CGD Flyer – Weds 27th August 2014

Here is the flyer for next week’s Clinical Governance Day. 

CGD Flyer (1)

Please note that as the training building is currently being refurbished, the CGD will instead be held in the conference room in the main office building (“The Castle”). 

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Is lamotrigine ketamine’s black swan?

black-swan-8288_1920.jpgThe black swan theory describes rare events beyond the realm of normal expectation. We use ketamine on a daily basis, but are there any circumstances in which ketamine simply will NOT work?

This interesting case report by an Ex-Sydney HEMS physician Daniel Kornhall describes how ketamine failed completely as an anaesthetic agent in a psychiatric patient with a toxic lamotrigine overdose.


Lamotrigine, as we all obviously know, exerts its antiepileptic effect by inhibiting presynaptic sodium channels thus reducing the release of the excitatory glutamate and stabilising excitable neuronal membranes. Ketamine’s dissociative anaesthetic effects are a bit more of a mystery and diverse, but they are thought to involve increasing glutamate release through non-NMDA receptor pathways. It therefore follows, that if one drug prevents the release of glutamate and second drugs effects depend on its release, the second drug will not work.

With our high volume of ketamine use, incidents such as this are worth bearing in mind the next time you see a patient with a mixed polypharmacy overdose.

Lamotrigine is therefore ketamine’s black swan.

Kornhall D, Nielsen EW. Failure of ketamine anesthesia in a patient with lamotrigine overdose. Case Rep Crit Care. 2014;2014:916360. Full Text Article

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Selective Aortic Arch Perfusion

Fascinating talk on the development of this resuscitative technology by Dr Jim Manning who appeared in person at our Clinical Governance Day.


For further information check out EMCrit Podcast Episode 123

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Developing EM in Brazil is coming soon

Several of our consultants are presenting at the Developing EM conference in Brazil.  If you’d like to hear more, organising emergency physicians and prehospital & retrieval medicine consultants Mark Newcombe and Lee Fineberg describe it and also discuss the highly successful Developing EM conference they ran last year in Cuba:


Check out the program and register here


The project is a not-for-profit venture and no SydneyHEMS specialist receives financial remuneration for involvement in the DevelopingEM conference.

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NSW Ambulance Radio Codes

With new team members about to join us, it’s worth revisiting some of the radio terminology used.

The most important one to know is Code 1 – “Officer in trouble requires Police”.

Here are some others we commonly hear, both on the radio and in conversation at the base. Read the sentences and see if you can guess what they mean. Answers at foot of post.

“What is the ETA for the helicopter? The patient is now Code 2″

“Helicopter can stand down, patient is code 4″

“What’s his GCS now? I’ll put in a code 3″

“They’re sending us to an adult female code 9″

For a full list check out the New South Wales paragraph on the Wikipedia page







Answers – turn your computer upside down to read.


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Clinical Governance Day 30th July 2014

CGD Flyer (5)

See here for directions

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Cognition and Decision Making Under Stress

MichaelLauriaDon’t train and prepare until you get it right. Train and prepare until you can’t get it wrong.”

Sydney HEMS is proud to be given permission to share Michael Lauria‘s talk on Cognition and Decision Making Under Stress. Training in medicine and working as a flight paramedic with the Dartmouth-Hitchcock Advanced Response Team, Michael has extensive military combat experience with special forces and is ideally placed to share thoughts and experience on how to prepare for and execute challenging missions.

His five take home points are:

  1. Take a load off
  2. Rally up
  3. Build power
  4. Inoculate for stress
  5. Stay flexible


You can download the audio file by right-clicking here


If you’d like to see the accompanying slides the talk can be viewed on YouTube

Audio made available thanks to our mate EMCrit

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