Stephen Fahy

Trying to become a better clinician, one case at a time. Emergency physician, member of an awesome team.

[Stephen Fahy @ED_StephenFahy]

Features and Benefits | QR Code Generator https://t.co/JJvphbO71k

[Stephen Fahy @ED_StephenFahy]

So what do people think of 360 feedback for senior clinicians? Any pearls and pitfalls? And any suggested tools?

[Stephen Fahy @ED_StephenFahy]

@DrSuneth There’s been a relatively fluid interpretation of guidelines for testing, as in it changes every shift!

[Stephen Fahy @ED_StephenFahy]

Reflections from my last shift
ED already inundated with worried well Coronavirus pts. When we are inundated with critically unwell pts, we will truly have to consider how we rationalize our care and resources.
We need:
clear guidelines
true collaboration
More PPE!
#COVIDー19

[Stephen Fahy @ED_StephenFahy]

Reflections from my last clinical shift.

Spont Bacterial Peritonitis often presents with non-specific abdominal pain, ABSENCE of fever & systemic symptoms in patients with ascites.

Have a low threshold for grabbing your ultrasound and doing a diagnostic tap in the ED

[Stephen Fahy @ED_StephenFahy]

Reflections from my last clinical shift

Paediatric intubation tips
1. Expect rapid desaturation-consider bagging through induction
2. Have a NGT ready and watch for stomach insufflation
3. The cords are not as obvious as adults-aim for the glottic inlet

[Stephen Fahy @ED_StephenFahy]

Reflections from my last shift...as a patient

Amazed at the care recently shown to me and my family, but in particular the high level of professionalism.

As clinicians, our professionalism is ALWAYS on show, in everything we say & do.

[Stephen Fahy @ED_StephenFahy]

Reflections from my last clinical shift

The first & most important step in good advanced airway management in the ED:

Good basic airway management

Watch the chest and neck to assess ventilation, proper positioning, ETCO2 on your BVM +/- adjuncts

[Stephen Fahy @ED_StephenFahy]

Reflections from my last clinical shift.

It’s been 7 years since I obtained my Fellowship. Despite my interest in teaching,lots of clinical knowledge drops out of my head. Sometimes on shift my ‘juniors’ are brimming with that knowledge. I am lucky to have such a team around me

[Stephen Fahy @ED_StephenFahy]

Listening to @symon_ben talking at #QPEM19 and realising I’m a very task-oriented listener! And that there are many different types of listening. Understanding all of these and recognising when to switch between them will help us care for our patients better.

[Stephen Fahy @ED_StephenFahy]

Reflections from my last shift

Ive noticed a growing trend of getting formal USS to rule out collections for every cellulitis case
Why?
This is a great ED skill-bedside USS in soft tissue infections:
- confirm cellulitis (cobblestoning)
- define collection
- look for nec fasc

[Stephen Fahy @ED_StephenFahy]

@freelancemedic I agree!!
Not sure why it get such a bad reputation!

[Stephen Fahy @ED_StephenFahy]

Reflections from my last clinical shift

The Bier block - often frowned upon in the ED world - is a very effective method of providing regional anaesthesia for wrist # reductions.

Max Prilocaine dose 2.5mg/kg (0.5ml/kg of 0.5%)

[Stephen Fahy @ED_StephenFahy]

@DrSuneth Nope, it was from the history. Took a while to persuade my inpatient colleagues...

[Stephen Fahy @ED_StephenFahy]

Reflections from my last clinical shift:

Infective endocarditis is often missed because its presentation is insidious and non-specific. Temp is often mildly elevated only

RFs:
IVDU
Rheumatic heart disease
DM
Severe renal disease
Post invasive procedures, not just valves!!!

[Stephen Fahy @ED_StephenFahy]

Reflections from my last clinical shift:

The ED is always busy. Sometimes that leads us to focus more on disposition.

Our goal should always be good assessment and management.

This sometimes get lost in the need to keep patients moving through the department.

[Stephen Fahy @ED_StephenFahy]

Reflections from my last shift

40yo F with sudden onset severe LIF pain. My main ddx ovarian torsion vs renal colic

Some learning points for me:
- bedside urinalysis was v helpful
- I need to improve my USS skills - torsion a lot less likely if normal ovarian architecture

[Stephen Fahy @ED_StephenFahy]

So I’ve run over 400km in preparation for the upcoming Melbourne Marathon but I haven’t raised over $400 yet!
Help push me over the line and support this great cause.
Thank you so much!

https://t.co/UuHngVzWEH

[Stephen Fahy @ED_StephenFahy]

Yup, they usually just tell me what to do and I follow!

[Stephen Fahy @ED_StephenFahy]

Reflections from my last clinical shift:

Febrile neonate:

Prepare your staff to do your full septic workup ASAP - bloods/urine/LP

Draw up your antibiotics whilst the workup is being done.
- Cefotaxime 50mg/kg IV
- Ampicillin 50mg/kg IV
+/- Aciclovir 20mg/kg IV