Kiwiology

Not sure the Australians would like that

Go for post graduate medicine mate; we will eventually make it to The London but of course you know we'll have to do paper-scissors-rock with Gareth Davies for who goes on the helicopter that particular day Thames, Medevac, airborne ...

Yooz cant tawk like diz yo you're from freaking Missouri or Kansas I fawget which one ... but a fawmah legal resident of the State of NY I can

Shut up, they don't have sheep bacon in Nevada

Sounds like we are sort of thinking along the same lines; I've had several strokes telling people "ventilation is not oxygenation, just because you cram oxygen down somebodies gob does not mean you are going to oxygenate them!" and perhaps I over-believed my own rhetoric (I mean its actually correct but still perhaps not in this case);

Yes Nat

you're in luck I make my own pepperoni pizza complete with home made deep dish crust and thick pizza sauce

Sure, actually a lot of the Doctors who come from funny Middle East countries are absolutely fantastic clinically and very friendly; so much more so than "Western" Doctors who are often very brisk; walk in, palpate this, mumble something and walk out never mind the patient is covered in faeces in a messy bed and their tummy is so empty the hunger pangs measure on the Richter scale. An interesting comparison US: Four years pre-med + four years med + one intern year + three years vocational training = Attending Physician NZ: One year pre-med + four years med + one intern year + two house surgeon* years + five years vocational training = Consultant Physician * the Senior House Officer year (second post-graduate year) can (and often is) spent entirely in ED for those who want to register with the Australasian College for Emergency Medicine So lets see if I start right now I'll be THIRTY NINE when I'm a Consultant ... ugh that's OLD

What kind of pizza did you want again?

Come on mate, the guy needs to bring his $600 Littman Master Cardiology stethoscope, belt pouch brimming with shears and clamps and whatnot and the ten pocket size spiral bound EMS field guides he has plus the Thomas Pack full of gear out his car. Have you learned nothing from these forums?

You said that was your pet name for me SupremeFireMonkeyologyReg is a bit too long I like Superdad

Thanks for that mate, your thoughts almost mirror my own, I had considered deep tracheobronchial suctioning as well but wasn't sure if we tubed her if it would improve her oxygenation but perhaps I did not place as much emphasis on total protection of the airway as I should. Well off the top of my head .... DKA causes metabolic acidosis because hypoinsulinameia reverses lypogenesis (induced lypolysis) releasing free fatty acids from adipose tissue into the blood which go to the liver, are beta oxidised into pyruvate and Acetyl CoA which get used to produce ATP through oxidative phosphorylation in the mitochondria. In addition to the free fatty acids being released from storage the beta oxidation spiral produces beta hydroxybutyric acid as a byproduct, further aggravating acidosis. Generally speaking acidosis will reduce enzyme activity because the active sites are denatured or something like that; I briefly remember covering that in biochemistry. As to the exact effect on mitochondria / electron transport chain and the F0F1ATPase I am not sure. Oh and the only thing he's gonna encourage me to do is eventually go to medical school; you know its possible to become a Doctor with two years training and a smart phone now (I wish! five years my bottom!)

There goes my theory that you live in your mothers basement like some sort of family outcast Yes

You could always download the Android emulator as part of the SDK http://developer.android.com/sdk/index.html

So I am curious to know what our Resident Emergentologist (who is actually a Consultant trapped in a funny tawking Attending Physician's body yo) thinks about airway management in this lady Whether or not to intubate her is pissing me off; I thought about it a bunch today. I asked the House Surgeon, he said to ask the Reg, the Reg said to ask the ICU Consultant since he would be accepting her, the ICU Consultant asked who in the bloody hell I was, how I got into his office and when security was coming ... prick I really want to shove a tube down her gob as an SPO2 of 90% is kinda bad y'know but I am reminded of the times I have screamed in a blinding rage to people that ventilation is not oxygenation. Just because we intubate her does not mean we are going to do any better job of ventilating her lungs; she's got heaps of chunky bits (Coneheads anybody?) and vomit in there and neither the LMA nor an ET tube is going to fix the obstructive problem preventing adequate oxygenation. Gah .. I tell you what I'm going to get out teh kettymainz and put it in my juice box like can be done for paeds or those who have no IV access; hopefully when I wake up the scenario will have been fixed up and I'll have had some nice nightmares!* *The incidence of ketamine nightmares is actually quite low [citation needed] so I don't want to hear anything about it ...

Depends on how many hours the FRU is going to have to wait for a stretcher ambulance You know it takes a minute or two for the kettle to boil mate

The Australasian College for Emergency Medicine requires a paediatric logbook to be completed during training which must have at least 400 paediatric patient encounters; 100 of which must be status one or two (critical or serious) triage categories and at least half (200) must be in ED We have only one childrens hospital here in NZ (Kidzfirst/Starship) which is on the Auckland City Hospital site

Outside of North America all Specialists are called a Consultant so you can stay north of the equator and work in Europe if you like The first two post graduate years (House Officer/House Surgeon) is called so because rich people back in the days of old used to have a Doctor (Chiurgeon) at their house

Because it is less invasive to see if they'll tolerate some oral fluid Her BP and SPO2 are still way too low for my liking This presentation to me is unusual; DKA often takes several days to develop and does not typically present with significant coma so I have to balance the fact that she could have been like this for 3 days and is nunngered vs a patient with DKA should not be this unconscious unless there is neurogenic cause for coma; even with a bit of aspiration and some osmotic diuresis I am struggling here because I am very worried about her oxygenation but are we dealing with a ventilatory problem or an oxygenation issue? Obviously there is some aspiration which will impair ventilation but hell ventilator dependant people in ICU with complete white out pneumonia have SPO2 higher than 90% I want to RSI this lady but I do not think she is an overly excellent candidate for RSI because if she has aspirated a bunch of gunk into her lungs the problem is mechanical vs physiologic The limit of my clinical decision making skill has been reached here, it's quicker to get going on a 1 toward hospital than to ring up an Ambulance Service Medical Advisor and then tube her. Then put in a drip and give baby 10cc/kg fluid Lets go to the adult ER; the big people doctors had to study little people too!

Reading sex? Dwayne are you so deprived you have to look at Playboy still? Damn dude, RedTube, it's all I can sez ... poor bloke

Yes, but I'm hesitant to really get into this; if you want your medical records explained ask your GP or gynae

... and you call yourself a Consultant Physician? Mind you so do I, but only quietly, and in places where other people and the Medical Council cannot hear me

Feel free to use any of the following Emergency Medical Technician Paramedic Intensive Care Paramedic State Registered Paramedic Emergency Care Assistant Primary Care Paramedic Emergency Care Practitioner Advanced Care Paramedic Ambulance Technician Emergency Care Support Worker Emergency Care Technician Emergency Medical Technologist - Paramedic Ambulance Officer Intermediate Care Officer Emergency Medical Care Attendant Advanced Care Officer Ambulance Assistant Advanced Emergency Medical Care Attendant Mobile Intensive Care Paramedic ...but not Ambulance Driver! Thanks!

Oh oh oh I knowz! Its teh multifocal atrial tachycardia for the win! Take that emergentologist!