SMACC 2013 – EM in review

Associate Professor in Emergency Medicine Richard Paoloni, from Concord Hospital in Sydney, reviews topics in EM over the last year, including high-sensitvity troponin, non-invasive real-time vital sign measurement, and new forms of anticoagulants.

Link for accompanying audio is below the slide set

Click HERE for the audio (right click and open this in a new tab)

Useful Websites

Life in the Fast Lane: I can’t recommend these guys enough. It’s 100% necessary for your Part 2 Examinations. It’s also a 100% informative, entertaining, up-to-date medical blog for every other ED doctor.

Emergency Medicine Literature of Note: feeling rusty? Preparing for a big interview and scared they will ask that dreaded “what interesting medical literature have you read recently?” when in fact you don’t care about medical literature at all? Take a look here where all that boring stuff is broken down into tasty titbits that will help you sound impressive…

The Sharp End: written by our good friends over at Middlemore, specifically the wonderful Doctors Andy Brainard and Chip Gresham. This blog is full of tips written by our own colleagues, relevant to our patient population here in Auckland.

EM:RAP and EMCrit: must-listen Podcasts for any aspiring or already aspired ED doc.

ECG Wave-Maven: I personally used this website constantly to practice my ECG’s for the Part 2’s, and couldn’t help thinking I really should have perfected my ECG-reading skills far earlier…

Emergency ECG Video of the Week: recommended by Dr Chris Duncan as a good place to passively absorb knowledge while drinking a cup of tea.

Trauma.org: the moulages on this site are very useful. Personally, I don’t think I’ve ever managed to save the neurotrauma moulage patient – please let me know if you do, as I would love to save them one day!

Resus.com.au: useful videos and lectures. Especially if you just can’t bring yourself to open those textbooks again. Requires a subscription to get full usage of the website though…

Instant Anatomy: this website is a staple product for any anatomy Part 1 participant. The simple diagrams are fantastic revision tools.

The wonderful Dr Alana Harper also compiled a great list of free web-based learning sites, which can be found here (highly recommended!).

These are the only websites I have ever used on a regular basis. If you have any other recommendations, please let me know!

Procedure Videos

There videos were posted recently to support a wonderful Procedures teaching session run by Dr Lynn Theron…

Cricothyroidotomy – for information on “the difficult airway” also see the RSI fact sheet found here.

Rapid rhino insertion

Chest decompression and chest drain insertion: video one and video two; for more in depth discussion of pneumothroax see the fact sheet found here.

Limb tourniquet application

Use of stapler

IO insertion: landmarks are from the 10 minute mark…

Pelvic sling application: the demonstrators look like they’re doing an inflight safety video… for more in depth discussion of pelvic fractures, see the Pelvic Trauma fact sheet found here.

Donway femoral splint application: you most likely have no idea how to work this contraption… but you should! This video stars either Smurfs or The Blue Man Group for some reason… the femoral fracture fact sheet can be found here.

FAST scan: clearly, you have to complete the course to be a competent FAST scanner – but if you’re constantly looking over your consultant’s shoulder wondering what they’re looking at, maybe watching this video will make you appear more intelligent!

Arterial line insertion: useful from the 2 minute mark…

Pericardiocentesis: rarely done, therefore probably rarely well done! For more information on pericardial tamponade, there’s a fact sheet here.

Suprapubic catheter insertion: be sure to use ultrasound as a guidance – we have it in ED for a reason!

ED thoracotomy: everyone has an inner surgeon just yearning to get out!

ED perimortem C-section: hopefully you will never be called upon to perform this, but in case you are…

General Advice

When do I start to study?    Start 1 year out from the Written Examinations. This will mean that you are studying for 1.5 years overall. In case you hadn’t noticed, this is a long time. This is an endurance event. It is taxing not only on yourself (mentally and physically) but on loved ones around you.

What shall I do before I start studying?    Don’t “gently study” before your starting date – give yourself a complete rest from academic stress for at least the 6 months leading up to your start date. In the month before you start studying get your books together – the syllabus is found here. Enjoy yourself buying nice furniture for a study. Sort out a study group. Ideally this should be 4 people. You don’t have to know each other amazingly well beforehand, but clearly it helps if you get on! Your study group is really what gets your through this ordeal – when you feel low or unmotivated, generally there is another who is doing OK and they drag you through. You are then there to drag them through when they are low. It sounds very dramatic and emotional, but that is the honest truth.

What job should I do while I’m studying?   Try to organise your training time so that you can sit the exam from ED. People said this to me and I didn’t see why on earth this would matter – but it does. I ended up sitting the exam from PICU which was quite simply a nightmare. It’s much harder to get study leave and the rosters are more gruelling. More importantly, during preparation for the Clinicals you are missing out on vital opportunities to practice while at work. Seriously, do the exam from ED.

Which books should I use?     If you’re a NZ trainee, buy all the books on the syllabus. Why not? They’re free after all. Dunn is your bread and butter. Everything revolves around Dunn. Cameron (adult and paediatric) is essential – it is pretty simple and doesn’t seem all that useful, but a lot of the MCQ questions come from Cameron. TinTin is massive, but I found it useful. You should be aiming to read Dunn, Cameron and TinTin on all topics. The Tox Book is wonderful – this is very important for toxicology and envenomations. The other books are less important – I didn’t even open Rosen or Oh.

Which other resources are useful?     Life in the Fast Lane is wonderful, you may as well put a bookmark on your browser for this site. ECG Wave-Maven from Harvard University has an enormous ECG database that is perfect for ECG practice. There are many other websites out there, but those are the only two I used on a regular basis.

Should I do a Part Two Course?    I attended the Fellowship Course run by Resus.com.au in Aussie early in my study. It was useful to get an idea about what I needed to be doing, and helped scare me into more study – but, in case you were hoping, in no way is a course going to be a substitute for a year of good, dedicated study. I wasn’t able to attend Lou Finnel’s course at Middlemore, but I wish I could have as I know that other people found it incredibly useful.

How do I prepare for the Writtens?   Follow the Auckland syllabus. Hopefully you will be able to do each topic 2.5 times if you start studying a year out. Start off aiming to read Dunn, Cameron and TinTin on the Topic of the Week the first time around. The second time round you will have laid the foundations of knowledge, and be able to layer it up from any resource you choose.

MCQ’s     Do them, lots of them. You will be scoring a maximum of 60% initially – maybe even more like 40%. The only way to get it is to keep doing them though. I noted common statistics found in MCQ’s in my fact sheets – there are a few facts that are a common theme. A good website for MCQ practice is imeducate – although the questions do start to recur and seem a lot easier than the actual ACEM MCQ’s are.

SAQ’s     Have key points at the beginning. Then follow your proformas (found in Written Examination Resources). Think about what the “consultant issues” are – try to show that you are cut from the right cloth, not just a robot regurgitating the correct answer – although of course you have to regurgitate that too. Start doing them with open book technique, then closed book, then to time. Doing SAQ’s to time is very important – you need to train your hand muscles to endure writing for up to 2 hours solid. Start by doing just one to time, then two in a row, then three… and build up. Use a stopwatch and be firm on yourself. Tell anyone in the house not to disturb you for that time and just keep writing. You find that if you go just one minute over on one question, it throws you off for the rest of the exam. Time management cannot be under-estimated in importance.

VAQ’s     The advice for SAQ’s can be applied to VAQ’s. For ABG’s and ECG’s have your proformas and follow them. Approach them in a structured way and then interpret your answer relating it the stem and making your answer clinically relevant. Practice ABG’s and ECG’s to time again and again – the ABG’s especially need drilling so that you can do the calculations and recall the formulae quickly.

How do I prepare for the Clinicals?    Start thinking about these before the Writtens – although, to be honest, I found this nearly impossible. After the Writtens, take 1-2 weeks completely off. Do not open a book. You will find yourself virtually incapable anyway as you finally discover how tired and broken your brain is. Then read your Clinical Examination book. Learn your Short Case and Long Case Proformas. Practice on your partner, dog, cat, a pillow. Learn these proformas like you are an actor going to an audition – that’s essentially what you are doing anyway. Finally, hit the wards – you will be spending hours doing this, but after a year of sitting alone in a room studying it actually seems quite social. Trawl in twos, threes at the most – otherwise you just find you are spending a lot of time watching other people doing the examinations. Make dates with consultants – it’s far more useful to go with a consultant than it is without as it recreates the impression that you are being examined and gets you used to being watched. Attend the mocks – they are very good at recreating the exam conditions. For the SCE’s you must retain your Written knowledge. It is incredibly hard to bring yourself to study again, but in the final few weeks you do have to get out those old notes and remember the theoretical stuff. Practice SCE’s and be prepared to look like an idiot and have your friends critique you. Finally, set up mock Shorts and Long Cases with friendly consultants. It’s gruelling work, but you have to do it.

Any final comments?     In the end: it is just an exam. There are more important things in the world. It is a hurdle that needs to be jumped – but while running the race, remember that you have to be kind to yourself to stay strong. Take rest days without guilt. Make time for your loved ones, and appreciate that this is a hard year for them as well as they essentially become involuntarily “single”. It is hard work, but this exam is fair and passable – and well worth it in the end. It will hopefully be the final exam of your life – it is the top of Mount Career. And the view is going to be great! 🙂

 

Clinical Examination Resources

SCE Resources

How to Be A Doctor              A document summarising the Clinical Examination handbook, which is a guide to Short and Long Cases.

Short Cases Template          A vital document that you must learn from front to back. Be able to perform each examination smoothly and quickly – this is a performance, not real medicine. Practice on your cat / significant other. Take it with you as you trawl around the wards pestering those poor patients unfortunate enough to have been listed as “good for examination”.

Heart Murmurs                    A fantastic document to support the “Short Cases Template”.

SCE Resources

Below are listed links to many many SCE’s. It’s time to do these with your study group… be prepared to look like an idiot and be critiqued by your peers!

Brookes_SCE

Dissection_SCE

FE Course SCE 1

FE Course SCE 2

FE Course SCE 3

FE Course SCE 4

FE Course SCE 5

FE Course SCE 6

SCE_1_2009_2

SCE_1_2010.1

SCE_2_2009_2

SCE_2_2010.1

SCE_3_2009_2

SCE_3_2010.1

SCE_4_2009_2

SCE_4_2010.1

SCE_5_2009_2

SCE_5_2010.1

SCE_6_2009_2

SCE_6_2010.1

SCE

Taylor_SCE

FE_2008-1_SCE_1_Marking

fec_viva_marking_2003_2

fec_viva_marking_2007_2

MCQ Resources

This is every MCQ I own. They are in no particular order, and they may repeat themselves. Some have answers, some don’t. For MCQ’s by topic, see Resources By Topic.

 

Brand New Practice 60 question MCQ paper (you shouldn’t have seen any of these questions before, as of August 2014)

 

50 pages of MCQ’s

100 pages of MCQs

200 pages of MCQ’s

ACEM_Prefellowship_Jan_03_MCQ

Aug02_Mock_MCQs

MCQ 2008 Real questions

MCQ Exam August 2009 Answers

MCQ March 03 Answers

MCQ_2009_Feb

MCQs 2009.2

PRACTICE FE MCQs MINE2

Xam-MCQ8-01_(1)

CNS_MCQ

Crisis intervention MCQ

Dermatology MCQ

ECG MCQs

Emerg med systems MCQ

Emerg med topics MCQ

Endocrine MCQ- di

Endocrinology MCQ

Environmental MCQ

Eye ENT Dental MCQ

Fluids Electrolytes MCQ

MedicalMCQs1[1]

Radiology MCQ

Repiratory MCQ

Research MCQs

Respiratory MCQ

RespiratoryMCQs

Stats legal wounnds MCQ

Trauma MCQ – di

Trauma MCQ

TraumaMCQ_ST

Cramming Resources

Important Facts

This document includes lists of drugs doses, acronyms, important research, tests and scores…. Basically all the stuff you don’t bother to remember up until the very end when you just cram numbers and lists into your head. I went over this document again and again during the final countdown, and as a study group we tested each other until we had the vital statistics drummed in to our brain.

ABG Resources

How To Interpret ABG’s         How to read an ABG. Make your own proforma and follow it for every ABG. Do ABG’s again, and again, and again, and again. Learn your formulae and practice the arithmetic. You do get it in the end.

ABG VAQ’s                Every ABG VAQ known to man. You should have done each one at least once. You should have done each ACEM ABG at least three times.

HyperK fact sheet

HyperNa fact sheet

HypoK fact sheet

HypoNa fact sheet

Respiratory acidosis fact sheet

Respiratory alkalosis fact sheet

Metabolic acidosis fact sheet

Metabolic alkalosis fact sheet

NaHCO3 fact sheet

Other metabolic derangements fact sheet