Kiwiology

Ick! I hated Walraven's Basic Arrythmias, it is what was used for the Paramedic (ICO) modules when I did them, Dubin's ECG Interpretation is where its at .... shaaaaaaaaazam!! OK I have no idea why that got put in there but I just wanted to say shaaaaaaaaaazam! like an old school 1980s African American movie character or something

Freaking New Jerseyites, as a former resident of the State of New York it is my moral duty to hate on people from Jersey, why do you think there's a body of water physically separating the two? Seriously I kid, welcome to the forum, watch out for Kiwi, no flash photography and please keep your hands and feet inside the screen at all times

Peeeeeee-u! does it ever ...

LOL I'd like to see some of those because they probably aren't "physician" level questions but rather make use of knowledge not taught to ambo's in your part of the world It is commonly held that your paramedic books are written to a 10th grade reading level and for that to be the comprehension level for a profession let alone a profession in charge of medical decisions and powerful drugs is a bit concerning ... Awesome, I'd love to see all the references supporting spinal immobilisation and high flow oxygen!

Locum pays crazy insane here but reliance upon locums has been recognised as unsustainable by Health Workforce NZ They have to pay well to match up to what is on offer elsewhere in the world and in some cases to attract anybody; I know one hospital had a single Consultant OB/Gynae and they'd been relying on locums for over two years because nobody wanted to come work there. Wow I am jealous seriously; all of our hospitals are teaching hospitals so they must have a Consultant (board certified/Attending) in whatever speciality they are accredited to offer a training post for however that doesn't mean the Consultant does not work 8 hours a day on-site with the other 16 hours on call.

I'll elaborate; medicine in US seems much more glamorous than here (and I'm not talking about Grey's Anatomy etc) just in general the medical establishment seems to be portrayed in a much higher regard than here or elsewhere eg NHS in UK. Driving down the highway here I haven't seen massive billboards for a hospital or glossy magazine ads; when I was in ED in California for a stomach infection it was like being in a hotel (seriously it was real flash) and the Physician looked more like a male model surfer than a Doctor. I realise there is probably a lot of subjectivity and in-somebodies-endo in there but still, after nearly 2 years in US to me it seemed like Medicine and Physicians are treated a lot better than other places I've lived eg UK

In situations where the House Officer is "alone" in the emergency department it just means they are the only doctor physically present in the emergency department; it happens less than it used to but it still happens; for the nearly three decades I have been alive we've had a shortage in the specialist medical workforce because as a small country we can't compete with the lucrative international salaries/working packages and experience available elsewhere in the world. Take emergency medicine, go to Australia, South Africa or US and you will see more shootings and stabbings in a week than you will in your entire career here. In fact in Australia the pay even for a junior doctor (House Surgeon or Junior Registrar) is up to double what it is here and it's only a four hour flight away! Anyway, yes in some situations the House Surgeon is "running" ED (i.e. the Doctor physically present) but this is usually only overnight in the smaller hospitals and they have a Surgical Registrar on-call as well as a Consultant Emergency Physician. The Surgical Registrar is often (if not always) physically onsite and the Consultant generally has it in his contract he must live within a certain travel time from hospital e.g. 20 minutes. There is also a Medical Registrar (internal medicine) awake in the hospital as well. Our hospital also has ICU but I'm not sure if they have a medical officer on 24 hours; I think after 11pm they have a Reg on site i.e. asleep in the on-call room. Locally ED has a Consultant during the day and a Registrar until 11pm/midnight during the week then at least one House Surgeon sometimes two; in the weekends we have a Reg on overnight. Remember the sixth year of our Medical Degree is our "Intern" year and we are the only country in the world to do this; you have the full responsibilities of a House Surgeon but you cannot prescribe (this may change in the future to some simple things like it was 20 years ago e.g. IV fluids, antibiotics, laxities, analgesia) so really a first year House Surgeon is what would be considered elsewhere in the world in their second post graduate year as far as their experience is concerned.

Come on bro, every emergency department in the country cannot possibly have an Attending (Consultant) Physician 24/7 wait maybe they do if it's only like 4 years of post-graduate training instead of like 7; hmm .... but still, this,

It's called emergency medicine here; the speciality is governed by the Australasian College for Emergency Medicine The correct term here is "emergency department" however some old timers still call it A+E for accident and emergency but that term is not used any more as it now (post 2003) refers to the vocational scope of accident and medical practice or what you would call in US the private urgent care / mini ED clinics. Yes, urgent care is its own speciality here defined by the Medical Council as "The primary care of patients on an after hours or non-appointment basis where continuing medical care is not provided". Many urgent care clinics here just have a GP but some have an A&M qualified doctor and there are two professional qualifications for this; Fellowship of the Accident and Medical Practitioners Association or Fellowship of the College of Urgent Care Physicians. Now we get 75 hot dogs for $25 for our church barbie's so I've got plenty of logs Oh and Emergentologist you should sign up and become a Kiwiology Registrar; that way in a couple years you get Fellowship and can become a Consultant Kiwiologist.

That is like one of the most awesome stories I think I've ever heard ... Good bloody luck finding an after hours dentist here; it's not part of our health system unlike NHS in UK so as private practitioners who work during the week the overwhelming majority choose not to work on the weekend. It's almost as bad finding an after-hours GP but you can always go to the Emergency Department; at the very least they will have an International Medical Graduate first year House Surgeon on duty who has the tiniest amount of acute care experience required to graduate ... but hey he is still a doctor, technically.

Got any ketamine in your hip pouch? That would be being of service, I need to get four teeth extracted and at $200 a tooth that ain't cheap, some ketamine and a bro with the pilers would be you know, free ... and I'd have some good ketamine dreams! so its win-win

Now that is a ROFPMSLMAO moment

A lot of our emergency departments do not have a Consultant (Attending) 24 hours; most are office hours or until midnight only; our local ED has a Registrar on until midnight then it's just two House Surgeons or a House Surgeon and a Senior House Officer. At weekends they have a Reg or Consultant on all night because of the increase in workload due to alcohol, other drugs and assaults. It varies by hospital system (DHB) but here many House Officers working in ED can independently discharge people without senior review; some can't and must speak to the Reg or Consultant. At my local hospital the House Surgeon can discharge people without Specialist review but cannot admit people without referral to the appropriate services' House Surgeon or Registrar; e.g. the Surgical House Officer must be consulted to admit somebody to surgical ward, you'd think the House Officer on the surgical service would be the House Surgeon but no. Now I wonder if that Emergentology bloke's hospital is approved by ACEP or ABEM or KIWI or whoever the heck regulates the training of emergency physicians in US; provided I can take three steps and get a post I can do my vocational training in US. "Yes hello my name is Kiwi and I'm one of the House Officers Junior Doctors; it looks like your bit crook mate you hurt yourself what in the bloody hell did you do to nunnger yourself up that badly how did you manage that? Oh I see you got shot in a gang war, well that's no good be a bit puckeroo eh bro lets have a squiz and if we can't get some number eight wire lets see if we can fix that up, do you have insurance by some chance? you don't hmm well federal law says I have to stablise you regardless but after that it might not be looking so choice for you ow good but I'll be watching telly not at work by then so um yeah ...." I am having visions of Emergentologist looking like Bill Lumbergh out of Office Space or something eh ...

Take it up with the Medical Council then; all post-graduate programs are called "vocational training" here All vocational training programs lead to Fellowship of the appropriate college here, same in AU and I think in the UK; e.g. Emergency Medicine is five years and you become a Fellow of the Australasian College for Emergency Medicine. The cost of medical education in US is absolutely unbelievable; it's roughly NZD75,000 (USD63,000) for NZ, AUD45,000 (USD46,000) in AU, GBP55,000 (USD79,000) for UK compared to like USD200,000 plus ... I'm not having a hack at your blokes system I'm just taking a bit of the piss and I am liking this gig where your doctors (depending on speciality) get paid several hundreds of thousands of dollars per year and get treated like pseudo royalty. I know several anaesthetists who make probably a quarter of a million dollars a year; sorry Intensive Care Medicine my dual-specialisation just changed to emergency medicine and anaesthesia; I need a couple years working in US to pay off my medical school debt of seventy k and save up for a private jet I wonder if that Emergentologist bloke needs an anaesthetist for his private practice in a few years ... And I'm not even going to go near the "unlimited license to practice medicine" thing ... you may find it interesting to note the Medical Council defines cardiology as "The diagnosis and management of patients with complex medical problems which ...include ... cardiology" so you are limited to performing procedures and prescribing medicines specific to that scope (and your general scope which is like generalist GP type medicines) so Conrad Murray wouldn't have been able to prescribe propofol here; that would be restricted to an appropriate vocational scope (emergency medicine, anaesthesia or intensive care medicine and maybe, maybe at a reach palliative care and rural hospital medicine)

Good points there AA I didn't think of haemolysis hmm it would appear sterile water is super duper hypotonic which is really bad haemotajuju Hey I was right, awesome

Hasn't the medical house officer or the surgical registrar arrived yet? I know its not ideal but lets face it its who youre going to get after hours around here until the consultant drives to the hospital in his jammies Yes this lqdy is mega super crook but im not touching it with a ten foot pole except for fluid and 2g.ceftriaxone

Well true

I'm on my phone posting this from the emergency department where there are two, house surgeons, a registrar and a gaggle of nurses on duty plus a couple.students and the ambos drop in once in a while to drop people off Now certainly all three of the medical officers can tell you what hypotonic means, the nurses should be able to and the Paramedic ambos and above as well I know for a fact they all leant it Our enry level Technicians do not learn it as part of the Diploma but they learn the general principal of fluid homeostasis as they pertain to eg pulmonary edema Should they know hypotonic from hypertonic, active transport from facilitated diffusion and collloid osmotic pressure from capillary hydrostatic pressure yes but is it reasonable to tech the vollies that, I hate to admit it but no its not

I would suggest bleach or the modern equivalents of chloride of lime or carbolic acid

I agree; but what's this I hear about in US you can do a four year medical degree with between none and very little patient contact in first two years, then do a one year internship which bestows upon you an unlimited license to practice medicine then hook up to a three year vocational training program and at the end of that you're a qualified emergency medicine physician? And here I am applying to a medical program that lasts six years, with structured patient contact and clinical decision making in all years which then requires a minimum of two years as a House Officer* only to have to endure an additional five years of specialist training but most likely six ** which makes me a Consultant Physician with a vocational scope of practice which has set limits to what procedures and medicines I can perform or prescribe*** ... man I'm such a sucker! * PGY1 (House Officer or House Surgeon) is largely same as in the US except we do four three month rotations (runs) whereas PGY2 (Senior House Officer) can be and often is spent entirely in one speciality or only in related specialities e.g. emergency medicine or a combination of emergency medicine +/- anaesthesia +/- ICU ** five years specialist training is requires to become an emergency physician, six for dual-specialities in emergency medicine and anaesthesia or intensive care *** the Medical Council sets a "vocational scope" for specialists which restricts the practice of specialist branches of medicine to appropriately qualified specialists (what an idea!) e.g. emergency medicine is one and is defined as "the field of practice based on the knowledge and skills required for the prevention, diagnosis and management of acute and urgent aspects of illness and injury affecting patients of all age groups with a full spectrum of undifferentiated physical and behavioural disorders" so prescribing medicines such as adrenaline, amiodarone, insulin, potassium or haliperidol would be appropriate as would performing a thoracotomy for somebody who has a cardiac tamponade however performing a dermatology procedure or prescribing a chemotherapeutic drug would not be allowed as they do not fit within the scope of practice. Oh and lets not get picky I know technically all antibiotics are chemotherapeutic agents but you know as well as I did we mean specific to oncology Take that Emergentologist! Kiwi, (MBChB, FACEM FANZCA(c. 2026))

See back in the day I'd have been like horrendously aghast and somewhat perturbed at that notion but now I'm like eh what the fuck ever Carry on then sir

I am not sure if you'd do somebody serious harm infusing sterile water; after all it's water (H2O) but it is most likely slightly hypotonic compared to normal saline; all it would do is cause a small fluid shift from the intracellular fluid so it's not like they'd drop dead or anything

I know you're a good bloke Marc and that you genuinely try to do what is best for your patient because you care about them and want to make a positive impact in their life; hope you are doing OK Um, wow, dude, that is the most fucked in the head thing I have ever read and it makes my blood boil to the point of wanting to get stabby or something, at you, multiple times, in a blind rage and I sincerely hope you never set foot in the ambulance service or really any sort of role where you have contact with people Hmm, re you s/b Kiwi ix hgb ok fe ok tv ok fio2 43.8 imp oxygen thief (p) ignore

I had a quick look but in the vast of the questions the treatment options are not appropriate and there is no "other" box so you're stuck choosing the best wrong answer which is going to screw up your statistics

Very true mate. I think orthostatics are about as useful as blood letting and boiling oil Oh how simple medicine used to be; you either died of infection or exsanguination Damn it to the bowels of bloody hell, curse Ambreas Pare and that Semmwlweis bloke! Not really, the dead have evil powers and I don't wanna get struck down by dead Hungarian Chirurgeon