudie, A., Bennamoun, M., Sprivulis, P., Sanfillipo, F., & Dwivedi, G. (2021). Applications of machine learning to undifferentiated chest pain in the emergency department: A systematic review. PLOS ONE, 16(8), e0252612. https://doi.org/10.1371/journal.pone.0252612.Presenter: Hao Tran.Credits:This episode was produced by HETI's Emergency Medicine Training Network 5.Music/Sound Effects Descriptions by RYYZN | https://soundcloud.com/ryyzn, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Got My Love by LiQWYD & Markvard | https://www.liqwydmusic.com, https://soundcloud.com/markvard, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Sunset Beach by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Sound effects from https://www.free-stock-music.com.  Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

Theme: Cardiology.Participants: Dr Karan Rao (cardiologist), Dr Nick Moore (ED consultant), Dr Hao Tran (cardiology advanced trainee), David Emmerig (ED trainee), Aran Sandrasegaran, Amanda De Silva, Pramod Chandru, Shreyas Iyer, and Samoda WilegodaDiscussion:Boyle, R., & Body, R. (2021). The Diagnostic Accuracy of the Emergency Department Assessment of Chest Pain (EDACS) Score: A Systematic Review and Meta-analysis. Annals Of Emergency Medicine, 77(4), 433-441. https://doi.org/10.1016/j.annemergmed.2020.10.020.Presenter: David Emmerig. Credits:This episode was produced by HETI's Emergency Medicine Training Network 5.Music/Sound Effects Ascension by Keys of Moon | https://soundcloud.com/keysofmoon, Music promoted by https://www.free-stock-music.comAttribution 4.0 International (CC BY 4.0), https://creativecommons.org/licenses/by/4.0/.  Descriptions by RYYZN | https://soundcloud.com/ryyzn, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Maximalism by Punch Deck | https://soundcloud.com/punch-deck, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Something 'bout July by RYYZN | https://soundcloud.com/ryyzn, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Sound effects from https://www.free-stock-music.com.  Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

Theme: Cardiology.Participants: Dr Karan Rao (cardiologist), Dr Nick Moore (ED consultant), Dr Hao Tran (cardiology advanced trainee), David Emmerig (ED trainee), Aran Sandrasegaran, Amanda De Silva, Pramod Chandru, Shreyas Iyer, and Samoda WilegodaDiscussion:Green, S., & Schriger, D. (2021). A Methodological Appraisal of the HEART Score and Its Variants. Annals Of Emergency Medicine, 78(2), 253-266. https://doi.org/10.1016/j.annemergmed.2021.02.007. Presenter: Shreyas Iyer. Credits:This episode was produced by HETI's Emergency Medicine Training Network 5.Music/Sound Effects Descriptions by RYYZN | https://soundcloud.com/ryyzn, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Feel It by MBB feat. JV Saxx | https://soundcloud.com/mbbofficial, https://www.instagram.com/JVSAXX/, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0, Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US Nothing Better by Vendredi ft. ELLE | https://soundcloud.com/vendrediduo, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Medical Examination by MaxKoMusic | https://maxkomusic.com/, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.  Sound effects from https://www.free-stock-music.com.  Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

Theme: Workplace Violence. Participants: Dr Margaret Murphy, Dr Lex Narushevich, Arvind Karthikeyan, Adamina Drazkiewicz, Aran Sandrasegaran, Amanda De Silva, Pramod Chandru, Harry Hong, Shreyas Iyer, and Caroline Tyers. Discussion:Davids J, Murphy M, Moore N, Wand T, Brown M. Exploring staff experiences: A case for redesigning the response to aggression and violence in the emergency department. Int Emerg Nurs. 2021 Jul;57:101017. doi: 10.1016/j.ienj.2021.101017. Epub 2021 Jun 24. PMID: 34174545.  Presenter:Amanda De Silva (emergency medicine trainee at Westmead Hospital). Summary:  It is widely recognized that emergency departments (EDs) are a high-risk environment when it comes to violence towards healthcare workers.  A big contributor to this is the environment in the ED – it is chaotic, messy, busy, and sees a large turnover of patients. Compounded by access block and understaffing, this often exacerbates tense and potentially volatile situations.  The Australian College of Emergency Medicine has created a policy regarding violence in emergency departments to provide a guideline by which departments can maintain a safe working environment.  They examine the Code Black response and identify important elements of ED design to encourage a positive patient journey through the ED.  This observational study was conducted in the Western Sydney Local Health district across four hospitals, one of which is Westmead Hospital.  It involved interviewing 20 staff members from across the four sites to gauge their personal experience with violence in the emergency department. The data was analyzed and codes were created to capture concepts in the data.  The study identified several points of interest when it comes to Code Blacks.  Perpetrators of these events tended to be patients who had presented with drug or alcohol-related illness, as well as mental illness.  There are several common triggers of violence, including extensive wait times, frustration/fear/anxiety, and being involuntarily detained for psychiatric care.  Staff members feel undertrained when it comes to responding to violence in the ED – 6/20 staff reported not being given formal training when starting their job in ED, while many others reported learning through on-the-job training and observation.  Good communication was identified as crucial to managing an escalating situation.  Staff members were unsure when to activate a Code Black, and also reported feeling reluctant to call one for fear of interrupting other busy colleagues.  There is no culture of formal debriefing after a Code Black, and staff members are often left to manage their own stress.   Take-Home Points  Communication and de-escalation skills are vital to the Code Black response and in preventing violence in the ED.  Early escalation of concerns about agitated patients is important, to allow for these communication skills to be utilized and to diffuse escalating situations before they reach a point of physical violence.  More education is required around the Code Black response, with particular attention paid to the specific roles of each member of the response team and how they can assist in managing violent situations.  Credits:This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney and, Deepa Dasgupta. Music/Sound Effects Beach by Limujii | https://soundcloud.com/limujii, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Eternal Sunshine by LiQWYD & Luke Bergs | https://www.liqwydmusic.com, https://www.lukebergsmusic.comMusic promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.  Lie 2 You by Leonell Cassio ft. Dylan Emmet | https://soundcloud.com/leonellcassio, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.  Sound effects from https://www.free-stock-music.com.  Sittin' Throwin' Rocks by Leonell Cassio ft. Lily Hain | https://soundcloud.com/leonellcassio, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

Theme: Workplace Violence. Participants: Dr Margaret Murphy, Dr Lex Narushevich, Arvind Karthikeyan, Adamina Drazkiewicz, Amanda De Silva, Pramod Chandru, Harry Hong, Shreyas Iyer, and Caroline Tyers. Discussion:Jeong, I., & Kim, J. (2018). The relationship between intention to leave the hospital and coping methods of emergency nurses after workplace violence. Journal Of Clinical Nursing, 27(7-8), 1692-1701. https://doi.org/10.1111/jocn.14228. Presenter:Dr Arvind Karthikeyan - ED Trainee at Tweed Hospital.Summary: The main aim of this study was to identify the relationship between emergency nurses' intention to leave the hospital and their coping methods following workplace violence. The coping methods were split into emotion-focused and problem-focused mechanisms.  The study was a cross-sectional study in which surveys were sent out to 7 hospitals in 7 different cities around Korea (completed by nursing staff working in the emergency department). They received 246 returned surveys, and 32 were incomplete, leaving 214 questionnaires to derive their results from. Verbal abuse was the most frequent violence experience.  Of those who experienced violence, 61% considered leaving the hospital. Emotion-focused coping appeared to have a stronger association with nurses' intention to leave following workplace violence.  This highlights the need for resources and processes in place within the emergency department to support staff and encourage healthy coping mechanisms in response to incidents of violence.  Take-Home Points:  This article highlights the importance of healthy coping strategies. Having a more formalised, standardised counselling service for healthcare providers would be extremely beneficial (ideally an ‘opt-out' service).   Credits:This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney and, Deepa Dasgupta. Music/Sound Effects Paradise by MBB | https://soundcloud.com/mbbofficial, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.  Sound effects from https://www.free-stock-music.com.  Youth by JayJen & Krishi Sarma | https://soundcloud.com/jayjenmusic, Music promoted by https://www.free-stock-music.com,Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

Theme: Workplace Violence. Participants: Dr Margaret Murphy, Dr Lex Narushevich, Arvind Karthikeyan, Adamina Drazkiewicz, Aran Sandrasegaran, Amanda De Silva, Pramod Chandru, Harry Hong, Shreyas Iyer, and Caroline Tyers. Discussion:Nikathil, S., Olaussen, A., Symons, E., Gocentas, R., and Mitra, B., 2017. Review article: Workplace violence in the emergency department: A systematic review and meta-analysis. Emergency medicine Australasia : EMA. 29. 10.1111/1742-6723.12761. (Nikathil et al., 2017). Presenter: Aran Sandrasegaran - ED SRMO at Westmead Hospital.Summary: Workplace violence in the emergency department is a systematic review and meta-analysis published in 2017 in EMA by Nikathil, et al. From 7235 abstracts, 22 studies were deemed relevant. A meta-analysis was conducted on the primary outcome variable-proportion of violent patients among total ED presentations. A secondary meta-analysis used studies reporting on the proportion of drug and alcohol-affected patients occurring within the violent population. It reported the prevalence of violence in Australian Emergency Departments (EDs) as at least 36 events per 10 000 patients, with about 45 in every 100 violent presentations estimated to be associated with alcohol and/or other drugs. These findings had good confidence intervals. The study reported that young males were the young (aged between 28-42 years) males were the primary demonstrators of violence. Due to statistical heterogeneity in study methodology, definitions and rates, and under-reporting the results are not a full reflection of the incidence of WPV in EDs.    Take-Home Points: Studies examining violence in the ED consistently report a high prevalence of workplace violence (WPV). Nikithil et al. is the only recent study to confirm a high proportion of violence in terms of patient presentation. Drugs and alcohol were commonly associated with violent episodes, often in the absence of an underlying psychiatric diagnosis. The findings of this study are likely an underrepresentation due to statistical heterogeneity and under-reporting and analysts and future studies must consider this. Public health and legal interventions are urgently required to curb workplace violence in EDs. References:  International Labour Office/International Council of Nurses/World Health Organization/Public Services International. Framework Guidelines for Addressing Workplace Violence in the Health Sector. Geneva: International Labour Office, 2002. Nikathil, S., Olaussen, A., Symons, E., Gocentas, R., O'Reilly, G. and Mitra, B., 2017. Increasing workplace violence in an Australian adult emergency department. Emergency Medicine Australasia, 30(2), pp.181-186. Credits:This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney and, Deepa Dasgupta. Music/Sound Effects Cinematic Epic Music | Story by Alex-Productions | https://www.youtube.com/channel/UCx0_M61F81Nfb-BRXE-SeVAMusic promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License,  https://creativecommons.org/licenses/by/3.0/deed.en_US.  Eternal Sunshine by LiQWYD & Luke Bergs | https://www.liqwydmusic.com, https://www.lukebergsmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.  Medical Examination by MaxKoMusic | https://maxkomusic.com/, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.  Sound effects from https://www.free-stock-music.com.  Vacations by Mehul ShaRma | https://www.instagram.com/mehulsharma4284/, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

Theme: Christmas SpecialParticipants: Kit Rowe, Harry Hong, Caroline Tyers and Shreyas Iyer.   Discussion:Mohammad, M., Karlsson, S., Haddad, J., Cederberg, B., Jernberg, T., & Lindahl, B. et al. (2018). Christmas, national holidays, sport events, and time factors as triggers of acute myocardial infarction: SWEDEHEART observational study 1998-2013. BMJ, k4811. https://doi.org/10.1136/bmj.k4811.Ferner, R., & Aronson, J. (2020). Harms and the Xmas factor. BMJ, m4067. https://doi.org/10.1136/bmj.m4067.Presenter:Caroline Tyers. Credits:This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney and, Deepa Dasgupta. Music/Sound Effects  Arcade by Flanzen | https://soundcloud.com/flanzen, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Jingle Bells by Alexander Nakarada | https://www.serpentsoundstudios.com, Music promoted by https://www.free-stock-music.comAttribution 4.0 International (CC BY 4.0), https://creativecommons.org/licenses/by/4.0/. Sound effects from https://www.free-stock-music.com. Wakeboard by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Winter by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

Theme: Christmas SpecialParticipants: Pramod Chandru, Kit Rowe, Caroline Tyers and Shreyas Iyer.   Discussion:Snake Bites - a case from The Australiasian Medical Gazette (from the late 1800s). Presenter:Kit Rowe. Credits:This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney and, Deepa Dasgupta. Music/Sound Effects We Wish You A Merry Christmas by Alexander Nakarada | https://www.serpentsoundstudios.com, Music promoted by https://www.free-stock-music.com, Attribution 4.0 International (CC BY 4.0), https://creativecommons.org/licenses/by/4.0/.  Sound effects from https://www.free-stock-music.com. Time by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Time by Mike Leite | https://soundcloud.com/mikeleite, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

Theme: Christmas SpecialParticipants: Harry Hong, Kit Rowe, Caroline Tyers and Shreyas Iyer.   Discussion:Brookfield, C., Phillips, P., & Shorten, R. (2019). Q fever—the superstition of avoiding the word “quiet” as a coping mechanism: randomised controlled non-inferiority trial. BMJ, l6446. https://doi.org/10.1136/bmj.l6446.Presenter:Harry Hong - ED trainee at Westmead Hospital. Credits:This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney and, Deepa Dasgupta. Music/Sound Effects Christmas Is Coming by MaxKoMusic | https://maxkomusic.com/, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Sound effects from https://www.free-stock-music.com. Winter by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

Theme: Pulmonary Embolism.Participants: Dr Bristi Roy (respiratory physician), Dr Vanessa Wong (respiratory advanced trainee), Dr Arwen Morath (emergency physician), Dr Pramod Chandru, Kit Rowe, and Caroline Tyers.   Discussion:van der Pol, L., Tromeur, C., Bistervels, I., Ni Ainle, F., van Bemmel, T., & Bertoletti, L. et al. (2019). Pregnancy-Adapted YEARS Algorithm for Diagnosis of Suspected Pulmonary Embolism. New England Journal Of Medicine, 380(12), 1139-1149. https://doi.org/10.1056/nejmoa1813865.Presenter: Dr Vanessa Wong (respiratory advanced trainee at Westmead Hospital). Summary: PE is a leading cause of maternal death in pregnant women.  However, the radiation exposure to both mother and foetus involved in the diagnosis of PE remains a complex issue.  This is a multi-centre prospective study that utilised the YEARS algorithm (published several years prior) and a D-dimer to predict PE in pregnant women presenting with suspected PE.  The study was conducted over a 5-year period from October 2013 to May 2019.  It looked at pregnant women over the age of 18 years that had been referred to ED or the obstetric ward with concerns for potential PE.   The YEARS algorithm focuses on the 3 elements of the Well's criteria considered to be the highest yield (being clinical signs of DVT, haemoptysis, and PE as the most likely diagnosis).   As part of the algorithm, those patients with clinical signs of DVT underwent a doppler US and were commenced on anticoagulation (and presumed to have a PE) if this was positive for DVT.   PE was excluded in those patients without any of the YEARS criteria and with a D-dimer less than 1.0.   PE was also excluded in those who had 1-3 of the YEARS criteria and a D-dimer < 0.5, while those with 1-3 of the YEARS criteria and a D-dimer > 0.5 went on to have a CTPA to look for PE.  The primary outcome was the cumulative incidence of symptomatic VTE on objective testing during a 3 month follow-up period.   The secondary outcome was the proportion of patients in whom CTPA was not indicated to safely exclude PE.   There were 510 pregnant women recruited into the study (46% of whom were in the third trimester of pregnancy) with 12 being excluded   Of the 498 patients included, 4 had signs and symptoms of DVT with a positive doppler ultrasound.  20 patients of the remaining 494 were diagnosed with PE as part of the pathway.  During follow-up, one popliteal DVT was diagnosed, and no patient had PE.  CTPA was avoided in 195 patients (39%).   Take-Home Points: This provides a framework for assessing patients, particularly in the first and second trimesters of pregnancy (and may aid in safely excluding PE without CTPA for low-risk patients).  However, in high-risk patients, pursuing a scan remains the most appropriate approach.   References: van der Hulle T, Cheung WY, Kooij S, et al. Simplified diagnostic management of suspected pulmonary embolism (the YEARS study): a prospective, multicentre, cohort study. Lancet 2017;390:289-297. Credits:This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney and, Deepa Dasgupta. Music/Sound Effects Dusk by MusicbyAden | https://soundcloud.com/musicbyaden, Music promoted by https://www.free-stock-music.comCreative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. It's Time by Jay Someday | https://soundcloud.com/jaysomeday, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Magic by Savfk | https://www.youtube.com/savfkmusic, Music promoted by https://www.free-stock-music.com, Attribution 4.0 International (CC BY 4.0), https://creativecommons.org/licenses/by/4.0/. My Old East Coast by Vendredi feat. Melanie | https://soundcloud.com/vendrediduo, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Nightswim by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Sound effects from https://www.free-stock-music.com. Tropical Fever by LiQWYD & Luke Bergs | https://www.liqwydmusic.com, https://soundcloud.com/bergscloud, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

Theme: Pulmonary Embolism.Participants: Dr Jimmy Chien (senior respiratory physician), Dr Kevin Lai (senior emergency physician), Dr Arwen Morath (emergency physician), Dr Pramod Chandru, Harry Hong, Kit Rowe, and Caroline Tyers.   Discussion:The Use of PE Response Teams (PERT) in the Care of High-Risk Pulmonary Embolism   This is a discussion with senior respiratory physician Dr Jimmy Chien who helped to develop the PERT system at Westmead Hospital.  Within this segment, “Venoarterial Extracorporeal Membrane Oxygenation in Massive Pulmonary Embolism-Related Cardiac Arrest: A Systematic Review” by Scott et al, is also discussed.  The graphs included in this study are examined closely, so we would recommend reviewing this article while listening to this segment.   Summary: The first place to establish a PE response team was in Massachusetts.   It took 2 years to form the PE response team at Westmead Hospital (involving a respiratory physician, an ED physician, an intensivist, an interventional radiologist, a vascular surgeon, and a haematologist).  We call a PERT call for patients who have high or intermediate-risk PE.   High-risk PE entails a patient with haemodynamic instability (in whom mortality lies between 25-50%).  Within the intermediate group, there are two subdivisions: intermediate high-risk (with radiological signs of RV strain with an increase in troponin or pro-BNP) and intermediate low-risk (with either evidence of RV strain OR a troponin rise, or a PE-severity index score class III-IV).   When looking within the high-risk PE group, the age group with the worst outcomes (both in PE and with thrombolysis) was those aged > 65 years.   The study exploring VA-ECMO in patients with high-risk PE and cardiac arrest (detailed above) also demonstrated that survival rates below the age of 65 years were relatively high, while those over the age of 65 years had a significantly higher mortality rate.  The Westmead PERT team has data on 52 patients thus far; of whom 21% were high-risk, 58% were intermediate high-risk and 21% were intermediate low-risk.  The most recent analysis of mortality for the Westmead PERT team high-risk PE patients demonstrated a mortality rate of only 10% (compared with the previously stated 25-50%).   Take-Home Points: In addition, the length of stay for these patients managed by the PERT team has been reduced from 13 days pre-PERT to around 8.5 days.   The PERT team facilitates high-level nuanced conversations dependent on the clinical judgment, experience, and knowledge of the specialists involved.  The development of this PERT team has resulted in improved outcomes for PE patients, and more streamlined care for these patients while in the emergency department and on the ward.   References:  Scott, J., Gordon, M., Vender, R., Pettigrew, S., Desai, P., Marchetti, N., Mamary, A., Panaro, J., Cohen, G., Bashir, R., Lakhter, V., Roth, S., Zhao, H., Toyoda, Y., Criner, G., Moores, L. and Rali, P., 2021. Venoarterial Extracorporeal Membrane Oxygenation in Massive Pulmonary Embolism-Related Cardiac Arrest: A Systematic Review*. Critical Care Medicine, 49(5), pp.760-769.  Piazza, G., Hohlfelder, B., Jaff, M., Ouriel, K., Engelhardt, T., Sterling, K., Jones, N., Gurley, J., Bhatheja, R., Kennedy, R., Goswami, N., Natarajan, K., Rundback, J., Sadiq, I., Liu, S., Bhalla, N., Raja, M., Weinstock, B., Cynamon, J., Elmasri, F., Garcia, M., Kumar, M., Ayerdi, J., Soukas, P., Kuo, W., Liu, P. and Goldhaber, S., 2015. A Prospective, Single-Arm, Multicenter Trial of Ultrasound-Facilitated, Catheter-Directed, Low-Dose Fibrinolysis for Acute Massive and Submassive Pulmonary Embolism. JACC: Cardiovascular Interventions, 8(10), pp.1382-1392.  Herzallah, K., Saleh, Y., Elkinany, S., Abdelkarim, O., Abdelnabi, M. and Almaghraby, A., 2020. Saddle pulmonary embolism successfully managed by thrombus aspiration followed by ultrasound-enhanced catheter-directed thrombolysis. Journal of the American College of Cardiology, 75(11), p.2445.  Credits:This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney and, Deepa Dasgupta. Music/Sound Effects Be Myself by Nettson | https://soundcloud.com/nettson, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Chile by ASHUTOSH | https://soundcloud.com/grandakt, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Happier by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Memories by Roa Music | https://soundcloud.com/roa_music1031, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Sound effects from https://www.free-stock-music.com. Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

Theme: Pulmonary Embolism.Participants:  Dr Kevin Lai (senior emergency physician), Dr Arwen Morath (emergency physician), Dr Pramod Chandru, Naveendran Rajendran, Harry Hong, Samoda Wilegoda Mudalige, Kit Rowe and Caroline Tyers.   Discussion:Robert-Ebadi, H., Robin, P., Hugli, O., Verschuren, F., Trinh-Duc, A., & Roy, P. et al. (2021). Impact of the Age-Adjusted D-Dimer Cutoff to Exclude Pulmonary Embolism. Circulation, 143(18), 1828-1830. https://doi.org/10.1161/circulationaha.120.052780. Presenter: Naveendran Rajendran - ED Resident at Westmead Hospital. Summary: This was a multinational, prospective, diagnostic outcome study designed to determine the impact of the use of age-adjusted D-dimer on clinical practice in the outpatient setting.   This study follows on from the ADJUST-PE study released in 2014, which established the safety of using an age-adjusted D-dimer cut-off retrospectively.   The primary outcome was the incidence of symptomatic thromboembolic events in the period following which a PE had been excluded in a patient based on a negative D-dimer (with the age-adjusted cut-off), and a low pre-test probability.  The secondary outcome looked at the number of D-dimer results which sat between the conventional cut-off of 0.5 and the age-adjusted value in the whole cohort, as well as more specifically in those aged over 75 years (to determine the diagnostic yield of the age-adjusted cut-off).   Of the 1421 patients with a low pre-test probability for PE and a D-dimer below 0.5, only 1 was found to have a non-fatal PE.  The proportion of patients with D-dimers that fell between the conventional cut-off of 0.5 and the age-adjusted cut-off was 301 of 1507 patients, with 0 identified thromboembolic events noted during follow-up.   This translates to a 20% increase in the number of negative D-dimer tests using the age-adjusted cut-off, with an even more pronounced increase of 67% in the group of patients over the age of 75.   Take-Home Points: The age-adjusted D-dimer is a potential tool to assist with risk-stratifying patients presenting with possible PE.  Previous concerns regarding various assays may have limited the implementation of an age-adjusted D-dimer in prior years.  Further audits to quantify the impact of utilizing the age-adjusted D-dimer (with regards to imaging, treatment, costs, etc.) are required.   References: Righini M, Van Es J, Den Exter P. Age-Adjusted D-Dimer Cutoff Levels to Rule Out Pulmonary Embolism: The ADJUST-PE Study. Journal of Vascular Surgery. 2014;59(5):1469.Credits:This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney and, Deepa Dasgupta. Music/Sound Effects Got My Love by LiQWYD & Markvard | https://www.liqwydmusic.com, https://soundcloud.com/markvard, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Medical Examination by MaxKoMusic | https://maxkomusic.com/, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.  Shine by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Sound effects from https://www.free-stock-music.com. Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

Theme: General SurgeryParticipants: Dr Michael Haddock (ED consultant), Dr Sergei Tsakanov (general surgical Fellow), Sunny Rajput (ED trainee), Edgardo Solis (general surgical registrar), Shreyas Iyer, Samoda Wilegoda Mudalige, Kit Rowe, Caroline Tyers, Harry Hong and Yelise Foon. Discussion:A Randomized Trial Comparing Antibiotics with Appendectomy for Appendicitis. The CODA Collaborative. (2020), 383(20), 1907-1919. https://doi.org/10.1056/nejmoa2014320.Summary: This study was undertaken in the United States towards the end of their initial COVID-19 wave.   The results were reported at 90-days, however, they still have analysis intended for the first 2 years (so it is an ongoing study).    It looked at patients 18 years or older, with image-confirmed acute appendicitis in emergency departments across 25 centers in the United States.    Septic, diffusely peritonitic, complicated, or recurrent appendicitis patients were excluded.   The study compared antibiotics (with IV antibiotics for at least the first 24 hours, followed by oral antibiotics to complete a total 10-day course) with appendectomy.   The primary outcome was a ‘general health survey' which was conducted at the 24 hours, 1-, 2-, and 4-weeks, and 3-, 6- and 12 months following discharge.   The secondary outcomes included resolution of symptoms, adverse events, complications (including abscess formation, C.diff infection, the requirement of a more extensive operation, perforation, and neoplasm rates), ED presentations related to appendicitis, length of stay in hospital, and days of missed work (for patients and caregivers).   The results of this study found that antibiotics were non-inferior to appendectomy at 30-days according to the ‘general health survey'.   However, representation to the emergency department was significantly higher for those treated with antibiotics (9% compared with 4% for appendectomy patients), as were adverse events.   It is important to note that the presence of an appendicolith is an indicator for complicated appendicitis (carrying the risk of ischemia and subsequent appendiceal perforation) and an increased likelihood of failed management with IV antibiotics alone- however, such patients were included in this study.   Take-Home Points: Acute uncomplicated appendicitis may be considered for treatment with IV antibiotics alone, although an appendicolith would still exclude a patient from this at this stage in most cases.   10% of patients treated with IV antibiotics alone will fail in the initial treatment phase and may represent to the emergency department during their antibiotic course.   Thus, the emergency department may start to see a new cohort of patients; rather than ‘post-operative complications', we may start to see ‘post-non-operative complications' (such as recurrence, intra-abdominal abscess, or those from antibiotics themselves).   7/10 of patients will be able to avoid an operation with antibiotics in acute uncomplicated appendicitis.  However, long-term data (over the course of more than 5 years) is still required to characterize this issue further.   Credits:This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney and, Deepa Dasgupta. Music/Sound Effects Sound effects from https://www.free-stock-music.com. Heart Of The Wicked by Cjbeards | https://soundcloud.com/cjbeards, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Nightswim by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Sweet by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. You by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. You're Welcome by RYYZN | https://soundcloud.com/ryyzn, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~