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Tales from the Big Smoke…that’s not a cigarette in his mouth…
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Tonight I thought I would broach a subject that might be somewhat uncomfortable for the non-medical, uninitiated in the audience. A primary purpose for our coming to Australia was the chance to practice Emergency Medicine in a foreign system. It was the reason I was recruited by Queensland Health; and my advanced EM training is what made the whole trip possible, right down to the working visa. As a condition for gaining my FACEM, or Fellowship in the Austral-Asian College of Emergency Medicine, I am required to do a six month, part-time stint in a Level One, Tertiary Trauma Center ED. As scary as that sounds, I spent 3 years in a much worse ED environment at Boston City Hospital in the early 1990’s. So, a homecoming of sorts…
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| The PA, a modern 700 bed Tertiary Medical Center |
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| The Big Smoke….indeed |
It’s hard to know exactly how decisions made years ago dictate your life’s pathway, but mine has led me into the somewhat arcane, and highly specialized world of modern Emergency Medicine; a place where even many seasoned physicians find themselves uncomfortable.
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| Rooftop Helipad with elevator. Bad things incoming….. |
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| Extra recuscitation “stuff” |
But it’s my world, and these are my people. I get the jokes, understand the veneer of fatalistic cynicism that ultimately shields one’s inner core, and feel strangely at home, and even enlivened, by the steady stream of the bizarre, the grotesque and the tragic played out daily in the ED.
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| Main ambulance bay, early morning, pre-gridlock… |
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| Doorway detail |
An old Australian expression for the Big City is the “Big Smoke…” The Princess Alexandra is every bit that. As the Level one Trauma Center for the entire southern half of Brisbane , pop. 1.5 million, it takes in all the critically ill, trauma and multi-system failure patients from SE Queensland, around 65,000 patients a year. It has full USA level multi-specialty backup, and is one of the major teaching hospitals in Australia.
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| Greetings from Brisbane Australia! |
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| Bribane River and City Cat ferries |
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| Downtown Brisbane from Kangaroo Point |
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| Meanwhile, back at the PA |
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| A clean, well lighted place |
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| Standing By…and then… |
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| First morning, first patient…. |
Of course, on my first clinical day, I walk in at 0745 and everyone’s in one of the five trauma rooms. A male bicycle rider vs a truck. Truck wins, every time…..I don’t want to upset anyone with the graphic details, but I spent the morning lead-gowned as an observer in the Interventional Radiology suite watching them coiling hemorrhaging mid-face arteries.. Though I was a complete stranger, the Aussie crew couldn’t have been more professional or accommodating; even allowing me to shoot pictures of them busy at their life-saving work….And what an amazing privilege, to be allowed a glimpse inside their fascinating environment…. Here are a few shots, while still trying to keep it family friendly…
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| CT 3D, Lots of facial trauma if you know where to look… |
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| Prepping the patient for angiography |
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| Interventional Radiology, |
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| The trauma team in action |
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| Nice to have on your side when you need it… |
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| Who’s gonna lift that bandage…? |
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| Incoming… |
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| Right mainstem bronchus ETT with whiteout on the Left |
For the Medical people following along, I have to say, it’s been a wonderful and humbling experience to be back in the Tertiary world after 20 or so years.. I’m one of the “senior” team members now, but everyone is extremely helpful; and luckily, they aren’t expecting me to run the team. Unless I want to, of course…! Teaching Residents again has been very rewarding; I have seen a lot over 20 years it seems……The clinical conditions are similar, but the management has changed somewhat. We are using lots of pressors, Adrenaline and Noradrenaline (no “Epi” down under!), Propofol infusions, lots of Ketamine, even in adults; auto-infusion devices..But no Dilaudid, IV Benadryl, Lorazepam or Quinalones…Ultrasound guided everything..central lines, arterial lines…Very high acuity, very invasive and intellectually challenging for sure! And the 64 slice scanners with near instantaneous 3-D reconstruction provide very rapid confirmation, or humiliation of your clinical diagnoses…
Below are some random images of fascinomas and curiosities I’ve encountered thus far in Australia, most from Redlands Hospital. Probably no stranger than a thousand other ED cases around the world, but a glimpse into my ED world in Australia…enjoy! PS: all patients gave me their express permission to be photographed and have their images used for teaching and blog purposes, so no worries about patient confidentiality mates…
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| ? spider bite in Papau New Guinea, 3 days old… |
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| Sebaceous cysts |
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| Rugby blow, see free air around R orbit..? |
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| Good leg, bad leg |
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| Finger nail…haha..get it?? |
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| Finger nail #2, with open fracture |
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| Swallowed a bone..see arrow…. |
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| Skin graft, failing… |
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| Flipper foot; rare congenital deformity, only two toes etc…! |
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| Very bad legs… |
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| Rheumatoid Arthritis #1 |
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| RA #2 |
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| Dead Toe |
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| Chest tube detail |
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| Breath of Life |
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| Critical, intubated |
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| Back of the Bus, on the road again… |
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| Critical Transport, QAS |
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| Ankle reduction, procedural sedation |
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| Pleuricentesis detail |
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| Success! 1700 ml… |
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| Bier’s Block, fracture reduction |
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| Intracerebral Hemorrhage…always BAD… |
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| “Belt Burn” boobie, car accident |
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| QAS at Redland Hospital ED |
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| …and now a psychic pause… |
I hope you’ve enjoyed the whirlwind tour through this major part of the Aussie adventure. I think that it’s reassuring to know that throughout the world, there are emergency professionals standing by to assist 24/7; in fact right now, in every major town and city. Not generally recognized or even acknowledged by the public, but standing ready all the same. My people…Give them a thumb’s up for me please.. Until next time, stay safe and healthy.. ddu.
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| The Brissie eye… |
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| Southbank Brisbane |
