EmergencyPedia

PRINT Radiology Lecture

I had the honour of being asked to speak to the new Sydney doctors at the annual PRINT conference.  Having also been along to this event last year it appears to be a spectacular success.  Congratulations to all the guys that organised the conference…

My Slides – CLICK HERE

My Handout – CLICK HERE

How do I deal with a Difficult Radiologist/Staff Member?

• Let them vent
• Consider who is at pHALT? Are you or the colleague hungry, angry late or tired (or is it personality)
• Above all be nice (the caveat is do NOT apologise for calling – they are on call!)
• Ask for help – doctors like to feel important and being asked for help is a way to ‘feel important’
• Use Negotiation Skills
  • “Credibility, authority, and being LIKED are powerful persuasion tools” Cliff Reid
• Show a genuine respect for the patient/colleague’s opinion – show respect for their point of view even if you don’t agree with them… Attempt to negotiate
• Seek to compromise – Make the conversation about the patient care and not your disagreement(s)
• Involve senior colleagues early
• Close the loop – repeat back what has been discussed – cross-check what will happen now

Lecture Take Homes

• Calling Orthopaedics Consult Checklist
  • iSBAR format (keep it brief), patient haemodynamics, fracture closed v open, type (e.g. spiral, simple comminuted…), location of fracture, arm dominance if upper limb, fragment position, neurological status, vascular status.

• Don’t miss the second abnormality
  • a cognitive bias known as ‘search satisfaction’ is common)

• Central Lines
  • position varies but ideally should be in the proximal SVC. check for pneumothorax…

• Endotracheal Tubes
  • should be around 4cm above the carina (between clavicles)

• Nasogastric Tubes
  • should be in stomach at least 10cm below the diaphragm

• Trauma Neck Imaging
  • Worry about patients with any of the following (1) Neurological Deficit, (2) Persistent Spinal Tenderness (Midline), (3) Altered Mental Status/Level of Consciousness, (4) Intoxication, (5) Distracting Injury (especially chest injuries). CT is more reliable than C-spine XR