Thank you to Western Sydney Local Health District for enabling us to create this podcast!

All views and opinions expressed are individual and do not represent any affiliated organisation.

We have now transitioned away from WSLHD and created our own educational charity - Network Five Emergency Medicine Group! 

Our team is proud to present our new podcast - The Critical Debrief!
https://open.spotify.com/show/2Ee9iHV94aHotmfCdiWKAU?si=040facbf40934c0c

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 Rajput

Music/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 Management

Participants: Dr Chetan Pandit (Paediatric Respiratory & Sleep Specialist), Dr Pramod Chandru (FACEM), Dr Shreyas Iyer (FACEM), and Dr Sunny Rajput (ED trainee)

Presenter: Shreyas Iyer

Music/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 Management

Participants: Dr Chetan Pandit (Paediatric Respiratory & Sleep Specialist), Dr Pramod Chandru (FACEM), Dr Shreyas Iyer (FACEM), and Dr Sunny Rajput (ED trainee)

Presenter: Pramod Chandru

Interlude: Dr Chetan Pandit

Music/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 Management

Participants: Dr Chetan Pandit (Paediatric Respiratory & Sleep Specialist), Dr Pramod Chandru (FACEM), Dr Shreyas Iyer (FACEM), and Dr Sunny Rajput (ED trainee)

Presenter: Shreyas Iyer

Music/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 Iyer

Discussion:
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.

Summary:

• The purpose of this paper was to gather qualitative data about the experiences of trans and gender-diverse patients during emergency department visits within the United States.
• Data was collected using an anonymous retrospective survey between June 2012 and December 2014. 
• The primary themes that emerged were those of self-efficacy and power inequity. 
• The issues raised within this included inadequate practitioner knowledge and communication (leading to frequent misgendering of patients, discrimination and rude encounters, as well as perceived unnecessary histories and examinations). 
• The recommendations that arose from the study to improve the experience of gender-diverse patients included: 1) not discussing gender diversity with other providers unless relevant to the provision of care, 2) standardizing the practice of providers to ask all patients their preferred names and pronouns (and then using these when referring to the patient), 3) not enquiring about gender or related experiences unless related to the provision of care, 4) systemic training of emergency department providers around important aspects of trans health care (such as surgeries and their complications, hormone medications and their side effects and social stigma and marginalization of this population within healthcare settings). 

Take-Home Points:

• What it all comes down to is treating people as people, and treating people with respect. 
• It is important to remember that people may have very different life experiences from our own and that coming to an emergency department is going to be a stressful period for anyone – as healthcare providers we need to consider how we can alleviate some of this stress. 
• Ensuring that we are calling patients by their correct names and pronouns is something simple that we can all incorporate into our practice.  

 
Interlude: Dr Dervla McGrann.

Resources:

• https://www.acon.org.au/ 
• https://www.transhub.org.au/ 
• https://auspath.org.au 
• https://aifs.gov.au/sites/default/files/publication-documents/22-02_rs_lgbtiqa_glossary_of_common_terms_0.pdf 
• https://www.health.nsw.gov.au/lgbtiq-health/Publications/lgbtiq-health-strategy.pdf 

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 Video
Music - 

• 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 Parliament

Presenter: 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.

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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.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:
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/03JYfsI9Ke7JFuxHD239m2
  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!

~