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The Royal New Zealand College of Urgent Care’s annual general meeting 2024 took place at 6pm, Saturday 23 March 2024 at the Goodfellow Symposium (Dew Drop Centre, Manukau, Auckland). A small number of members were present in the room and online. Of the motions presented to the members through online voting: The motion to allow…
Advice to clinics and health professionals is to check the Ministry of Health page on Covid-19 or follow your DHB/PHO recommendations. Click ‘read more’ for brief information on College events and courses.
MediCross is a well-known and respected Urgent Care & GP Clinic, located in New Plymouth on the west coast of the North Island. As a Level 2 ACC accredited clinic we are looking for an enthusiastic Urgent Care Doctor.
We are seeking an experienced male GP for a full-time role in a busy Christchurch City General Practice and Urgent Care facility.
We are seeking an experienced male GP for a full-time role in a busy Christchurch City General Practice and Urgent Care facility.
We should be aware of artefacts as a cause of error when interpreting an ECG.
Heinrich Quincke has a number of eponyms, but Quincke’s disease is isolated angioedema of the uvula.
We are seeking an experienced male GP for a full-time role in a busy Christchurch City General Practice and Urgent Care facility.
The Medical Council want to know about trainees’ experience. Torohia is an annual online survey for doctors in training across Aotearoa New Zealand to feed back on their training experiences. Torohia is open from the 18th of August to the 8th of September 2025, at torohia.org.nz All submissions are confidential and guarantees the anonymity of…
Our biennial Virtual Urgent Care Bootcamp returns on Saturday, September 13th, 2025. This year, we have a keynote talk from Dr Ceri Battle, creator of the STUMBL score. Our event also coincides with Sepsis Awareness Day, allowing us to receive contributions from the Sepsis Trust. Other topics being covered this year include nasal fractures, AI,…
For this month’s newsletter, I wish to share information on the following Bootcamp tickets available Urgent Care Research Network Bootcamp tickets available The biennial virtual urgent care Bootcamp will be on September 13th from 0830-1700. Details and tickets can be found here This year, we have a presentation from Dr Ceri Battle, the creator of…
Tēnā koutou. We hope everyone has been managing to keep well this winter. Good luck to those trainees who are about to start studying for the UCPEX and the OSCE in November. I may see some of you in the upcoming Skills and Demonstration Weekend (SDAW) on the 16th August. Here is a quick list…
Remember that you can also connect with RNZCUC Registrars via our Facebook group If you are interested in becoming involved with the Registrar Subcommittee, please e-mail: regsc@rnzcuc.org.nz 🥳 Social Calendar (Upcoming Events) Informal Winter Social Dinner Date: Saturday, 16th August Time: 6:30-8:30 pm Location: Lone Star Manukau, 792 Great South Road, Wiri, Auckland Details: Come…
The RNZCUC Virtual Bootcamp 2025 is on Saturday, September 13th, starting at 0830.
Victoria Clinic A&E and GP Clinics in Hamilton is looking for an Urgent Care Fellow to run our teaching programme in Urgent Care and supervise registrars.
Do you perform a DRE before referring a suspected case of cauda equina syndrome?
We are seeking Locum Doctors to join our clinical team
You need to be an RNZCUC fellow or, trainee, or RNZCGP fellow or advanced trainee
You will be legally entitled to work in NZ
Please forward your CV to andy.dixon@shorecare.co.nz
Shorecare are seeking Locum Doctors, to join our clinical team.
To deliver urgent care services to the North Shore community. Across our two clinics – Smales Farm, Takapuna, operating 24hours and Northcross, near Albany operating 8am to 8pm.
Victoria Clinic A&E and GP Clinics in Hamilton is looking for an Urgent Care Fellow to run our teaching programme in Urgent Care and supervise registrars.
Join Our Caring Team Across Auckland – Doctor Opportunities with Tāmaki Health Tāmaki Health is looking for compassionate and dedicated doctors to join our skilled teams across Auckland. Whether you’re looking for a full-time, part-time, casual, or locum role, we have flexible opportunities to suit your career goals and lifestyle. As part of the Tāmaki Health network, you’ll be contributing…
Te Whatu Ora is seeking expressions of interest from clinical representatives to join the national Extended Primary and Community Care (EPCC) Clinical Advisory Group. They encourage the circulation of this announcement to individuals who may be interested in joining this important group. Those interested in becoming a clinical representative on this group are invited to…
We are looking for a Doctor with a interest in Urgent Care and a passion for Community Health at any level in their career.This is a full time role in our Urgent Care, with great roster flexibility. You’ll be working with a fantastic team of nurses and doctors, and serving a diverse patient population in…
Kia ora koutou, As we move through the year, it’s clear that there is no let up in our workload. This update covers a range of key areas, from necessary revisions to our College rules and the upcoming Strategy 2030, to the launch of the workforce survey for the year, and advancements in our internal…
Wound glue is commonly used in urgent care, and it has an interesting history.
Clinical Practice Visits – King’s College Hospital Urgent Treatment Center (UTC) London UK King’s College Hospital (London, UK) recently welcomed Dr. Dinesh Deonarain, RNZCUC-appointed observer and previous ExC member, to conduct clinical practice visits for two doctors pursuing their Fellowship in urgent care with the College. King’s College Hospital, Denmark Hill UTC stands as the…
Remember that you can also connect with RNZCUC Registrars via our Facebook group If you are interested in becoming involved with the Registrar Subcommittee please e-mail: regsc@rnzcuc.org.nz 🥳 Social Calendar (Upcoming Events) Informal Winter Social Dinner Date: Saturday 16th August Time: 6:30-8:30 pm Location: Lone Star Manukau, 792 Great South Road, Wiri, Auckland Details: Come…
Nau mai, haere mai ki Ūpoko ki te uru hauora
Location – Kenepuru Accident and Medical Clinic, Kenepuru Community Hospital
Contract – Casual, permanent or short-term pool
We’re looking for Urgent Care trained doctors or doctors with equivalent ex
Join Anglesea Clinic Urgent Care’s dedicated team of healthcare professionals as a dedicated nightshift (11pm-8am) Doctor in Hamilton Central, Waikato. About usAnglesea Clinic Urgent Care is a leading provider of high-quality, accessible healthcare services in the Waikato region. Our team of experienced healthcare professionals is committed to delivering exceptional patient care 24 hours a day,…
How can we avoid missing these rare but commonly missed injuries?
Vitamin B6 is both a prescribed medication and available in many over-the-counter preparations. In high and prolonged doses, it can be a cause of peripheral neuropathy.
There are a few Hutchinson’s signs, but this one relates to Herpes Zoster Ophthalmicus.
Purchase a business providing doctor and nurse led medical service covering events around NZ. With an established model and existing relationships, would be an ideal add for a clinician or clinic looking for a change of pace or solid side venture. Ascent Medical Support provides doctor and nurse led medical care at extreme and endurance…
I will keep this month’s newsletter short and brief, though it does contain important information and requests for help. College’s position on the announcement of funding to support urgent care and after hours We welcome the recognition of the importance of urgent care clinics and the acknowledgement of the role they play in the healthcare…
Kia ora koutou, It is my pleasure to produce this month’s DCT newsletter. Please review my post from May 2025, which contains very important information for trainees. UCCIS – workplace We often notice missing information in UCCIS. Trainees must enter their workplace into UCCIS so that we can track the proper allocation of clinical hours…
Tēnā koutou. Thank you for everyone’s patience and understanding as several components of the training programme have been introduced or revised. Here are some quick updates for trainees. TalentLMS All trainees should now have access to the online urgent care course (UCC) and the Leadership Module through TalentLMS. All of the compulsory external courses and…
Join us in our upcoming teaching sessions held by the Urgent Care Registrar Subcommittee. A reminder this is not examined material but rather an opportunity to revise, ask questions and consolidate learning. We do try to base the sessions on exam topics/cover some of the curriculum to help your exam study! Thursday 12 June at 6pm…
Basketball NZ is urgently seeking medical cover for the upcoming tours. Experience traveling with sports teams is preferred.Ideal candidates should have a broad range of medical and practical skills.An interest in sports medicine and performance optimization.All teams travel with physiotherapy support, and there is a clear handover pathway upon return. This is an excellent chance…
We are seeking an experienced doctor to work in our Acute Care Clinic. Come and join our close-knit, vibrant rural community. This is an excellent opportunity to work in a supportive environment alongside a passionate and professional team. Katikati Medical Centre is centrally located in the heart of the Western Bay of Plenty, offering a…
We can diagnose a TFCC injury clinically. Management is much like any sprain, but ongoing issues may need a hand surgeon workup.
Testing for dysdiadochokinesia is simple, and something we learned way back at the start of medical training. But it is a useful and important test to still do in urgent care
Onychomycosis is not an urgent condition, but it can present through urgent care.
It is my pleasure to create my first formal newsletter as Chief Executive Officer. I would like to thank the Executive Committee for their trust in me to help move the College forward with the revised governance structures and roles, the development of the College strategy, and the fresh approach to our training and education…
Kia ora koutou, It is my pleasure to produce this month’s DCT newsletter. Core skills list – eye examination It has been noted that there is another new core skill called eye examination. As we did not notify registrars of the change there is a new deadline for completing this skill. Registrars on the 2024…
For this month’s newsletter, I wish to share information on the following An in-house simulation course that counts as a resus refresher ACC joint market engagement: Primary and Secondary Care Presenters wanted for the Virtual Bootcamp 2025 Urgent Care Research Network In-house Simulation course The College has approved a 4-hour, in-house paediatric-focused simulation course as…
This week, we chat with Khang Gan and Erin Carn-Bennett from MedSim Solutions.
The College has approved an in-house 4-hour paediatric resus course run by MedSim solutions as an equivalent to one triennial refresher course We all experience some simulation training when we undertake our annual resus courses. Simulation can be a very powerful educational tool. One of the drawbacks of attending a resus course is that you…
It is important to check for hyphaema, blood in the anterior chamber of the eye, after trauma. It is also important to use a slit lamp to check for microhyphaema
ACC are inviting you to join them on May 29 for an online engagement event for primary and secondary care during which they will discuss and seek feedback on the issue of increasing numbers of patients needing time away from work. This is a key part of urgent care practice, so it is important that…
How can we avoid errors associated with cognitive biases? In retrospect, we can easily see these biases unfold, but how can we identify them as they happen?
A tip to ensure you align the vermilion border accurately.
The RNZCUC Registrar Subcommittee is excited to host a Dermatology Advanced Trainee for an insightful talk on urgent care-based dermatology. The presentation will cover case-based topics, derived from the recent RNZCUC Registrar Facebook Dermatology Poll, focusing on high-yield and interesting topics. Event Details: Date: May 29th Time: 6:30 PM – 8:00 PM NZT Zoom Link:…
Time seems to have flown by and we find ourselves already in April. There are numerous important College activities and deadlines approaching and I anticipate the next few months will be very busy. For this report I am focusing on key developments across governance, education, accreditation, and strategic planning. Annual General Meeting (AGM) Thank you…
Tēnā koutou. This month will contain some brief updates around the progress the College has been making towards a new curriculum and several new components of the training programme. But firstly, I’d like to thank all the trainees who attended the registrar orientation webinar last Friday. What a great turnout and it was fantastic to…
Kia ora koutou, It is my pleasure to produce this month’s DCT newsletter. This month I am providing some reminders of important changes to requirements for all those on the training programme. For all trainees We have moved most learning resources across to TalentLMS, the new learning platform. We have created accounts for you all…
For this month’s newsletter, I wish to share information on the following Presenters wanted for the Virtual Bootcamp 2025 Telehealth Survey Urgent Care Research Network Presenters wanted for the Virtual Bootcamp 2025 Bootcamp will take place on Saturday, September 13, 2025, and will run from 0800 – 1700. This year it is virtual, with all…
Do you use colchicine for acute gout flares? Are you aware of the risk factors for toxicity?
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What is the knee to wall test and what does it measure?
Wānaka Mountain Guides in collaboration with Dr Sam Bartholomew FRNZCUC bring you a bespoke mini-medical conference that utilises the unique opportunity to allow a small group to share learning experiences and ideas in the winter backcountry environment relevant to Front Line Medical work. The conference explores risk management and acute medical care both in the…
Do you establish the patient agenda at each consultation?
The National Rural Health Conference 2025 hosted by Hauora Taiwhenua, is New Zealand’s leading rural health conference. The Conference features over 70 presenters, workshops, and posters. The programme is diverse with 5 different streams for concurrent sessions and seven keynote speakers from varying backgrounds. We believe there is something to be learnt from all sessions with…
BMJ Best Practice is a website that collates best practice evidence relating to all aspects of clinical practice. It has a variety of different resources and tools to help your clinical practice, including a comorbidities manager, differential diagnoses algorithms, patient leaflets and much more. It is an extremely useful site to aid in your management…
For this month’s newsletter, I wish to impress upon you all the following requirement of the recertification programme. Your annual recertification requires you to keep and maintain a Professional Development Plan (PDP). Your PDP is a personal document, and you may design and keep this in any way that you choose. The College does provide…
Kia ora koutou, It is my pleasure to produce this month’s DCT newsletter. Training program 2025. As you may be aware there are changes for registrars starting after 2025. You will be completing work based assessments and transitioning through the stages of training. For registrars on the prior training program there are no work based…
Kia ora tātou. I am pleased to report several important updates on behalf of the education committee. This includes timelines for the release of the new curriculum, online urgent care course and leadership module. I have also included a link to the Work Based Assessment webinar held last month. Finally, there are a few reminders for trainees…
The RNZCUC’s Leadership Working Group (LWG) is proud to announce that a new leadership development curriculum will be released soon. This project represents the culmination of over a year’s dedicated work. The curriculum seeks to help bridge the gap that practicing clinicians face when transitioning from clinical positions into leadership and management roles. This body…
What conditions should we consider in hair professionals?
Seeing Bitot’s spots is pathognomic of vitamin A deficiency.
Professor James Reason was the originator of the Swiss Cheese model which has been an important model in developing ways to improve patient safety and reduce adverse events in healthcare.
What is a sentinel headache before a SAH and could they help us pick up earlier on a diagnosis in urgent care?
The summer break seems a long time ago and the office team and committees are hard at work finalising plans for 2025. There is a lot going on, so it’s understandable if anyone feels slightly overwhelmed with the pace of change. We will do our best to keep everyone updated and informed. Thank you for…
Resuscitation courses We are aware of a recent change to the GP College resuscitation requirements, and I wanted to use the newsletter this month to advise you all that the RNZCUC resuscitation requirements are unchanged. The College recertification programme has required an annual resus course for a long time now. We require a certified, examined…
Call for Applications – Registrar Subcommittee 2025 The Registrar Subcommittee represents the interests of trainees within the Royal New Zealand College of Urgent Care. We advocate for registrar teaching, policy writing, and training improvements—and we’re looking for new members to join us in 2025! Why join?✅ Represent the Registrar voice in RNZCUC ✅ Gain experience…
Thank you once again to both trainees and supervisors for your patience as we are undergoing several changes within the training programme, including having introduced a new training programme for trainees commencing in January this year. We welcome feedback at any stage, particularly if there are any concerns as these changes have been implemented –…
Kia ora koutou, It is my pleasure to produce this month’s DCT newsletter. This newsletter contains a lot of important information for registrars. Pre -Exit SAFUntil the leadership module has been finalised and completed all registrars and supervisors will need to complete a new pre exit SAF. This applies when they have or are near…
You might think that neck pain after minor trauma is probably a musculoskeletal injury. But do not forget to consider vertebral artery dissection.
Look out for the Holstein-Lewis Fracture which is associated with radial nerve injury. Also, be aware of the torsional forces associated with arm wrestling.
It is important to check peripheral neurology after trauma. Neurapraxia, with an o, is one cause of altered sensation.
This two-day course is run by the University of Auckland and is designed for everyday clinical educators working across a variety of disciplines. It covers facilitating small group learning, planning tutorials, supervising clinical students, using feedback, remediating professionalism lapses, teaching cultural safety and assessing mini-cex. It will be an ideal course for urgent care supervisors…
Welcome to the first DPD newsletter of 2025. Happy New Year. The College is forming the Urgent Care Research Network. This will be a voluntary network of urgent care clinicians interested in research and aims to result in increased urgent care specific research being published. Within the urgent care community, there are clinicians with experience…
I’ll keep this brief as there are quite a few other posts for you to read (including the exciting news about the urgent care research network, the Education committee update, and the Registar Subcommittee plans for teaching topics in 2025). Annual Survey We’ve been sending out reminders to all full members, asking them to compelte…
Registrar teaching topic planning The Registrar Subcommittee is working to structure and tailor our teachings for Urgent Care Registrars in 2025. We would like your help to identify the topics that are most relevant and interesting to you. Based on your feedback, we will invite Urgent Care Fellows and registrars from other specialties to lead…
The Royal New Zealand College of Urgent Care is establishing an Urgent Care Research Network to bring together anyone with an interest in all aspects connected to research in the urgent care field. It is hoped that by connecting people who share a common interest in developing urgent care research we will be able to…
The Education Committee welcomes back everyone from what has hopefully been a refreshing and happy holiday period as we enter into a new year and new training programme in 2025. Online Urgent Care Course We thank you for your patience while the online Urgent Care Course has been taken off-line as we transition to a…
Are your patients aware that a fracture is the same as a break? Do they think that one is worse than the other?
Each month, the Journal of Urgent Care Medicine (JUCM) present its Abstracts in Urgent Care. Edited by Dr Ivan Koay FRNZCUC, these posts cover around 6 recently published papers and breaks them down into digestible form, clearly identifying the benefit to urgent care. These abstracts are a great source of regular CME. Claim for time…
Type 2 diabetics can present with a DKA associated with SGLT-2 inhibitors. And it may be euglycaemic. So be wary.
Pinworms are often asymptomatic, or cause mild pruritus ani, but do they cause abdominal pain?
If you are working in urgent care over the holiday period, thank you.
While the Christmas period is supposed to be a happy holiday for all, there are many increased stressors at this time of year. These papers give food for thought for the season.
Registrations for the Goodfellow Symposium 2025 are open. It is on the weekend of March 22 and 23, 2025. For the urgent care stream, we have some fantastic talks. Dr Craig Ellis asks – are we underthinking anaphylaxis? Things you were taught that might be wrong. Dr Rachael Niederer will talk to us about sudden…
We should be familiar with Reye Syndrome and its association with aspirin.
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UCPEX UCPEX went as smoothly as ever, and this year we were able to share the results well within the three week window we set ourselves. Results were sent out last week. Registrars – if you are expecting them and haven’t seen them, check your inbox and spam/junk folder. If still not there, contact alex@rnzcuc.org.nz…
Governance review As reported to members in June the College engaged an external consulting company (Allen and Clarke) to complete a review of our governance and operational structures. This report was received in October and makes recommendations relating to the overall governance structure of the college, governance and operational processes, and additional operational staffing requirements.…
Welcome to the December DPD newsletter. I would like to encourage you all to check out this BPAC page called Recovery at Work – reframing the conversation. One of the metrics that ACC monitor looks at the number of fully unfit for work certificates issued by urgent care clinics. As I understand it, we are…
Do you palpate for the epitrochlear lymph node?
An interesting and thought-provoking TED talk that argues for the need for clinicians to continue to examine patients thoroughly.
Do you have a way to quickly and succinctly indicate that there is a possible patient of clinical concern within your clinic?
As clinicians in urgent care, we see many injuries covered by ACC. We are, therefore, responsible for completing many ACC 45 forms, which indicate a patient’s work capacity following their injury. We will also complete many ACC 18 forms for patients returning for planned reviews (Fracture Clinics) or who choose to return to urgent care.…
This week we talk with Dr Lindsey Fish, Medical Director of the Peña Southwest Urgent Care Clinic at the Denver Health and Hospital. She is an Associate Professor of Medicine at the University of Colorado School of Medicine.
While occurring in adolescents, Osgood-Schlatter Disease can persist into adulthood and is an important differential for anterior knee pain.
Welcome to the latest DPD newsletter. This month we are looking at how we meet our CPD/CME requirements during the year and includes links to various CPD opportunities at the bottom of the page. In addition to other yearly requirements (Audit, Resus etc) each year we have a minimum requirement of 5 hours of CME…
UCPEX The office is busy getting ready for UCPEX, which is taking place on 15 and 16 November. We will be sending out any final confirmation emails to registrars and examiners by Monday next week. Look out for our emails in your spam/junk folder if you are not receiving them, and if necessary call the…
Dr Joshua Russell, Editor in Chief of the Journal of Urgent Care Medicine came to New Zealand from the USA for our Bootcamp in Wellington. Here we discuss his thoughts on NZ, UC down under, the future of Urgent Care and why UC research is so important.
The Education Committee remains committed to ensuring a quality training programme for Urgent Care. As most of you are aware, we are in a transition period where two training programmes are being run concurrently, for those due to start training in 2025 on the new programme, and all the current registrars who remain on the…
As announced at our Bootcamp weekend in Wellington, the Journal of Urgent Care Medicine (JUCM) has just launched a Fellowship in Medical Writing and Editing. This should interest anyone interested in medical writing, publishing and journalism. It is hoped that this Fellowship will run yearly. Anyone interested in discussing future Fellowship opportunities should contact the…
What should you look for in quadriceps tendon and patella tendon ruptures?
Most of my report is made up of “bits and bobs” that don’t fit in anywhere else. They include: A quick mention of the bootcamp and Fellowship ceremony Seeking volunteers to help progress the Distinguished Fellow concept Governance review latest news Strategy 2030 update Consultation – suicide prevention action plan ACC seeking experts Bootcamp and…
The Education committee continues to oversee the review of the training programme, in preparation for the new training programme for those registrars starting from 2025. We have endeavored to keep changes to a minimum for current registrars, and have advised members of these changes in several ways (email, DCT report, and website updates). Please contact…
This year we took Bootcamp to Wellington, holding it at the Rydges Hotel on September 14 and 15, with the Fellowship ceremony and dinner on the Saturday evening. The Saturday sessions got underway after a wonderful opening Mihi Whakatau from the local iwi. The first three sessions followed the previous Bootcamp format, featuring groups of…
Some important considerations when working up chest pain that will make us think of a thoracic aneurysm.
This webinar was hosted by the Journal of Urgent Care Medicine on October 16 at 0700 NZDT The COVID-19 RAT test gave us our first experience with a rapid viral test that we could perform within our clinics. With the availability, albeit at a cost via the pharmacy, of similar tests for RSV and influenza…
Drug-induced tendinopathy can occur early, and late in a person’s usage. So we must consider a patient’s medication history closely whenever they have symptoms of tendinopathy or rupture.
Dry socket might present to urgent care. What is it and what should we do about it?
A caddy offers words of wisdom to their golfer. Some of their advice is relevant to urgent care.
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The hands-on course from the University of Otago offers a thorough grounding in point-of-care ultrasound. It has been extremely popular in recent years. There are currently slots available for the 2025 course so if you are keen to enrol you should follow this link. https://www.otago.ac.nz/courses/qualifications/pgcertcpu The course is an approved paper for RNZCUC Registrars. Scanning…
Kia Ora Koutou, We hope this message finds you well. The Registrar Subcommittee is excited to share the latest updates with you in our College newsletter. Membership Changeover We extend our congratulations to our former subcommittee members—Adrianne, Zilah, and Sanjeev—who have recently graduated as Fellows of the Urgent Care College. We are pleased to welcome…
Kia ora koutou, It is my pleasure to produce this month’s DCT newsletter. I’m going to cover off some important items for registrars – please read and take action where necessary. University Papers A reminder firstly we’ve noted that University of Auckland have limited access to some university papers. POPHLTH709 was cancelled for semester 2…
Welcome to the third DPD newsletter. Multi-Source Feedback Surveys (MSFS) I wish to share these important points regarding the completion of the MSFS. MSFS must be commenced by requesting the College to set them up online Old PSS forms must not be used – if you have previously downloaded them please delete them. It is…
We always look for the sail sign when reviewing radiographs of the elbow, but how often are they associated with occult fractures?
Cluster headaches present through urgent care and it is important to differentiate them correctly.
This two-day course is run by the University of Auckland and is designed for everyday clinical educators working across a variety of disciplines. It covers facilitating small group learning, planning tutorials, supervising clinical students, using feedback, remediating professionalism lapses, teaching cultural safety and assessing mini-cex. It will be an ideal course for urgent care supervisors…
We need to be aware of medications with anticholinergic effects, especially in the elderly.
We need to be aware of medications with anticholinergic effects, especially in the elderly.
Bootcamp We recently sent out emails to all members about the Bootcamp and Fellowship Ceremony and Dinner, taking place in Wellington on 14 and 14 September. Tickets are now available to be purchased for both. Planning for the Bootcamp continues, with details being added to the Bootcamp post as and when they become available. It…
We need to be aware of medications with anticholinergic effects, especially in the elderly.
Weight-bearing at the time of the injury and assessment forms part of the Ottawa ankle rules.
Welcome to the second Director of Professional Development (DPD) newsletter. This month we focus on the importance of providing documentation and reflection within UCCIS to support your CPD. All Fellows wishing to remain vocationally registered within the scope of urgent care must maintain compliance with our recertification programme. We are required by MCNZ to design…
Kia ora koutou, It is my pleasure to produce my first DCT post for the revised newsletter process. I’m going to cover off some important items for registrars – please read and take action where necessary. University Papers We’ve noted that University of Auckland have limited access to some university papers. POPHLTH709 was cancelled for…
Do antihistamines help with the itch of dermatitis?
The Medical Protection Society NZ have a podcast called Reducing the Risk. It is accessible from most podcast providers (Apple, Spotify etc.) or you can listen on your browser at this link. These podcasts cover important Medico legal issues and are accessible to all even if you are not a member of their society.
The Urgent Care Bootcamp and Fellowship Ceremony 2024 will be held at the Rydges Hotel in Wellington on 14 and 15 September 2024. This will be an opportunity for the urgent care community to gather in the capital to share learnings, to network, and promote and celebrate the speciality of Urgent Care. On the Saturday…
When you need help with identifying medications from overseas visitors, you can always call your local pharmacist, or you could try this website.
As medical professionals, we must know our legal and moral obligations to help in case of emergency.
Certain music can help improve your concentration, help you relax and improve your sleep.
Welcome to the first Director of Professional Development (DPD) update in our newly structured newsletter. As DPD one of my main roles is to oversee the ongoing recertification programme and to encourage good quality CPD. CPD can be viewed as an unnecessary imposition on hard-working clinicians so I wanted to use this first newsletter to…
As General Manager my focus is on strategy, stakeholder engagement and oversight of the administrative aspects of the College, including support to the committees. I will share information from all those areas.OfficeAs you know, Claire left the College, and we are waiting for her replacement to arrive in post. Kushani arrives on 24 June as…
Governance review In line with our current strategy the Executive Committee has initiated a full review of the College’s governance structure. An external consulting company has been engaged to complete the initial review. The intention is to ensure that our governance and operational structures are fit for the College’s role and purpose, effective, efficient, and…
Clinical assessment with Māori whānau. For more information click here. (The College is not responsible for external links).
The Education committee with 7 members is the largest of the College’s committees. The committee and DCT David Sorrell meet every 2-3 months as required via zoom and communicate regularly by email. This year Palm Kamolpanus has joined the committee as the new convenor of the Registrar subcommittee. The committee wishes to thank outgoing convenor…
Cold and flu remedies containing pseudoephedrine are now a class C drug in New Zealand and available from pharmacies.
Dr Tony Smith, Deputy Clinical Director at Hato Hone St John, tells us about Double Sequential and Vector Change Defibrillation for resistant VF/VT. These new techniques, not currently covered in our NZRC resus algorithms, are being utilised by all ambulance services in New Zealand for patients who do not get ROSC after three shocks.
You are invited to attend Connect Communication’s first Lets Connect Wellness Webinar entitled “Ask me Anything”: Everything you have always wanted to ask a Psychiatrist on Tuesday June 25th 7 pm. Is there something you have always secretly wanted to ask a Psychiatrist, but you’ve never had the opportunity? Maybe questions about anxiety, medication, depression…
At its meeting on 22 May, the Executive Committee endorsed the strategy working group’s (SWG) recommended approach to the College’s support for the promotion and development of urgent care outside of Aotearoa New Zealand. The SWG met to discuss this as the College is experiencing a significant increase in the numbers of doctors based overseas…
Professor Bruce Arroll talks to us about a practical technique that can help regulate breathing in people having panic attacks or during an asthma attack. The conversation then leads into discussing the Polyvagal Theory, physician wellness, and chronic pain.
Remember to consider an ASIS avulsion in young athletes who experience pain and a pop around their hip when sprinting.
A differential to consider when examining a dorsal wrist swelling.
Much like going to the gym, CPD can be a hassle or an imposition, but it can also be fun and hugely rewarding.
Auckland Eye Specialists run slit lamp training and acute eye care seminars at their Remuera premises. 18 June 2024 – Further details are available here. 3 July 2024 – Further details are available here.
A College member, Jasmine MacKay, who is also the convenor of the Board of Censors and Secretary of the Executive Committee, presented at the Urgent Care Convention in Las Vegas in April 2024. Jasmine’s presentation is saved as a pdf, and accessible for reviewing here.
Each year shortly after the AGM, the Executive Committee goes through a process to ensure representation in the committee, and that the standing commmittees and working groups are appointed.
Should we be listening for bowel sounds? Despite evidence suggesting they are not useful, I still think it is an important part of an urgent care assessment.
What impact do your acute referral letters have on the admitting team?
We must be aware of the possibility of Cozen’s phenomenon in urgent care.
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Today we hear of a case of Chopart injury presenting through urgent care. Thanks to Dr Antionio Castro.
2 years ago we spoke with Dr Tamsin Lillie, a Fellow of the RNZCUC who runs a medical charity that helps fund African students through medical training. Last time we spoke she was calling in from Malawi, but a chance meeting in person prompted a quick catch-up about what has been going on over the last 2 years and her hopes for the charity moving forward.
Those of you who attended the Goodfellow Symposium 2024 may have seen a talk within the urgent care stream given by a Critical Care Paramedic on the topic of C-Spine management in the community. It focused on how St.John approaches transporting patients with C-Spine injuries, particularly those from urgent care clinics. It generated some good…
Some common, non-psychotropic medications can have psychiatric side effects.
Hoffmann’s sign is a simple test that can help in diagnosing cervical myelopathy and upper motor neurone disease as part of a thorough history and examination.
Wellens’ Syndrome is an ECG finding indicative of critical LAD stenosis. Recognising this ECG change is vital.
We must counsel about the possibility of abnormal uterine bleeding starting, or worsening when commencing oral anticoagulation.
An interesting eponymous syndrome with a Kiwi connection.
In cases of ongoing post-prandial epigastric pain and sitophobia despite endoscopy work up and treatment perhaps we should remember to recall Dunbar Syndrome to our differential list.
Grover disease might present through your urgent care. While not a critical or life-threatening condition, recognising it so we can advise and support your patient is important. To help us consider differentials for various presenting complaints there is a useful website you can use.
When considering calcaneal fractures we must remember the Böhler angle and the angle of Gissane.
Thank you those who responded. This year’s response was smaller than previous years – 107. Four were General Practitioners, 53 were Fellows of the College, 10 additionally were Clinical Directors and registrars were divided into senior (23 replies) and junior (15 replies) on the basis of UCPEX pass. This represents about 1/4 of RNZCUC members…
Could caffeine withdrawal result in an urgent care visit?
Supervision is a vital part of registrar training and support. To help foster and develop quality ongoing supervision it is important that supervisors engage in regular continuing professional development that focuses on supervision. While supervisors are free and encouraged to seek out suitable CPD wherever they can find it, the College will collate CPD opportunities here…
An eponymous sign that helps in the diagnosis of glandular fever.
This week, the world’s best snooker players are competing for the Paul Hunter Trophy at the Masters in London. Paul sadly died of neuroendocrine tumours in 2006 whilst in his snooker prime.
Urgent Bite 201 – Thinking about referrals from UC
Jean Batten was a New Zealand pioneering aviatrix who died of empyema.
You might encounter an Ice Cream Headache over Christmas.
The 2024 Urgent Care Bootcamp conference will be held at the Rydges Hotel in Wellington on September 14th and 15th.
The University of Auckland is scoping the feasibility of developing a Post Graduate Qualification in Point of Care Ultrasound and Echo for Clinicians. They believe that this would be of interest to a wide range of clinicians in acute care settings, including urgent care. Please take 2 minutes to complete the following survey to help…
We have updated the one-page summary of Urgent Care in New Zealand using the data collected from clinics this year. This summary provides a snapshot of how urgent care contributes to primary health delivery in New Zealand.
Several policies are up for review. They are listed below along with some proposed minor changes. If you have comments about any of these, please email policy@rnzcuc.org.nz. Clinical practice visit policy. This policy is very out of date, and will be rewritten in the current College document format. At a previous ExC meeting, the ExC…
Over the past year RNZCUC has been reviewing the College’s curriculum, and we now wish to gain your feedback on a section of our draft document. Any proposed changes will not be implemented until 2025. The CanMEDs physician competency framework has been utilised with permission of the Royal College of Physicians and Surgeons (Canada), with new graduate…
We should be reporting suspected medication-induced anaphylaxis to CARM. Likewise, remember to report cases of ACE-induced angioedema.
Whether an incidental finding or related to a presenting issue, advising a surfer about preventing exostosis progression is important in urgent care.
Join us at 12.30 on Thursday 7 December for our next ‘How to’ webinar as we cover ‘How to complete an ACC18 medical certificate’. We know that not everyone has the same understanding of when to use ‘fully unfit’, ‘fit for selected’ and ‘fully fit’ when completing an ACC18 medical certificate. We also know it…
Whether reviewing a possible subungual haematoma or an opportunistic finding, urgent care clinicians need to be aware of subungual melanoma.
We should always observe our patient’s gait and make sure to look our for a foot drop.
The Zurich Tongue Scheme may help you in assessing tongue lacerations in kids.
What would you think if a patient presents with a spontaneously bruised digit?
It is important to remember our role in recommending simple measures to help our patients and it is worth thinking about the power of take-home information that details the advice you have given.
The health care sector is experiencing unprecedented times, coupled with staff shortages and high levels of unenrolled patients. We are all in the same waka. City Medical Napier has proposed a quarterly forum of the urgent care centres across Aotearoa New Zealand, where we can sit around the virtual table and share our challenges and…
Urinary alkalinisers can reduce the effectiveness of certain antibiotics
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On Tuesday the 26th of September our Director of Professional Development, Guy Melrose, delivered a webinar presentation to a GP audience as part of a Te Whatu Ora NRHCC webinar series. The talk was on four commonly missed hand and finger injuries. Also presenting at this webinar was Dr Peter Gow, a recently retired Rheumatologist…
Dave has used this test for years to help with his diagnosis, so he was relieved to find a paper that supported its use.
A new audio interview series featuring health care professionals and researchers involved in trauma care and rehabilitation has been published on the Te Tāhū Hauora Health Quality & Safety Commission website. Called Trauma Exchange, the interviews are of interest to anyone involved in trauma care and rehabilitation. They cover a range of topics: State of…
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ANZCA’s Gender Equity Subcommittee is hosting a free webinar Words matter: inclusive language in gender diverse care on Thursday 12 October at 6 PM AEDT. The webinar will discuss inclusive language to create safer interactions with gender diverse communities in healthcare. It features guest speaker Hannah Maher, policy writer and LGBTQ+ Inclusive Practice trainer from…
Being burnt out can change the way we prescribe.
Kia ora koutou, The theme for Aotearoa Patient Safety Day 2023 is ‘Engaging patients for patient safety’ with the tagline ‘Elevate the voice of patients’. Resources are available to order now; more information about how to place your order is below. Te Tāhū Hauora Health Quality & Safety Commission is using Aotearoa Patient Safety Day…
Smells can be nostalgic, but can they be antiemetic?
B12 deficiency is worth considering in some of the patients who present through UC.
Dear Colleagues, tēnā koutou katoa, My name is Albert Wu, I am a FRNZCGP and am currently working as the Medical Administration Registrar at Counties Manukau. I would like your opinion on rationalising the primary care inbox to streamline paperwork, as your time is valuable. All clinically active and training General Practitioners, Urgent Care Physicians,…
Døds Diving, or death diving, is a Norwegian extreme sport. Watching it made me consider traumatic tympanic membrane ruptures
Palpating the cervical lymph nodes is a vital part of our examination of febrile kids.
On Tuesday 22nd of August Dr Paul Huggan, an Infectious Disease Specialist from Waikato and co-founder of the NZ Sepsis Trust presented a webinar for the Goodfellow Unit on recognising sepsis in primary care. The recording of the webinar is available below. This is valuable CPD for urgent care physicians. https://www.goodfellowunit.org/events-and-webinars/sepsis-how-not-miss-it-primary-care
Today we look back at 5 years of the Royal New Zealand College of Urgent Care podcasts.
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Auckland Eye is hosting an hour-long webinar with presentations on hot topics from four of their leading Ophthalmologists – Dr. Justin Mora, Dr. Dean Corbett, Dr. Sarah Welch and Dr. Taras Papchenko on Tuesday, 12th September 2023 at 7.00 pm. Register at the link below https://us02web.zoom.us/webinar/register/WN_utyvzr61QPiL9a6F2EYqmw#/registration
A couple of eponymous signs to use in evaluating abdominal pain that helps determine a rectus sheath haematoma.
Look for the cardinal signs of Kawasaki disease in kids with persisting fever.
Elson’s test is an important test to know in urgent care.
Free Professional Development eLearning module opportunities Last year the HDC launched a series of online learning modules to improve providers’ knowledge and understanding of people’s health and disability rights. These three free modules cover how the Code of Rights improves health and disability services, what you need to know about informed consent, and complaints management…
High-pressure injection injuries might look innocuous on the surface, but they need an immediate surgical referral.
Bell’s palsy can be diagnosed clinically, but it is important to exclude other differentials.
Why should we look at the tongue in urgent care? And why does it sometimes stick out when we are thinking?
A tibial stress fracture in a golfer. Unusual, given that they are often associated with runners, but it does highlight how listening to your patient when they say something is wrong is important.
Today we chat with Dr David Sorrell about how he bends the needle to aid corneal foreign body removal.
A Latissimus Dorsi tear is a rare sporting injury but one we should be aware of in urgent care.
Will we need urgent care clinicians in an AI health system?
Author: Dr Gareth Norton
Date: August 2022
Abstract:
Croup, or laryngotracheobronchitis, is an extremely common presentation of respiratory
disease in the paediatric population. The mainstay of treatment is oral corticosteroids and in moderate/severe cases nebulised adrenaline. Concerns exist around the possibility of a rebound effect where their are increased symptoms when the effect of a drug has passed. If a drug produces a rebound effect, the condition it was used to treat may return with an
increased severity. Or is there no rebound effect and the return of symptoms, even at an
increased severity is due to the natural course and progression of the treated condition?
Cullen’s sign is an important eponym to recognise in urgent care.
Something a concerned parent might bring into urgent care.
We need to be aware of complex regional pain syndrome in urgent care.
Today we talk about a study into errors in primary care and ED with Dr Ivan Koay. We also discuss the Abstracts of Urgent Care that he curates at the JUCM and the importance of research in urgent care.
Cholesteatoma is an important diagnosis to consider in urgent care.
Pectoralis Major ruptures would seem to be an injury of the last 30 years and are related to bench pressing heavy weights.
It is worth refreshing your knowledge on local anaesthetic systemic toxicity.
Today we catch up with Dr David Sorrell, Director of Clinical Training, to discuss hand injuries.
The health literacy of our patients is an important consideration in urgent care.
What are the red flags when we see a patient with torticollis?
SUFEs will often first present in primary care and are easily missed.
Not everything that comes through UC is urgent, but knowing a little about these out-of-scope topics is still necessary.
a news article from Whaikaha about data from the Ministry of Health – Manatū Hauora on COVID-19 on case rates, hospitalisations and mortality rates for people who receive Disability Support Services. There are links to the report
Thank you those who responded. This year a record 150 doctors replied to the workforce survey. Nine were General Practitioners, 73 were Fellows of the College and this year we divided registrars into senior (34 replies) and junior (16 replies). This represents about 3/8 of RNZCUC members but may not be directly comparable to last…
Looking for and identifying a hypopyon is an important part of the UC eye exam.
We should all know how to do Seidel’s test in urgent care.
Author: Dr Gustav Fourie
2019
Abstract:
Hypertension is a common presentation but there is no New Zealand based guideline for the management of severe asymptomatic hypertension (greater than 180 systolic or 110 diastolic) in urgent care. Definitions have varied in both naming ( hypertensive emergency, hypertensive urgency, hypertensive crisis ,malignant hypertension,accelerated hypertension, severe asymptomatic hypertension) and parameters.
Method:
A review of recent literature was conducted.
Author: Dr Gary Mitchell
Abstract:
Rivaroxaban is well established as a treatment for deep vein thrombosis and pulmonary embolism, but there has been hesitation in using it as a bridging agent in clinical situations where DVT is suspected but not yet confirmed by definitive ultrasound scan. The evidence for the safety and efficacy of this approach is explored. During this time of research, the use of rivaroxaban began to gain acceptance and usage in New Zealand, leading to a brief analysis of factors involved in trying to introduce up to date guidelines into a small health organisation in New Zealand prior to widespread acceptance and definitive guidelines at District Health Board level.
Diverticulitis: the role of antibiotics in urgent care
Author: Dr Eleri Clissold
Abstract:
Our understanding of this common and painful disease is evolving. What was thought to be a predominantly infective process is postulated to be inflammatory and self-limiting in the majority of cases. Over several decades multiple high quality studies have emerged questioning the role of antibiotics in the management of acute diverticulitis without perforation, sepsis or other complications. No study has demonstrated the superiority of any antibiotic strategy in any one of multiple outcomes assessed. This literature search seeks to examine the evidence in-depth and place it in context for urgent care practitioners.
Good safety netting and follow-up are vital for patients presenting through UC with rectal bleeding.
As of February 1st, 2023, adrenaline auto-injectors are now funded in New Zealand under Special Authority.
Do you use Prednisone of Dexamethasone for croup?
One of our urgent care fellows working in the Bay of Plenty is passionate about recycling and reducing waste. The healthcare industry creates huge amounts of waste and plastic pollution, but there are ways that we can make our working environments more sustainable.
Tamsin has set up a recycling box in Rotorua Emergency Department to collect flexible cleaning wipe packaging and soap pumps, trigger heads. In just two weeks, 100 plastic packets have been collected. These are sent in to Terracycle using a freepost label where they are recycled into their component parts. Can you set up one in your work place and help divert plastic waste from landfill?
See the steps below for setting one up:
1. Get permission for the recycle box from the in charge / supervisor.
2. Repurpose a cardboard box for collections (as shown). I can send you a poster of the collected items similar to the one below if required.
3. Promote and advertise – inform those working in your area by email / intranet communications about the collections. Discuss with cleaners and HCAs. Put a poster up in a common area. Leave messages on white boards about the collections.
4. Empty collections when full.
5. Download a postage label from Terracycle (or email Tamsin when you need one and she can send it to you).
6. Attach label to packaged items and drop off at post office (freepost label!)
Author: Dr Jin Gao
Type: MLP-research
Date: 16 December 2020
Abstract:
The pulled elbow(PE) is a common childhood injury. In most cases, the clinical management is straight forward, however, the diagnosis and management may be difficult if there is an unclear history, an unwitnessed injury or an atypical mechanism of injury. This medical literature project evaluates the effectiveness of point-of-care ultrasound in the diagnosis of PEs.
Nausea and Vomiting in Pregnancy (NVP)
Author: Dr Richard Chen
Abstract:
Aim:
Nausea and Vomiting in Pregnancy (NVP) is a common presentation seen by a wide variety of medical professionals however the evidence around the safety and efficacy of drugs used to treat NVP is often not well understood. This review looks to explore current prescribing practices of drugs used to treat NVP and provide evidence-based recommendations.
Method:
The current New Zealand Guidelines for treatment of NVP was studied and an in-depth literature search into the safety and efficacy of drugs available was conducted.
In addition, a survey of current doctors working in the Urgent Care setting was conducted to determine current prescribing habits.
Results:
Pyridoxine, Doxylamine and Metoclopramide are the medications with the most proven safety profile in pregnancy respectively. There have been significant studies into the Pyridoxine-Doxylamine combination as well as Metoclopramide to demonstrate effectiveness against placebo. However, there is insufficient evidence to suggest any drug is the most effective drug available.
A large proportion of prescribing preferences of the doctors working in Urgent Care surveyed in the context of treating NVP were not supported by the available evidence.
Conclusion:
Considering both safety and efficacy, Pyridoxine and Doxylamine are the recommended initial drugs of choice to manage NVP. This is closely followed by Metoclopramide. More doctors working in the acute medical setting should be aware of the potential teratogenicity of drugs used to treat NVP.
Author: Dr Alexander Stapleton
Type: MLP-case study
Date: 2022
ABSTRACT
Background: This literature review was devised to clarify the rationale between the use of
Dexamethasone and Prednisolone for the treatment of paediatric Croup in the community setting.
Methods: A computerised literature search of local and international Guidelines, PubMed and CENTRAL
(Cochrane Central Register of Controlled Trials) was carried out. Fifteen sources were included.
Indications and use of dexamethasone and prednisolone varied across the cited literature. An evidence
based practice viewpoint and appraisal of the literature was undertaken and the results collated.
Results: Analysis of the literature shows a clinical benefit of Dexamethasone in comparison to
Prednisolone when it comes to re-presentation, with a reduction in patient readmission and
re-presentation when using Dexamethasone compared to Prednisolone. Clinical benefit outside of this
parameter has not been proven. There was also a demonstrable effect on caregiver stress levels when
Dexamethasone was given compared to Prednisolone given ease of use. Some benefit with improved
tolerance with Dexamethasone compared to Prednisolone. There is also a potential cost benefit
involved in treating Croup with single dose Dexamethasone but this would need further exploration in
the New Zealand context.
Always look for a nasal septal haematoma in cases of nasal trauma.
Does expectation influence the experience of receiving an injection?
Author: Dr Sandy Crofts
October 2021
Abstract:
Cannabinoid Hyperemesis Syndrome (CHS) is a syndrome of intractable vomiting with severe abdominal pain that is associated with chronic marijuana use. Classically, symptoms are relieved by hot showers and are often unresponsive to traditional acute interventions such as antiemetics.
Patients commonly undergo multiple investigations without diagnosis. Complete resolution of symptoms occurs with abstinence from cannabis.
The following Medical Literature Project gives an overview of Cannabinoid Hyperemesis Syndrome and review of current management.
Author: Dr Alice Mason
March 2022
Abstract:
Paediatric forearm fractures are a common presentation seen in Urgent Care, often occurring from a fall onto an outstretched hand. Currently, best practice is for an x-ray when there is suspicion of a fracture.However, this comes with exposure to ionising radiation and can be associated with prolonged waiting times, pain, and further cost. This review aims to investigate whether point of care ultrasound (POCUS) could be used as an alternative or preferred option for suspected distal radius fractures in children.
Author: Dr Imran Zia
December 2021
Abstract:
A literature review was carried out to assess the safety of Adenosine in Urgent Care (UC) setting for the termination of Paroxysmal Supraventricular tachycardia (PSVT). Thorough literature evaluation advocates the use of adenosine for the acute termination of PSVT in Urgent care settings, especially in rural and remote practices. It has the potential to improve patient management and satisfaction along with a reduction in cost, ED load, and associated hospitalization.
Author: Dr Zeeshaan Khan
Type: MLP-research
December 2022
Abstract:
Paediatric lateral condylar fractures (PLCF) are the most common fractures in children under the age of 7. This article will provide an overview of paediatric lateral condylar fractures with an emphasis on the importance of obtaining adequate radiographs and providing an accurate classification to guide management. It is essential for Urgent Care clinicians to be competent in the reading of paediatric elbow radiographs and possess a sound knowledge of the different classification systems of PLCF in order to provide the correct treatment and knowing when to refer for operative and non-operative treatment.
We should be cautious with penetrating volar hand lacerations.
A drug interaction that should be at the front of our minds.
We are joined by Dr Joshua Russell, Editor in Chief of the Journal of Urgent Care Medicine to talk about why we should be doing more vital sign re-checks in urgent care.
Urgent Care is for life, not just for Christmas
The rash of scarlet fever looks different, depending on skin colour.
It benefits our patients to remember to advise on whether they should remain nil by mouth on acute referral to hospital.
And conversely, a cup of tea can have beneficial treatment effects.
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COVID-19 Care in the Community has updated the clinical guidance for COVID-19 antivirals and Primary Care COVID-19 Quick Reference Guide, and we will be grateful if you can use these to inform your care from now on. These documents will be available on the COVID-19 Advice for all health professionals webpage
Remember that increased activity can cause a venous thrombosis in the upper limb.
National Immunisation Programme – Stakeholder hui recording and slides available Thank you to those who attended NIP’s stakeholder hui yesterday. Amongst other updates, attendees from yesterday’s hui were fortunate to hear from the team at Kōkiri Marae Health and Social Services about their success with their vaccination events. If you missed the hui yesterday and would…
What actually is Rovsing sign and is it useful?
Is a Katz extractor an easier way to remove a nasal foreign body? And is it worth it?
Supervision Stage 1 videos Which of these are described in the three hats metaphor? Leadership, instructive and demonstrative Educational, supportive, and managerial Inspirational, dynamic, and coordinated Up-front, stand-off and intermediate What is the point of the three hats metaphor? To help identify different roles you have as a supervisor To assist with managing the tensions…
For such a seemingly sedate and passive game played by old people, golf must be considered in a number of injuries.
Author: Dr Dinesh Deonarain
Type: Other research
Date: Sep 2022
Abstract:
Mountaineering is a dangerous recreational activity with falls causing severe injuries and deaths. Survival from falls longer than 100 m is uncommon. We present a case of a high-altitude porter on Mount Everest who fell 400 m and survived. He slipped from a ridge at 7000 m (22,900 ft). A rescue party found him above Camp 2 (6600 m, 21,600 ft) and arranged a helicopter rescue. The Everest ER medical team at Everest Base Camp (5400 m, 17,700 ft) received the climber. They identified a head injury without signs of other serious trauma. A doctor provided manual inline stabilization of the cervical spine, airway support, and ventilation for the patient during the helicopter and ground transport to a tertiary hospital in Kathmandu. The time from the fall to definitive hospital care was 2.5 h. The hospital emergency team diagnosed an epidural hematoma and subarachnoid hemorrhage without midline shift and right parietal, orbital, and maxillary fractures. The neurosurgical team evacuated the intracranial bleed. The patient spent 6 d in the hospital. He had a positive neurological outcome. He had mild cognitive impairment and vision loss in his left eye but could perform activities of daily living. He returned to physical work, but not to climbing. This case report provides evidence that survival is possible after falls from extreme heights and sheds light on the challenges of an evacuation from austere environments.
Author: Dr Crispian Wilson
Type: Other research
Date: April 2022
Abstract:
Aims: To assess the error rate in plain film interpretation amongst urgent care doctors in the context of minor trauma, to determine where such errors occur and whether they affect patient care, and to identify possible causative factors. Methods: Five thousand X-ray interpretations occurring between March and August 2021 across six urgent care clinics were included in this retrospective study. Data analysis focused on demographic data, site of injury, the experience of the doctor interpreting the X-ray, and whether any change in management occurred following an error. Results: Six hundred and seventy-three X-ray interpretation errors occurred (13.5%), with 171 of these (3.4%) resulting in a change in patient management. Chest and elbow X-rays were misinterpreted most often. Both the age of the patient and training of the urgent care doctor had a significant effect on this error rate. The main impacts on patient management were cast removal and recall for review in the urgent care centre or an orthopaedic clinic. Conclusions: X-ray misinterpretation occurs at equivalent rates in urgent care when compared to the emergency department. Errors occur more commonly with paediatric patients and for doctors with less urgent care-specific training. These errors rarely result in any serious impact on patient management.
A person had 23 contact lenses under their eyelid.
Author: Dr Matt Wright, Dr Fiona Pienaar
Type: Other research
Date: Oct 2022
Abstract:
aims: The purpose of this study was to compare the frequency and profile of abdominal pain calls to Healthline with that from other national healthcare providers; to evaluate the outcomes for this symptom against international telehealth providers; and to explore any inter-clinician variation in the response to abdominal pain that could be part of a quality improvement cycle. methods: Data routinely collected about abdominal pain calls to Healthline from 2017 to 2019 were extracted, analysed; and compared to the literature, hospital, and ambulance data and international telehealth providers. A specialist group was convened to review the profile of Healthline callers and outcome data. Variation in outcome changes and acuity grouping was evaluated at an individual level. results: Approximately 50,000 abdominal pain calls to Healthline over three years were analysed, with three-quarters from women, mostly of childbearing age. The majority call afterhours, with NZ European and, to a lesser extent, Māori, and callers from smaller geographical areas are over-represented. One quarter of patients had a hospital outcome (including 4% receiving an ambulance), which was found to be less acute than comparable health systems. Whakarongorau’s Clinical Governance Committee and the Specialist Group both supported the relative distribution of outcomes given by Healthline for abdominal pain. There was found to be variation in the outcomes given to abdominal pain callers at an individual clinician level. This was both in their changes to the disposition given by the Odyssey decision support tool and in their overall outcome distribution. conclusion: Healthline should be considered a key part of New Zealand’s healthcare system, as illustrated by the volume of calls that it receives and the fact that presentation types are similar to general practice and emergency departments. Given that abdominal pain is a difficult symptom to accurately address without in-person examination and investigation, the findings support Healthline’s outcomes as appropriate with hospitalisation rates lower than comparable healthcare systems. Whakarongorau’s (the organisation which runs Healthline) ability to identify individual clinician behaviours gives it a unique opportunity to improve care through decreasing variation..
A few important things to remember about perichondritis of the pinna.
The COVID-19 Safety Pledge (covidpledge.co.nz) initiative was launched to help and encourage businesses and organisations to protect their staff from COVID-19 as well as other airborne illness. We encourage readers to visit the site and consider signing up to the pledge.
Watching the recent World Long Drive competition highlighted how sometimes a history can be misleading.
In the coming days, Parliament will undertake the final reading of an amendment to our legislation. This expands accident cover to include certain maternal birth injuries experienced during labour and childbirth from 12.00am on 1 October 2022.
This is a significant change for ACC, but more importantly represents a positive step for the health of birthing parents and improving equity of access to the Accident Compensation scheme. This change means those with a covered maternal birth injury will be eligible for ACC-funded support, treatment, and care to help them in their recovery.
In preparation for this, our focus has been to make sure health practitioners across the motu can begin lodging claims from 1 October and our systems and people are ready to process them.
The Urgent Care College Information System (UCCIS) will be an overarching information system providing (or linking) all of the IT and IS the College uses. This will greatly improve ease of use for members, and increase the efficiency and productivity of the College adminstration. UCCIS is being built in phases. UCCIS will evolve further over…
Dr Johanne Egan and Dr Charlotte Chambers spoke to us about burnout in urgent care at a webinar earlier this year. This podcast is the audio from that webinar.
This publication is a summary of the RNZCUC sponsored session: The use of paracetamol and ibuprofen in young infants from the 2022 Goodfellow Symposium. Professor Stuart Dalziel, University of Auckland and Starship Children’s Hospital, delivered guidance on the management of pain and distress in febrile infants. He also provided a comprehensive head-to-head review on the…
Author: Dr Ivan Koay
Type: Other research
Date: September 2022
Abstract: This pilot study was designed to investigate the ability of incorporating lean methodology into the delivery of medical education. The project worked within the academic remits of the University College Dublin (UCD), Master’s in Advanced Practice (Nursing) program, which provided the academic rigor for the project. Practical and procedural skills were taught based on an adapted version of the RNZCUC’s core skills list (CSL)
Can a patient accurately locate a fish bone stuck in their throat? And are X-rays good at locating them?
We see it quite often but why is it called herpangina?
The fourth urgent care Bootcamp was a fantastic success, with our members able to reconnect, re-energise, and rekindle passions for urgent care practice. Over 90 delegates attended the Bootcamp on Saturday and were treated to exciting, fast-paced, thought-provoking talks. Over 70 guests attended the Fellowship ceremony and dinner and celebrated our recent Fellows. Many stayed for the Sunday panel discussions which really helped us focus on what needs to be done at a system level to allow urgent care to provide the right care, to the right people, in the right places, at the right time.
For the full report
The Pharmacy Council is seeking feedback on the draft Competence Standards for the Pharmacy Profession and supporting Guidance Notes. Practitioners in all three scopes of practice must meet these competence standards. Council is responsible for setting standards of clinical competence, cultural competence, and ethical conduct for pharmacists. It is timely that the standards are…
Workforce survey Manatū Hauora has developed a survey for health practitioners including medical practitioners, nurses, midwives, as well as social workers or counsellors who may provide counselling. The survey will cover questions like what you know about abortion if you currently provide abortion care (and if you want to provide more than you currently do),…
We have three National Immunisation Programme updates to draw your attention to today: two new COVID-19 vaccination changes being implemented from tomorrow (22 September 2022), and a reminder about the change to vaccination mandates for healthcare workers.
Author: Dr Alison Curran
Type: MLP-research
Date: July 2022
Abstract:
Procedural sedation in the urgent care setting may be used to perform minor procedures, thereby enabling a patient to receive treatment sooner and in many cases avoiding a hospital admission1. There are safety concerns around using procedural sedation, therefore the use of clinical guidelines and credentialing is strongly recommended to reduce the risk of adverse events2,3,4,5,6. This project aims to review and make recommendations on the Procedural Sedation guideline at Pegasus 24 Hour Surgery, based on up-to-date literature and inclusion of the ‘Australian and New Zealand College of Anaesthetists’ (ANZCA) guidance2,7.
Important we consider potential interactions between opioids and antidepressants.
Today (Thursday 8 September) Medsafe published a safety alert in relation to the COVID-19 Novavax (Nuvaxovid) vaccine: Myocarditis and pericarditis have been reported with Nuvaxovid (Novavax COVID-19 Vaccine) There have been a small number of cases of myocarditis and pericarditis reported internationally following vaccination with Nuvaxovid. The medicine sponsor now considers that myocarditis and pericarditis…
Author: Dr Matthew Reay
Type: MLP-research
Date: June 2022
Abstract:
Lower limb immobilisation increases the risk of Venous Thrombo-Embolism (VTE). The aim of this medical literature project is to firstly examine the risk factors most associated with an increased risk of VTE and the accuracy of risk stratification scores in predicting who will benefit from thrombo-prophylaxis. There are a number of risk stratifications scores available, all with varying accuracy. The TRiP (cast score) shows the most promise with 2 prospective trials (CASTING and TILLIRI) currently running, with results yet to be published.
The ideal risk stratification score, will have low rates of both under (sensitivity) and over treatment (specificity).
Author: Dr Eleri Clissold
Type: MLP-research
Date: April 2022
Abstract:
Our understanding of this common and painful disease is evolving. What was thought to be a predominantly infective process is postulated to be inflammatory and self-limiting in the majority of cases. Over several decades multiple high quality studies have emerged questioning the role of antibiotics in the management of acute diverticulitis without perforation, sepsis or other complications. No study has demonstrated the superiority of any antibiotic strategy in any one of multiple outcomes assessed. This literature search seeks to examine the evidence in-depth and place it in context for urgent care practitioners.
An important eponym that may help us miss fewer lunate dislocations on initial presentation.
COVID-19 Aotearoa Immunisation Register to launch a new vaccinator portal We are excited to share with you that the Aotearoa Immunisation Register (AIR) is preparing to launch its new vaccinator portal. AIR’s vaccinator portal will support Vaccinators from all parts of the immunisation sector to record vaccinations and view vaccination history currently existing in the…
An eponymous fracture that we tend not to hear used so much these days.
Te Whatu Ora is hosting a webinar on 31th August at 7:30pm This webinar will focus on nationally relevant guidance forprimary care clinicians managing Monkeypox and COVID-19 inthe community.Topics include: • Monkeypox—case definition, testing, vaccination, treatmentand new Monkeypox pathway• Overall COVID-19 response– persistent infection, rebound,isolation requirements, international travellers, vaccination• Care in the Community— COVID-19 transition to…
COVID-19 Updated clinical advice re boosters and pregnant people It is recommended that pregnant people receive a booster dose of the Pfizer vaccine to help protect them and their baby against the effects of COVID-19. The booster vaccine can be given at any stage of pregnancy. If you are 18 or over, you can get…
Let’s ask Dr Rob Evison how not to miss significant ankle injuries.
The Mason Classification helps us determine which radial head fractures need orthopaedic review.
In response to the recent survey on the proposed quarterly supervision appraisal form, the Education Committee responded: Following the MCNZ accreditation visit in 2021, RNZCUC has undertaken to develop a more robust supervision form and align supervision requirements with the MCNZ. A working group was established and the Quarterly Appraisal Form developed. This form is…
Be aware that there is potential for some shorthand notes to be read two ways.
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As we approach the first anniversary of the new recertification programme we have a CPD newsletter. Here you will find some clarifications and important reminders about various parts of recertification as well as a list of accessible and UC relevant CPD.
Under the End of Life Choice Act 2019, the Registrar (assisted dying) reports annually to the Minister of Health. The first report was published last week, covering the period from 7 November to 31 March 2022. The report is available here: Registrar (assisted dying) Annual Report | Ministry of Health NZ
Dr Ruth Large from the New Zealand Telehealth Forum is seeking feedback from medical colleges on a white paper, that explores ways to deliver care via telehealth, creating a cloud-based, multi-specialty, national health provider. The paper and link to a survey where you can give direct feedback is available here: 220524-Telehealth-Whitepaper-Patients-Anywhere-Specialists-Elsewhere-PASE.pdf
When is a young person’s back ache not just a strain?
Weightlifters are at risk of triceps rupture. What should we look for in urgent care?
Regular reminders Weekly vaccination data Latest Māori and Pacific COVID-19 vaccination data is now available here. We’re also now publishing weekly flu data. This week’s statistics on the influenza vaccine uptake across the motu is available here. Collateral on Dropbox Don’t forget we have a range of collateral you and your providers can use to promote vaccinations.…
We must remember that kids can get Lisfranc injuries.
Kia ora koutou urgent care colleagues, We’d appreciate you sharing the below key messages on Novavax booster with your rural networks or contacts. There are also some Q’s and A’s further below. Key Messages From 5 July, Novavax booster will be available without a prescription. This gives everyone over 18 years old a choice in…
Come to our urgent care Bootcamp in Ōtautahi, Christchurch on September 17th and 18th 2022 at the Rydges, Latimer Square.
Dr Cole Rudolph, an Auckland GP, has launched a new website designed to collate CPD opportunities in one place for NZ clinicians.
Kia ora urgent care colleagues, Last night we sent you a message about the availability of second boosters for those at risk of severe illness from COVID-19 and extended eligibility for funded flu vaccinations. You can read the Minister’s media statement relating to this announcement here and an update on who is recommended to receive the second…
We have received the following from the Ministry of Health: The COVID-19 Public Health Response (Vaccinations) Amendment Order (No 5) 2022 is now: Notified in the Gazette: https://gazette.govt.nz/notice/id/2022-sl2582 Published online (as SL 2022/207): https://www.legislation.govt.nz/regulation/public/2022/0207/latest/LMS713761.html Vaccine mandates to end for some health and disability sector workers The Government is amending the COVID-19 Public Health Response (Vaccinations) Order 2021…
Venue: Christchurch, Rydges Latimer Square Date: 17-18 September 2022 The 2022 Urgent Care Bootcamp and Fellowship dinner will be held at the Rydges, Latimer Square, Christchurch, on September 17 and 18. Please note this page is only for Presenters. If you have not received a personal email from the College telling you to use this link,…
The College is strengthening its model of supervision. To do this, we are asking you to provide information to allow us to understand supervisor training and needs for ongoing support.
We must always think to look for the Monteggia fracture.
Do you see haematospermia presenting through urgent care often?
Venue: Christchurch, Rydges Latimer Square Date: 17-18 September 2022 The 2022 Urgent Care Bootcamp and Fellowship dinner will be held at the Rydges, Latimer Square, Christchurch, on September 17 and 18. Please note this page is only for recently graduated Fellows. If you have not received a personal email from the College telling you to use…
Venue: Christchurch, Rydges Latimer Square Date: 17-18 September 2022 The 2022 Urgent Care Bootcamp and Fellowship dinner will be held at the Rydges, Latimer Square, Christchurch, on September 17 and 18. Please note this page is for current members of the College who are not presenting or eligible for a free dinner ticket. The latter will…
Venue: Christchurch, Rydges Latimer Square Date: 17-18 September 2022 The 2022 Urgent Care Bootcamp and Fellowship dinner will be held at the Rydges, Latimer Square, Christchurch, on September 17 and 18. Please note this booking page is for attendees who are not members of the college, e.g. nurse practitioners, paramedics, allied health workers, resident medical…
We are joined by Dr Rory Miller to discuss a recently published paper that looked at the use of point of care troponin alongside an accelerated chest pain pathway in New Zealand rural and primary care.
Should you advise soaking the finger after nail trephination?
ACC has created some concussion educational material available through BPAC and the Goodfellow Unit.
Dr Jonathan Reisman is an ER physician, author and adventurer. He joins the podcast for a conversation about travel, medicine, adventure, food, anatomy and life, drawing on experiences he documents in his recently published book, The Unseen Body.
Find the Doctor NOS podcast here – https://doctornos.buzzsprout.com/
Do you have a passion for removing barriers to healthcare and social support for young people, and are interested in governance? Evolve is a Youth One Stop Shop (YOSS) delivering free integrated primary health care and social support services to young people aged 10-24 years old in the Wellington region. Our dedicated healthcare, social support,…
Find the Doctor NOS podcast here – https://doctornos.buzzsprout.com/
What factors can affect the reading you get from a glucometer?
Why is it called the tragus and when might we encounter it in urgent care?
(published March 2022) The results of the annual survey are available online here. In general, the College appears to be doing well, even very well, in the areas that we asked about. We asked about registrars’ experience of the training programme, and most (nearly all) responses indicated agreement or strong agreement to a range of…
We are joined by Dr Tim Funaki who talks to us about a recent experience he had when he discovered a guideline had changed without his realising. We discuss how we should feel comfortable looking up information, even if we think we already know it and we take a look at the Royal Children’s Hospital Melbourne infant reflux guidelines.
Why do we have to do a yearly resus course?
We talk with Dr Jonathon Webber about a recent paper on which they were an author that looked at the variability in CPR training among NZ health professionals. We go on to discuss the benefits of a yearly CPR course and ways in which teams can get the most out of their yearly resus training
Dr Tamsin Lillie is a FRNZCUC currently in Malawi. We talk to her about her career in medicine, how she found Urgent Care and the charity work she is doing in Africa.
Why have I got swimmers ear, when I do not swim?
Torsion is a diagnosis not to miss. This is a good paper to review
Author: Dr Pregasen Naicker
Type: Other research
Date: February 2022
Abstract:
Distal radius fractures are one of the most common fractures. Plaster casting remains the common treatment of choice for simple distal radius +/- ulna fractures. Casting has been noted by patients to be heavy, itchy, cumbersome, restrictive of work and leisure activity, and presents a hygiene risk. To alleviate the difficulties noted with casting, an evaluation of a novel adjustable wrist orthosis in the non-operative management of distal radius fractures was performed
Author: Dr Muhammad Asim
Type: Other research
Date: February 2021
Abstract:
In case you need some ideas for CPD, check out these ideas.
The Auckland Chinese Medical Association is holding their 2021 conference on May 8th 2021, at the Highbrook conference centre, East Tamaki, Auckland.
A good paper to read about antibiotic prescribing in children with LRTI and an opportunity to listen to the author of the paper
Professor Paul Little, a leading primary care researcher will speak on the above topic. Paul Little has been a GP for 20 years, and is Professor of Primary Care Research at the University of Southampton. He is a Fellow of the Academy of Medial Sciences, a National Institute of Health Research (NIHR) Senior Investigator (emeritus),…
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We’ve received a communication from St John asking urgent care clinics to call the 0800 health professionals’ line and NOT the 111 when requesting an ambulance. In summary, St John is experiencing record high 111 call demand due to the Omicron surge, and at times are experiencing severe delays in 111 calls being answered. As…
Professor Bruce Arroll tells us about his paper on the Emoqol 100 and how he uses it to screen for low mood.
Thank you to all that replied to this survey. The overall impression was that again there are large variations. Bear in mind when comparing to last year that the sample may not correspond to last year’s cross-section. There are two parts to the survey – the statistics and the free text comments from which I…
The ACC innovation fund is new for ACC and is a response to the array of good ideas we have had raised with us.
Our 2021/2022 Innovation Fund is here and we’re looking to partner with health innovators that have great ideas to help injured people recover faster.
We have up to $100,000 (ex GST) for innovative health services initiatives that will help improve outcomes and experiences for people recovering from injury.
Do you keep adequately hydrated during your shift? You should.
Read the paper – Hydration amongst nurses and doctors on call (the HANDS on prospective cohort study). El-Sharkawy A et al. Clin Nutr 2016 Aug;35(4):935-42 DOI: 10.1016/j.clnu.2015.07.007
Does a normal amylase/lipase rule out pancreatitis?
Our fourth Urgent Care at Christmas discussion is inspired by a film that changed modern action thrillers and bucked the trend of action heroes being muscle-bound giants. Die Hard has long been considered a Christmas classic but the reason it has made our urgent care list is that it shows a common and very painful presentation to urgent care. The glass foreign body in the foot. To talk about the Welsh tradition of Mari Lwyd, singing carols, Alan Rickman and the pain of injecting the sole of the foot we are joined by Dr Zoë Cruse.
Our third Urgent Care at Christmas discussion is inspired by the blockbuster comic book movie, Iron Man 3. While it might not strike you as a classic Christmas movie, it does take place at Christmas and it highlights a condition that often presents to UC, especially over the holidays. To talk about the charm of English pubs, whether Love Actually still holds up and approaching insomnia through Urgent Care we are joined by UC Fellow Dr Caitlin Randles.
Our second Urgent Care at Christmas discussion is inspired by the 2003 modern classic Elf. To talk about a cold versus warm Christmas, demonstrate his Jimmy Stewart impression and discuss Raccoon bites, we are joined by Urgent Care Physician and Wilderness Medicine expert Dr Dinesh Deonarain.
For Christmas this year we have a short series of Urgent Care discussions inspired by some classic Christmas films. First up, the Snowman (1982). We talk with Dr David Sorrell about Christmas in urgent care and managing exhaust burns.
Author: Dr Gary Mitchell
Type: MLP-research
Date: December 2021
Abstract:
Rivaroxaban is well established as a treatment for deep vein thrombosis and pulmonary embolism, but there has been hesitation in using it as a bridging agent in clinical situations where DVT is suspected but not yet confirmed by definitive ultrasound scan. The evidence for the safety and efficacy of this approach is explored. During this time of research, the use of rivaroxaban began to gain acceptance and usage in New Zealand, leading to a brief analysis of factors involved in trying to introduce up to date guidelines into a small health organisation in New Zealand prior to widespread acceptance and definitive guidelines at District Health Board level.
Author: Dr Sandy Crofts
Type: MLP-research
Date: December 2021
Abstract:
Cannabinoid Hyperemesis Syndrome (CHS) is a syndrome of intractable vomiting with severe abdominal pain that is associated with chronic marijuana use. Classically, symptoms are relieved by hot showers and are often unresponsive to traditional acute interventions such as antiemetics.
Patients commonly undergo multiple investigations without diagnosis. Complete resolution of symptoms occurs with abstinence from cannabis. The following Medical Literature Project gives an overview of Cannabinoid Hyperemesis Syndrome and review of current management.
Author: Dr Imran Zia
Type: MLP-research
Date: December 2021
Abstract: A literature review was carried out to assess the safety of Adenosine in Urgent Care (UC) setting for the termination of Paroxysmal Supraventricular tachycardia (PSVT). Thorough literature evaluation advocates the use of adenosine for the acute termination of PSVT in Urgent care settings, especially in rural and remote practices. It has the potential to improve patient management and satisfaction along with a reduction in cost, ED load, and associated hospitalization.
Please complete the following survey for the college which is a follow-on to our “Employment/Remuneration Survey” of the last 2 years with some new questions To complete the survey: Click here. Last year’s was found useful by a number of our members and we would like to repeat this to assist and identify trends. Responses…
Dr Eva Gregory is an Auckland based doctor training in sexual health and general practice. They are a board member for Pride in Health, a charitable trust looking to support health care professionals in NZ to deliver excellent care to LGBTQIA+ patients.
Do you look stuff up during a consultation?
Why is it called the malleolus? It is interesting that what our patients might perceive as complicated medical words are actually just simple descriptive terms coined by ancient anatomists.
Dr Avijit Barai is a FACEM and FRNZCUC who has used POCUS in his daily practice for many years. He talks to us about the way he utilises POCUS and why he thinks it is an essential tool for all Emergency and Urgent Care physicians.
Measuring and improving outcomes is an important part of continuing professional development.
We held a recertification webinar on 10 November.
We’ve created some FAQs based on the questions that were asked. They are available on the website here.
Some thoughts on how we make decisions to refer, observe or discharge, made through the lens of the aviation world. If you are interested, here is the YouTube video of the engine failure. https://www.youtube.com/watch?v=rEf35NtlBLg www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc Music licensed from www.premiumbeat.com Full Grip by Score Squad This podcast is intended to assist in ongoing medical…
We chat with Dr David Sorrell, Director of Clinical Training about how he manages paronychia and we discuss the great learning points from a recent Don’t Forget the Bubbles video.
Have a read of this position paper on oral corticosteroid stewardship from the Thoracic Society of Australia and New Zealand.
Have a read of this position paper on oral corticosteroid stewardship from the Thoracic Society of Australia and New Zealand.
Dear colleagues, We are delighted to announce the publication today of a collection of case studies – Research in Medical Curriculum in Australia and New Zealand 2021 – a window on innovation and best practice – which reflect the innovative and varied approaches to the teaching of research skills in the curriculum across the medical schools in Australia and New Zealand. Over the last 18…
Kia ora, this email seeks your feedback on the COVID-19 Vaccinator role. Your knowledge and experience is crucial to getting the next steps right. Background and uptake The role of COVID-19 vaccinator working under supervision (CVWUS) was created this year to support the rollout of the COVID-19 vaccination programme. It’s created a pathway for a…
Have a read of this position paper on oral corticosteroid stewardship from the Thoracic Society of Australia and New Zealand.
We should all know to look for the de Winter T wave.
Please read this post about the use of post-nominal letters if no longer a member, pausing training or recertification, and compliance.
Author: Dr Olu De Rozario
Type: MLP-research
Date:November 2020
Abstract: This retrospective audit was aimed at determining the best treatment modality for
proximal (zone one) fifth metatarsal fractures in an urgent care setting. The analysis was
not able to show a statistically significant advantage between treatment groups (weight
bearing moon boot/non weight bearing moonboot/non weight bearing below knee cast) in
fracture healing at six weeks post injury.
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This podcast is intended to assist in ongoing medical education and peer discussion for qualified health professionals. Please ensure you work within your scope of practice at all times. For personal medical advice always consult your usual doctor
FNE was created in 2021 with the aim to assist fellows and trainees in Ireland with their RNZCUC training and continued post fellowship work. FNE also aims to promote, develop, and work for the recognition of Urgent Care as a specialty in Ireland. FNE plans to have collaborations with the HSE, RCSI and other entities to…
Session 1 Never Split The Difference – Urgent Care Edition – Alex Calvey Fever in Childern – Tamsin Lillie Migraines in UC – Krishna Chatterjee Occipital Nerve Block – Miriam Martin Q&A Session 1 Session 2 How not to reduce a shoulder – John Trewick 5th MT fractures – Olu De Rozario Missed fractures in…
Here is a good website that features many talks and presentations on all things orthopaedic.
Check out the website – https://orthomedia.org.uk/
A nasty ankle fracture named after a bit of kitchen equipment.
Even if you think you know something, it is always worth refreshing your knowledge.
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Today we update our College members on the move to a virtual Bootcamp and the rollout of the new recertification programme.
Today, Dr Avijit Barai talks to us about sternoclavicular joint injuries.
Today we revisit a podcast recorded last August using clips recorded in July 2019. As New Zealand deals with another lockdown it is a good time to once again consider lessons from the past.
An eponymous paediatric ankle fracture we should all know to look for
We should consider asking some of our patients how many times they have seen a clinician with these chronic symptoms.
What is Takotsubo? To find out we speak with Dr Avijit Barai.
Today we look at two upcoming CPD opportunities.
Next week is Wound Awareness week. The theme for the week is Burns and Scalds. The New Zealand Wound Care Society is holding a Free Webinar on Monday 26th July, and one of the presenters is our Director of Clinical Training, Dr David Sorrell. Follow the link below to register. The webinar is claimable as…
You are invited to participate in the second End of Life Choice Act 2019 implementation workforce survey here https://consult.health.govt.nz/regulatory-assurance/19686d4c
We should all know about the hair tourniquet and never forget to look for one.
This podcast is a recording of a Webinar from the evening of 29th June 2021 with Dr Joe Bourne, the Primary Care lead for the New Zealand COVID-19 Vaccination and Immunisation Programme. In this talk he guides us through the stages of the vaccine rollout and tells us how we can get involved, as a vaccination site, a vaccinator or a vaccine advocate.
Please read this post about the use of post-nominal letters if no longer a member, pausing training or recertification, and compliance.
The Medical Council of New Zealand is excited to host the virtual 2021 Australian and New Zealand Prevocational Medical Education Forum on 18 and 19 October. For more information and to register go to: https://www.prevocationalforum2021.com/. This annual trans-Tasman conference will be opened by Director-General of Health, Dr Ashley Bloomfield. The main theme ‘Travelling forward…
The recording of the recent COVID-19 webinar hosted by Dr Joe Bourne from the COVID-19 Vaccine and Immunisation Programme is available to watch below. The webinar includes a general overview of the COVID-19 Vaccine and Immunisation programme. It also provides some detail about how you can become involved with the rollout of the COVID-19 vaccine…
Today we speak with Tom Bowden about research he is undertaking into how UC and ED clinicians access past medical history for their patients.
We should all be aware of the peritonsillar abscess. But why is it called a quinsy?
We should all be aware of the peritonsillar abscess. But why is it called a quinsy?
MoH have issued their latest guidance on COVID-19 testing
Macquarie University is interested in understanding your views on the risks and benefits of providing ED and UC clinicians with access to primary care records when patients present in the ED or UC.
Today we speak with Tom Bowden about research he is undertaking into how UC and ED clinicians access past medical history for their patients.
Today we update College members with some important news.
Thank you to those who completed this survey which we hope will be of use to both Urgent Care Doctors and Employers. The results were sub-analysed according to seniority, location and type of clinic. The corresponding figures for December 2019 are also presented but it should be noted that due to anonymity it is not possible to say if the respondents were substantially the same as in 2019 so a direct comparison may not be valid.
The Curriculum subcommittee has completed the new curriculum document. We wish to acknowledge and thank the Royal New Zealand College of General Practitioners and the Division of Rural Hospital Medicine New Zealand for their generous support in developing this document by permitting use of their Core Curriculum Statement as a base.
The story behind why a condition or part of the body is so named can help paint a picture when describing a diagnosis to your patient.
We’re now looking for someone to fill the role of Executive Assistant to the General Manager, to support our drive to meet our high-quality assurance requirements.
The administration team is seeking a skilled, dynamic, team player to join us.
Make sure you know which ones need an orthopaedic review.
Be aware of the palate abscess, and always remember to listen carefully to what your patient tells you.
The programme for the Second ever RNZCUC Bootcamp conference is taking shape, and tickets will be on sale soon. We are thrilled to be heading to the South Island and the beautiful city of Christchurch. Among many exciting speakers, we are delighted to announce that Dr Ashley Bloomfield, Director General for Health and Dr Anna Clark, Deputy Director-General, will be attending the weekend.
Always remember, an ankle exam includes the proximal fibula.
Dr Barai talks to us about identifying heart block and what to do about it in the urgent care setting.
We now offer annual educational resources subscription to non-members.
There are many different activities you can choose for CME. Remember to visit the recertification CME page so you understand how it fits in with your recertification.
The Auckland Chinese Medical Association is holding their annual conference on May 8th at the Highbrook Conference Centre, East Tamaki, Auckland.
The Auckland Chinese Medical Association is holding their 2021 conference on May 8th 2021, at the Highbrook conference centre, East Tamaki, Auckland.
Following on from her talk on giant cell arteritis, Dr Sujatha Kamalaksha, Consultant Physician and Rheumatologist in Whangerei, tells us the differential diagnoses to consider when working up a suspected case of GCA.
Here are two publications that provide short summaries of the latest papers which enable you to quickly and conveniently stay up to date.
Giant cell arteritis (GCA) is an important differential to consider in older patients with headache. Dr Sujatha Kamalaksha, a Consultant Physician and Rheumatologist in Whangerei, talks to us about what we need to know in the urgent care setting. We do not talk about the ongoing, complete management of GCA.
Thank you to everyone who completed the annual survey. I’m pleased to say that responses were generally positive, but we do have some initiatives in place to make this even better. The winners of the draw are also announced.
We’re busy completing the latest draft of the revised recertification programme. Next week we’ll post the programme on the website, and we aim to hold a webinar in the following week to allow members to ask questions about the programme.
For now, please see the key differences between the current and draft future programme.
The Executive Committee has unanimously agreed to endorse the Education Committee’s proposal that specialist clinics be made optional with immediate effect. The reason for the change is that registrar feedback is that they are difficult to organise and learning is limited. The Education Committee advise that the core skills lists cover many of the items…
The RACP is hosting a webinar on Indigenous Child Health in Aotearoa NZ and Australia on Thursday 11 March with high-calibre speakers on indigenous child health. The webinar will explore the recently-released RACP statement and provide an opportunity for participants to ask questions and explore the next steps in health care for Aboriginal, Torres Strait Islander and Māori children.
The Sustainable Healthcare and Climate Health Aotearoa Conference invites experts, researchers, up-and-coming leaders and sustainability champions to submit abstracts for presentation (in person or virtually) at our annual conference in Wellington on 22-23 June 2021.
Using the podcast this week to make sure everyone knows about the 2021 Bootcamp in Christchurch and the call for presenters, the AGM in March and the draft revised recertification programme.
Author: Dr Lize Upton
Type: MLP-research
Date: 10 November 2020
Abstract:
Injuries sustained from dog bites are often seen in Urgent Care. This review looks at relevant studies and the current management guidelines for these injuries in relation to wound closure and the use of prophylactic antibiotics.
The closing date for applications for research grants closes 9am, 3 May.
The Ministry of Health would like your feedback on the implementation of the assisted dying service.
If you have patients who work with sheep, you should be familiar with orf.
If you have patients who work with sheep, you should be familiar with orf.
Dr Dinesh Deonarain talks us through how he designed and completed his own audit idea.
A quick look forward at what 2021 from the NZ urgent care perspective.
A quick look forward at what 2021 from the NZ urgent care perspective.
A quick look forward at what 2021 from the NZ urgent care perspective.
It is Christmas day, 2020, so we take a quick look back at the year just gone from the urgent care perspective.
Today we talk to Dr Avijit Barai about how to approach managing migraines.
Registration is open for the 2021 Emergency Management of Severe Burns (EMSB) courses, held across Australasia by the ANZBA. This course will benefit all who work in UC but especially anyone working rurally or in ED. The ANZBA website also has other educational material, resources, and information so is worth checking out.
Have any of you tried this trick to help stop an anterior epistaxis?
We’re busy completing the latest draft of the revised recertification programme. Next week we’ll post the programme on the website, and we aim to hold a webinar in the following week to allow members to ask questions about the programme.
For now, please see the key differences between the current and draft future programme.
The Sustainable Healthcare and Climate Health Conference Aotearoa would like your feedback on what topics, themes and delivery mechanisms would be of a value to you.
The truth? You can’t handle the truth!
What should we tell our patients or our patients parents about their condition or diagnosis.
Do we actually know what’s wrong?
Soft tissue knee injuries in Kids. A lot of this applies to adults but this is the paediatric focus from DFTB team.
A rare type of shoulder dislocation that can be diagnosed from across the room.
Dr Kyle Perrin talks to us about the conservative management of moderate to large spontaneous primary pneumothoraces. He was a co-author on a recent paper published in the New England Journal of Medicine.
Nominations for the election of four Medical Council of New Zealand members are now open.
The Health Quality & Safety Commission has been supporting hospitals around New Zealand to implement and support New Zealand early warning system (NZEWS). This is a recognition and response system for adults.
Is it safe to use topical local anaesthetic for the short term relief of the pain from a corneal abrasion? Dr Rob Evison discusses the evidence.
What is scombroid fish poisoning? We ask Dr David Sorrell.
The Ministry of Health is looking to employ a Chief Medical Officer.
Humanity: A Taranaki Emergency Medicine Conference will be taking place in New Plymouth on 4-5 February 2021 and we would kindly ask your team to help promote this event to your Emergency Department staff, doctors, nurses and any other people who may be interested. This is a great opportunity for people to extend their emergency medicine skills within activities that we all love to do as Taranaki residents and earn some CPD points.
How did you discover urgent care existed? This New Zealand based perspective published in the JUCM demonstrates how urgent care is the career many people do not realise exists. It also argues that for urgent care to grow and develop around the world, having a College like the RNZCUC delivering a government recognised Fellowship programme is the way forward.
Evidence based medicine. Why is evidence ignored? Your guess is as good as mine.
What is the best medium in which to transport an avulsed tooth?
Dr Rachel Lee is going to expand on her talk from this year’s Virtual Urgent Care Bootcamp in a free RNZCUC webinar on Monday 2nd November at 1830. Rachel is a senior registrar in Urgent Care who has completed several years training in plastic surgery. This live webinar presentation will last 1 hour, and there will be about 20 minutes for Q+A at the end.
Do you diagnose children with wrist sprains?
Over the last 18 months, the College has been revising the recertification programme in line with the new MCNZ guidelines that all Colleges must meet. We presented the initial plans at a webinar back in September, which some of you were able to attend. We have had some enquiries following the RNZCGP announcing the rollout of their programme so we would like to give you a rough road map of our College plans.
As you know, this year Te Rā Haumaru Tūroro o Aotearoa | Aotearoa Patient Safety Day will be celebrated on 17 November 2020.
The day is coordinated by the Health Quality & Safety Commission, with support from ACC and PHARMAC, and promoted throughout the health sector. The theme is Getting through together | Whāia e tātou te pae tawhiti.
The report Choosing Wisely means Choosing Equity recommends a number of changes to make the Choosing Wisely campaign more effective for Māori.
On November 5th 2020, all codeine-containing products in New Zealand will require a prescription.
We talk with Dr Dinesh Deonarain about a new and innovative role he has just started. He explains how the job was created and how it should lead to an improvement in the delivery of Urgent Care.
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A useful provocative test when examining a patient with metatarsalgia.
If you are looking for an analogue way to keep track of your life tasks, it is worth having a look at the Bullet Journal method.
The Medical Council of New Zealand, in partnership with Te Ohu Rata O Aotearoa (Te ORA), has recently released an independent report outlining findings of the current state of cultural safety and health equity delivered by doctors practising in Aotearoa New Zealand and experienced by patients and whānau.
Paracetamol is in the news again. There is a question of limiting paracetamol sales. So let us review the treatment of paracetamol ingestion. Technically it is easy to manage if you know the exact dose and time of ingestion. Kids are a little different and you have to estimate maximum possible ingestion. Beware of delayed presentation, beware of multiple ingestions. Blood tests are important if you are not sure. the cost of getting this wrong is literally life and death. Community management can be challenging is you need blood tests to confirm lack of toxicity. Easy in the ED. Should we limit the size of paracetamol sales to below 10gm? What do you think?
Asthma is a common presentation to Urgent Care. How do the new adolescent and adult guidelines for NZ affect our management in Urgent Care? We speak with one of the guideline authors, Dr James Fingleton.
Conservative management of spontaneous pneumothorax. We talked about this in April with first10em. Now a review by the sceptics. This is a 25 minute podcast talking about all the ins and outs of this. Conservative management without chest tube MAY be appropriate but only if close follow up can be arranged. You may want to consider it but all the careful follow up steps must be followed.
This podcast was published 2 weeks ago for is Māori language and NZ Sign Language weeks. An improved knowledge of two of New Zealand’s official languages will improve our ability to deliver health care to our patients.
The Board of Censors (BoC) has re-evaluated how we offer the exam this year, considering the various responses to the pandemic. We have decided to run the written exam in multiple locations, and continue to plan to run the OSCE in Auckland.
We have been working on designing a new recertification programme to meet the new MCNZ requirements. We want to provide our members with a look at the preliminary stages of where our plans are heading. This webinar will present a video outlining the proposed recertification programme and some of the ideas and philosophies behind it. …
Given current restrictions and considerations for the health sector due to COVID19, the 2020 Trainee Forum a decision has been made to defer until early 2021.
We have two requests – the first is for you to send in questions about the clinical director role, and the second is to complete a short survey for medical directors. Ask a question and win a prize at the Virtual Urgent Care Bootcamp courtesy of DJO One of our Virtual Bootcamp sessions is looking…
For those enthusiasts who have POCUS or want POCUS here is a nice relaxing video to make you more comfortable with knobs.
Heard of the pink lady? Is it useful? Firstly you only need an antacid. Secondly, it should never be used to diagnose chest pain. It does not differentiate cardiac from epigastric related pain.
The historic streets of Edinburgh are layered with hundreds of years of medical history. During a modern day global pandemic, a look back at the past can inform the present.
Pre-septal vs orbital cellulitis. One of those nightmarish things you don’t want to get wrong. This is from our friendly paeds guy. Some really useful safety netting advice. If it’s worse go to the hospital. Also what to look for. Applies just as well to adults. Have you ever tested the colour vision?
New Zealand has a national out of hospital STEMI pathway. Aaron Turner, a St John Intensive Care Paramedic in Christchurch, talks us through the pathways and what Urgent Care needs to know about it.
Pre-septal vs orbital cellulitis. One of those nightmarish things you don’t want to get wrong. This is from our friendly paeds guy. Some really useful safety netting advice. If it’s worse go to the hospital. Also what to look for. Applies just as well to adults. Have you ever tested the colour vision?
Picture of the week. When do you need to do a knee x-ray? have you ever seen this? I recall a patient I saw with a chronic history of O-S and then followed by juvenile Rh resulting in steroids and then this type of fracture.
Dr Avijit Barai talks us through a 9 step systematic approach to looking at ECGs.
Dr Avijit Barai talks us through a 9 step systematic approach to looking at ECGs.
Today we look at what the RNZCUC has planned for the rest of 2020.
Today we look at what the RNZCUC has planned for the rest of 2020.
Another nasal foreign body post. You may remember the ENT one. You don’t have to buy this tool. You can attach your magnet to the base of an alligator forceps and use that. Then it’s already sterile.
Do you like or hate paediatric rashes? DFTB have created a wonderful resource of images. So be you loving or hating rashes, all your rashes are here to view and review.
What is the safest and most cost effective way to tourniquet a finger? We discuss a technique with Dr Dave Sorrell.
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What is FOAM? We talk with Dr Avijit Barai about his contribution to the FOAMed world.
Posterior circulation stroke. The most important cause of dizziness, but not the only cause. How do we miss it? How do we diagnose it?
What is FOAM? We talk with Dr Avijit Barai about his contribution to the FOAMed world.
A bit wrap of research from our friend and colleague Justin Morgenstern. Lots of amazing papers here. My thoughts. Wernicke’s yes think hyperemesis as well as post bariatric surgery.
What is FOAM? We talk with Dr Avijit Barai about his contribution to the FOAMed world.
How do kids get sick during a pandemic? Why were we still seeing rashes and other infections? NY times has some thoughts. I must say i did see a Roseola. And chickenpox has now arrived again.
Concussion management in urgent care can be challenging. Today we catch up with Director of Clinical Training, Dr David Sorell and we chat about how he currently approaches concussion.
This weekend is your last chance to get the early bird rates for the virtual Bootcamp! We’ll be using the webinar platform on 19 and 20 September to bring you a weekend of urgent care relevant education featuring a broad range of topics delivered by a wide mix of presenters.
There are reduced rates for nurses, paramedics, registrars, and students so please encourage all your clinic staff to attend, and share with those you think would be interested.
The Journal of Urgent Care Medicine is looking for an abstracts in urgent care section editor.
The irritable hip. A relatively common condition with quite a broad differential. The job is always to rule out the significant pathology especially osteomyelitis and septic arthritis. Sometimes completing the task by completing the tests does require investigations in hospital. One of the reasons for this is approval to x-ray in paediatric patients and time taken to get ESR and CRP.
Paediatric concussion, directly convertible to adults. Giving some excellent concepts on physiology and analogies.
What is the best imaging for suspected renal colic? And do you have easy access to that imaging?
This consultation document is seeking stakeholder feedback on the Medical Council of New Zealand’s(Council) proposal to gazette an increase to the practising certificate (PC) fee and disciplinary levy, to be effective from 1st September 2020.
Today we catch up with Director of Clinical Training, Dr David Sorrell. We chat briefly about life at Level 1 and then go over some of his recent Facebook posts that looked at mandibular fractures, paediatric pain relief and embedded ear rings.
The urgent care community is full of highly experienced clinicians who develop educational material to benefit others. One of those is Dr Avijit Barai, an urgent care Fellow and ACEM trainee.
ACC has worked with the Goodfellow Unit to release a new module on Work Capacity Certification.
So perhaps your patient has a triplane ankle fracture. Perhaps a 13% TBSA mid dermal burn. How do you manage and assess paediatric pain?
Had quite a few kids with embedded earings recently. With older individuals, I have removed them with anaesthetic but it can be quite challenging in the young. Do you have any tips for embedded earing removal?
Witnessing a young adult fainting recently reminded me of a video of syncopal German medical students from the 1990’s.
Mandible fractures, this is a post from DFTB. I did not realise that mandible fractures are the most common facial fractures in children! An interesting fact to store. My 50 cents is don’t forget the tongue blade test! Also if you have high suspicion don’t rely on plain radiographs for a rule out. They are too insensitive.
A reminder that the next AGM is 25 July, and that nominations for the Executive Committee are now open. The March AGM did not achieve a quorum. If you wish to nominate another member, please first confirm that they would like to stand for a position, and which position(s). Email the General Manager (adrian@rnzcuc.org.nz) with your nomination.
Fungal infections, particularly of the nail, can be frustrating conditions to treat when they present through an urgent care clinic. We speak with Dr Amanda Oakley, an adjunct associate Professor at Auckland University, Consultant Dermatologist and founder of Dermnet NZ.
Now for an ouch post. The triplane ankle fracture. These are ones that will need careful consideration and conservative management should be decided upon by an orthop. Probably after CT. So watch out for these ones. https://dontforgetthebubbles.com/triplane-ankle-fractures/
Patients choose to NOT disclose they have had a concussion. What we need is a change of culture around concussion not just a change in knowledge. https://cjsmblog.com/2020/05/11/cjsm-journal-club-nondisclosure-of-concussion-symptoms-by-athletes/
We’ve received an invitation from the Australasian College of Sports and Exercise Medicine for our doctors to complete a survey on Doctor’s Wellbeing and PA during COVID19
We should always look for two eponymous fractures of the shoulder on the post reduction radiographs.
Recertification requirements 2020 MCNZ proposed an 11-month waiver to the recertification requirements during the Covid19 pandemic. The Professional Standards Committee approved an extension in line with the MCNZ recommendation. This waiver was to ensure clinicians did not have to focus on CPD during a global pandemic when activities and availability of courses would be reduced.…
The MCNZ are reviewing their statement on unprofessional behaviour. They are looking for feedback on the consultation paper before 30th June 2020.
And in COVID news. This probably reinforces what NZ is doing re recovery. https://www.bloomberg.com/news/articles/2020-05-19/covid-patients-testing-positive-after-recovery-aren-t-infectious
Acute colonic pseudo obstruction. What looks like obstruction but is not? “A misleading symptom is misleading only to one able to be misled.” – Sir William Heneage Ogilvie https://first10em.com/acute-colonic-pseudo-obstruction/
Follow the link to the recent ACC document on consideration factors for labral tears of the hip. It is worth reading to see what factors get considered when ACC decide on whether a labral tear of the hip is a result of an injury or wear and tear.
Today, we start with Dr Sorrell hosting the podcast to introduce the college’s new DPD. We then talk about this years virtual Bootcamp and the evolving college forum pages.
We’re pleased to confirm that the bootcamp is definitely going ahead on the weekend of 19/20 September. It will be held online, using webinar technology. We’re sending out invitations to present – please check your inbox.
It is a great honour to take up the role of DPD for the RNZCUC, and I wanted to write to our members to introduce myself and talk briefly about what you can expect from me going forwards.
Happy mothers day! I found an interesting blog on my travels. Thought you might find it interesting. http://www.mothersinmedicine.com/
After the successful creation of the Covid19 forum page, we’ve decided to continue with the forum and add more topics.
As much as possible, do NOT visit the office. If you must, please call ahead. Zoom is becoming our preferred method for discussing more complex issues.
If you must visit, you will be required to leave your details, and active clinicians entering the office will be asked to wear a face mask.
Scan and email audit paperwork (especially PSS and CNA).
Wearing a mask all day affects the way we breathe, and our breath can affect how we see out of our glasses.
The epipen, an essential device to easily deliver life saving medication. Unfortunately it is at quite a cost. Something we could debate about for quite a while. Fundapen organisation has stepped in to help those in need. Unfortunately, their funding is running out with only a few hundred epipens left to give. I hope they…
CMC have released the latest copy of “Choosing Wisely in Aotearoa New Zealand: The achievements and the challenges”, which looks at the origins of the campaign in this country, what has been achieved, the challenges, and where we are today
Since we were talking about glue we should talk about the hair apposition technique. Kids love it when you say your going to perform a HAT trick. Parents are not stressed by this either. Personally I have never used it on a 10cm scalp cut but they say you can. https://www.aliem.com/trick-of-trade-hair-apposition/
All areas of medicine have had to become more familiar with PPE use during the current pandemic. But our colleagues in the paramedic world must be prepared to get called to all kinds of hazardous situations and be skilled in a wide range of PPE equipment.
This newsletter covers College activities and decisions about training, recertification, and projects for the coming year.
We catch up again with Dr David Sorrell, Director of Clinical Training, and talk about the Lunate Dislocation, assessing the limping child and the benefits of evidence based medicine.
We catch up with Director of Clinical Training, Dr David Sorrell, to chat about his experiences with COVID-19, a great paper from the MJA, SSD use in burns and the Seymour fracture.
It has been over a week of Level 4 lockdown. Getting podcasts organised and recorded has been tricky, so today is just a quick chat. We will have some clinical podcasts coming up soon. In the meantime, keep well.
Dr Richard Chen looks at the latest developments relevant to Urgent Care and talks about the use of PPE in your Urgent Care Clinics.
Dr Richard Chen looks at the latest developments relevant to Urgent Care and talks about the use of PPE in your Urgent Care Clinics.
Dr David Gollogly, Chair of the RNZCUC Executive Committee and convenor of the Pandemic Response Committee joins Dr Richard Chen to talk about the RNZCUC’s recommendations to NZ UC Clinics and UC clinicians. A newsletter detailing this advice has been sent out as well. The podcast was recorded at 1100 (NZT) on the 22nd March…
Dr Richard Chen is a UC physician who has worked with the Ministry of Health on the Wuhan and Diamond Princess COVID-19 quarantine. Dr Kelvin Ward is a UC physician and clinic Medical Director in Wellington. Both are working on the front line of this rapidly evolving pandemic. Today we chat about how this virus…
RNZCUC Covid response statement 18 March 2020
The AGM will now be held using an online videoconference platform, and all full members will have the opportunity to vote on all motions in the week before the AGM.
Managing burns in Urgent Care explained by our Director of Clinical Training Dr David Sorrell. www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc Music licensed from www.premiumbeat.com Full Grip by ScoreSquad This podcast is intended to assist in ongoing medical education and peer discussion for qualified health professionals. Please ensure you work within your scope of practice at all times.…
Do you know about the Seymour fracture? Make sure you never miss it.
Urgent Care is growing at an explosive rate all over the world. Dr Joshua Russell, @UCPracticeTips , the editor-in-chief of the Journal of Urgent Care Medicine (JUCM), joins us to discuss the American UC experience.
We have finally managed to align the stars such that Dr David Sorrell, Director of Clinical Training, can join us to discuss some recent podcasts.
Professor Bruce Arroll helps us navigate one of the trickiest consultations in Urgent Care; the depressed patient.
Calling Urgent Care Teams located in the Auckland and Waitemata DHBs!
Registration for the 2020 Safety in Practice programme is now open
Author: Dr Gustav Fourie
Type: MLP-guideline
Date: 26 February 2020
Abstract: Hypertension is a common presentation but there is no New Zealand based guideline for the management of severe asymptomatic hypertension (greater than 180 systolic or 110 diastolic) in urgent care. Definitions have varied in both naming ( hypertensive emergency, hypertensive urgency, hypertensive crisis, malignant hypertension, accelerated hypertension, severe asymptomatic hypertension) and parameters.
Can you consider prescribing an antibiotic when the patient reports a previous reaction?
Dr Barbara Blok tells us about a short trial of POCUS she undertook in Urgent Care.
We are now able to accept applications for the position of Director of Professional Development. This is a key post in RNZCUC focusing on helping the College move forward with its strategy by developing and improving the recertification programme, promoting quality urgent care, and fostering the development of urgent care. For more information click the ‘see more’ link below.
The Medical Council of New Zealand (Council) is currently seeking to appoint a vocational trainee to its Education Committee (Committee).
We should always ask specifically about complimentary therapies as part of the medical and medication history.
Trick of the trade and fluorescene eye drops.
Picture of the week to help you think about the next chest x-ray you order.
Face masks and hand sanitisers sell out in Auckland.
An update on the new virus. Hot off the press.
Our official journal the Journal of Urgent Care Medicine has a new editor, Dr Joshua Russell, FAAEM, FACEP. You may know Joshua from UC-RAP, Hippo Education, and @ucpracticetips.
He’s looking for original research to help JUCM achieve PubMed citation status.
Think Sepsis. We talk with Dr Paul Huggan of the Sepsis Trust of New Zealand about Sepsis, what it is, and how we can identify it earlier in Urgent Care.
Good self care and compassion can make us better doctors.
The sky on Sunday night in Auckland was a eerie colour. The smoke from the bushfires in Australia had affected us and so with this comes acute respiratory cases. I know we have had a few at our clinic and it has already reached the news media. What has your experince been?https://www.nzherald.co….Morenzherald.co.nz Australian bushfire smoke…
The HQSC is about to commence a project on developing co-design within the Primary Care Sector. The intention is to foster collaboration between local primary care teams to build capability in co-design, raise awareness of patient & consumer engagement, increase knowledge of service design methods, and apply these principles to a project of choice. The focus of this work will be achieving equity in health outcomes.
What mimics cellulitis? We ask Dr Amanda Oakley, Consultant Dermatologist, Adjunct Associate Professor at Auckland University and founder of Dermnet.
Twitter is a great source of little tips and tricks. Today we look at four tweets that convey practice changing information or simple little things to improve your quality of life, all in less than 280 characters.
What to expect in 2020:
• Annual Survey
• Branch accreditation
• Update to Urgent Care Course
• Revised recertification programme
• Appoint a new Director of Professional Development
• One additional administration staff member
• Appointing the new Executive Committee
• An increase in the membership fee
For more information on these, click on the ‘read more’ button below.
Thank you to all that completed this survey. We’ve had several requests from registrars and Fellows asking what the typical remuneration and conditions are for urgent care doctors. The Treasurer, Dr Steve Adams, took the lead to conduct the survey. The results have been summarised with all personal or sensitive information removed.
Gender equity in healthcare. Needs to happen now.
Why might Santa Claus come to an Urgent Care clinic?
Why might Santa Claus come to an Urgent Care clinic?
Did you survive Christmas?
Why might Santa Claus come to an Urgent Care clinic?
Why might Santa Claus come to an Urgent Care clinic?
Why might Santa Claus come to an Urgent Care clinic?
The Ministry of Health is looking to employ a further Clinical Chief Advisor. If you have any questions please call Andi Simpson, CMO, Mobile: 021 418 705.
Intensive Care Paramedic, Haydn Drake, talks us through ways of managing the inevitable stress we encounter during emergent situations.
Twins “scarred for life” by black henna tattoos
Dr Rathi Rajasekaran gave us an update on managing STIs in Urgent Care at this years inaugural Urgent Care Bootcamp.
Dr Rob Evison draws on his 34 years of clinical practice to advise us on managing rib fractures in the elderly and how he has learned to fail upwards, thereby improving his practice.
Health professionals are being encouraged to watch the new learning modules on understanding bias in health care, to be launched in November for Wiki Haumaru Tūroro | Patient Safety Week 2019. Patient Safety Week is an awareness-raising week held from 3 to 9 November. It is coordinated by the Health Quality & Safety Commission, with partners ACC and PHARMAC.
Today with talk with Intensive Care Paramedic, Haydn Drake, about approaching airway and breathing problems in your Urgent Care clinic.
How can we improve our diagnostic accuracy in Urgent Care? Dr Matt Wright tells us how frameworks and clinical support tools can help us improve our diagnostic accuracy and ultimately the quality of the care we deliver.
Health Workforce NZ has announced that the 2020 Ministry of Health Pacific People’s Support Fund is now open for applications.
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Boost this post for MYR84 to reach up to 6,700 people. SplintER Series: A Toddler’s Missed Step Resulting in FractureA review of the diagnosis and management of a Toddler’s Fracture, a common non-displaced spiral fracture of the tibia caused by low mechanism.
Boost this post for MYR84 to reach up to 6,700 people. Wheeze. It’s all in the timing…How long do you keep children post salbutamol/albuterol inhaler therapy? ….
How do you manage an uncomplicated boxers fracture?
How do you manage an uncomplicated boxers fracture?
Are kids with suspected scaphoid fractures different to adults with suspected scaphoid fractures?YesNoScaphoid fractures are less common in the under 16 yr olds and exceptionally rare under 12 yrs of age.I have seen scaphoid fractures in 12 year olds.My approach is with a normal xray to splnt…Moredontforgetthebubbles.com Scaphoid FracturesNow, in our series on minor injuries….…
Summer is approaching fast, I think. With this comes swimmers ear. In extreme cases you may want to place a wick. This is not to be confused with ear candling, it is not that kind of wick. We have exactly the same wicks presented here at our clinic. I have not actually used one for…
Welcome to your Cardiology quiz Email Name 22-year-old female presents to the Urgent Care Clinic with a “fast heart rate” and palpitations. She has experienced this before, but she came today because the current episode is lasting longer than usual. She is slightly dizzy but otherwise asymptomatic. She is in no apparent distress, is breathing…
MCNZ is seeking feedback on its proposed policy on publication of orders and directions, otherwise known as a ‘naming policy’.
For patients with vague symptoms including headache and lethargy, don’t forget to think Carbon Monoxide poisoning.
A post from our Irish friends at Emergency Medicine Ireland. Sexual trauma injuries and what you need to know. There is a good cover letter and no obscene images that I am aware of but an excellent teaching post. I had not heard of semen anaphylaxis before. I hope you can read this with good…
Boost this post for MYR84 to reach up to 5,800 people. Pelvic avulsion injuriesSudden onset groin sprain after sprinting? Could it be an avulsion fracture? Another post in our minor injuries series, this time from Owen Keane. ….
Acute flares of Eczema are a common presenting complaint to Urgent Care. We speak with Dr Amanda Oakley, Consultant Dermatologist, Adjunct Associate Professor at Auckland University and the Founder of www.dermnetnz.org about why eczema flares and how those flares should be managed.
Tranexamic acid use in Head Injury – it is worth reading this recent paper from the Lancet and some of the blogs that discuss it.
Fracture Fridays. What do you know about Tibial fractures? Specifically proximal tibial fractures? A gerat post about Tibial fractures and also some points about the non fractures. An important topic for several reasons.https://dontforgetthebubbles.com/proximal-tibial-fractures/dontforgetthebubbles.com·233 People Reached·Boost Post Proximal Tibial FracturesNow for another from our minor (and not so minor) injury series ….
Fracture Friday. Time a for a review of our old friend the supra condylar. Yes it’s all monkey buisiness. This is a DFTB review of the condition and important features. What I look most out of this was the position for gartland 2 being 30-40 degrees. These are all transported to hospital from our clinic. Perhaps we should review our transport cast positioning?
Sticky eyes eh! There is not a week that goes by that i don’t see a sticky eye. The team at DFTB have had a look at the problem and have come up with some key information for you. So watch this space.
A sharpie can provide great continuity of care when managing pre-tibial flap lacerations.
Boost this post for MYR130 to reach up to 8,300 people. Simple Cool Running Water Reduces Burn Severity in Children — JournalFeedSimply providing cool running water for 20 minutes within 3 hours of injury for children with burns was associated with a marked reduction in need for skin grafting and possibly burn depth and need…
Urticaria causes patients to present to Urgent Care Clinics. We hear from Dr Amanda Oakley, Consultant Dermatologist, an Adjunct Associate Professor at Auckland University and the Founder of Dermnet NZ about how it should be managed.
Moonboots are not benign devices and should be prescribed with the same thought and consideration as you would a medication.
Recorded for the recent inaugural Urgent Care Boot Camp, these 2 bites run back to back and look at injuries associated with being at a Boot Camp (the Military sort, not the Medical sort!)
Join us for the Cruis-ED Emergency Medicine Event of the Year.
As the landscape to healthcare continues to evolve so does the Emergency Medicine Conference. Emergency medicine involves the saving of lives. This however comes at a cost, the burden at times affecting a health worker’s ability to offer quality care to their patients. The 2020 Emergency Medicine Cruise Conference is designed for all physicians, paramedics and nurses involved in , front line, Acute and Trauma care. Limited spaces available for students.
AMRF-funded researchers from The University of Auckland will discuss the latest advances in heart health and how their current and future research can help ensure our good cardiovascular health. Topics will include:
· Atrial fibrillation
· High blood pressure
· Stroke
This is a guided 6 minute Mindfulness breathing exercise for you to see if mindfulness is for you. If you find it helpful, this will be available for repeat listens whenever you need it.
This is a guided 6 minute Mindfulness breathing exercise for you to see if mindfulness is for you. If you find it helpful, this will be available for repeat listens whenever you need it.
Could simple mindfulness techniques help you clear you mind at the end of a busy and stressful shift?
Palpitations are a common presentation to the urgent care or ED clinic. This like dizziness can actually mean a number of things. A very careful history is very important. In my practice I usually do a rhythm strip first to see if it is sinus. This blood shows that most cases are benign and may.
Burnout and Mental Health problems can affect clinicians in all specialities and of all grades. For too long it has been swept under the carpet for the mistaken belief that it is a sign of weakness and poor character. But of late people have started to speak up on the topic. For a profession that exists to care for people, failure to care for ourselves results in poorer patient outcomes and is the reason we have such a high suicide rate within medicine.
When you work in Urgent Care you will always be relieved when the Ambulance service takes our sickest patients to hospital. But do you truly understand what the EMTs, Paramedics and ICPs do day in and day out, what their training and scope of practice is and do you appreciate how hard it is to make clinical decisions out in the field. To get a better idea we talk with Intensive Care Paramedic and Programme Lead of Paramedicine at AUT in Auckland, Luke Summers.
Welcome to Episode 12
The FORCE study on Torus Fracture Management
Do you learn by a song. Heres a song about the serious causes of headache. This is one of those situations where it is good to have a song stuck in your head. Remember if the history or exam suggests serious or if the treatment is ineffective may need CT/LP/Labs!
So why not another measles update. Auckland has topped 410 cases as of Monday. We had a reminder to use nasopharyngeal swabs or throat swabs for PCR not buccal. But where does a buccal swab end and a throat swab begin? Still working that one out. The main treatment is prevention.
If you are on Twitter, you can now follow us there @rnzcuc https://twitter.com/rnzcucRoyal New Zealand College of Urgent Care (@rnzcuc) | TwitterThe latest Tweets from Royal New Zealand College of Urgent Care (@rnzcuc). The Royal New Zealand College of Urgent Care is responsible for training doctors and maintaining professional standards in Urgent Care. New Zealand
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Communication and history taking. It is sometimes important to go back to basics. For me it is 29 years since I learnt to take a history. Do you remember when as a student you took a history and the registrar or consultant walked in and got a better history in 10 seconds?
Is there anything more satisfying than reducing a pulled elbow? Is there a role for USS in the diagnosis and management?
Finally something you can get your teeth into. Tongue laceration. They are a very common paediatric presentation. Almost always they are managed conservatively and allowed to heal by secondary intention. If you are considering suturing you are in for a challenging time. Thus it is not likley you will be able to suture a tongue…
Imaging chests in children. Is this a routine test to order. i think not. Here is a discussion about imaging studies in children. Personally I don’t usually order a CXR unless I am looking for a coin or to exclude a battery. https://gppaedstips.blogspot.com/2019/06/chest-x-rays-in-children-wimbledon-rules.htmlChest X-rays in children – The Wimbledon RulesA combination of commentary and clinical…
What is Point of Care Ultrasound and how can it be utilised in Urgent Care? We talk with Urgent Care Physician and POCUS enthusiast Dr Kelvin Ward about how POCUS can benefit your practice.
Thank you for all Fellows and registrars who participated in the RNZCUC Recertification Survey. Your experiences, ideas and suggestions have given the College a new insight into what our new programme should be. We will now consolidate all your suggestions and work closely with the Medical Council to develop a new strengthened approach to recertification.…
Did you know the Welsh are responsible for modern orthopaedics?
Is there a quick and easy way to reduce non traumatic mandible dislocations without the need for sedation?
A shorter episode 11 this month, looking back at the Fundoscopy and Tetracaine Bites and looking at a genetic study that could determine how you metabolise Tramadol and a study that links anticholinergics with dementia.
What anti-emetics do you use for nausea and vomiting in pregnancy and which ones should you use? We talk with Urgent Care physician Dr Richard Chen who looked into this topic for his Medical Literature Project as part of his Fellowship Training with the RNZCUC.
Every clinic has certain unavoidable obstacles and workplace stress and burnout is seen frequently amongst Urgent Care staff. Are the things bothering you unchangeable? If they are too overwhelming, perhaps it is time to change jobs”
Ordering an ECG for your patient with syncope? In Urgent Care, we really don’t have the time to fluff around and especially not so when your waiting room is overflowing with winter ailments. Check out this excellent 3 min approach to identifying ECG red flags in your patient with a fainting spell. Want to learn…
Cspine is a pain in the neck. So here is a full on teaching blog with everything you need to Know. The ABC’s of the cervical spine provide a helpful mnemonic to guide the systematic assessment of these x-rays. Remember; you require all three views (later ….
Why you must ask about Sunscreen allergies and other important things relating to local anaesthetic eye drops.
We all do nerve blocks. Some more than others. Here are some hints. It is more ED based but a block is a block is a block.
Reserach roundup for May, yep I know it’s June. What is good here. Beer vs wine and chin laceration glue vs suture. All the important research.
Is it time to ditch the ophthalmoscope as a tool for viewing the retina?
Dr Dinesh Deonarain is a Fellow of the RNZCUC and has just completed 50 days at Everest Base Camp as one of the Doctors staffing the Everest ER.
Markers have requested that registrars send electronic copies (eg pdf or word) of the full text of all references used in the submitted Medical Literature Project. This is because the markers do check references, and the time taken to source the full text of the reference can be significant.
Dr Dinesh Deonarain is a Fellow of the Royal New Zealand College of Urgent Care who is in Nepal on assignment. He is volunteering for the Himalayan Rescue Association as one of the Everest ER base camp doctors for the 2019 climbing season. This blog follows his experiences in the high alpine of the Everest region.
Are IV antibiotics more effective than Orals when treating Cellulitis?
We discuss the evidence with Dr Justin Morgenstern, a Canadian Emergency Physician currently based in Taranaki Base Hospital, New Zealand. He writes a Medical Blog first 10EM which is worth a read.
Welcome to Episode 10 of the official podcast of the Royal New Zealand College of Urgent Care.
Are IV antibiotics more effective than Orals when treating Cellulitis?
We discuss the evidence with Dr Justin Morgenstern, a Canadian Emergency Physician currently based in Taranaki Base Hospital, New Zealand. He writes a Medical Blog first 10EM which is worth a read.
At 3:30am in emergency overnight,
You got a seriously worrisome fright.
That harsh sound whooshing through the chest,
Try hide your concern, you say “It’s for the best”.
Is it innocent or the beginning of the end,
Go back to the basics they’re your best friend.
Yep the flu has arrived. We had a case of a whole family sick on Tuesday and one of the childern was really sore in the calf muscles. So why is that?
Best orthopaedic teaching page ever! For elbow injuries. Massive content here, unfortunately the postcast is over an hour. So if you have attention deficit I can’t concentrate disorder like me, the notes are pretty cool.
Here is an excellent post on RTI in children and that includes URTI LRTI. What is important is use a severity based plan. Well children do not need antibiotics.
Welcome to this week’s Urgent Bite. Today we look at the use of ear drops when the tympanic membrane is not intact. Are you comfortable using potentially ototoxic drops as the first line treatment? How do you feel about the contraindications listed for these drops and how do they affect your practice?
Dr Dinesh Deonarain is a Fellow of the Royal New Zealand College of Urgent Care who is in Nepal on assignment. He is volunteering for the Himalayan Rescue Association as one of the Everest ER base camp doctors for the 2019 climbing season. This blog follows his experiences in the high alpine of the Everest region.
Do muscle relaxants work for back pain? Maybee yes, maybee no. So if thats the case which should you choose? Probably the best naswer to that is choose something non adictive with no serious side affects. Thus not diazepam.
Dr Dinesh Deonarain is a Fellow of the Royal New Zealand College of Urgent Care who is in Nepal on assignment. He is volunteering for the Himalayan Rescue Association as one of the Everest ER base camp doctors for the 2019 climbing season. This blog follows his experiences in the high alpine of the Everest region.
Welcome to this week’s Urgent Bite. Today we hear from Dr Justin Morgenstern, currently an Emergency Physician at Taranaki Base hospital in New Zealand. Justin trained in Emergency Medicine and Family Practice in Canada and he writes a medical blog which can be found here – https://first10em.com
We have completed the transfer of the recertification manual, and the elements of the training programme manual that referred to recertification, to the website. Requirements are now embedded in a series of pages, starting with the introduction page ( https://rnzcuc.org.nz/recertification/ ). You can save each page as a pdf if you wish to retain a hard copy. Relevant forms and more detailed instructions are available through links on the pages.
Are you too chicken to prescribe? Don’t give ibuprofen to children with chicken pox, right? Or is it one of PEM’s great myths? ….
Welcome to this week’s Urgent Bite. Wound management is a big part of Urgent Care and facial wounds add some extra issues for consideration. What are your experiences with facial wounds and what rules to you personally practice by with regards to when to refer for specialist input? We will discuss this issue in a future main episode of the podcast so your input will help develop the discussion. Pop over to Facebook or send us an email.
Dr Dinesh Deonarain is a Fellow of the Royal New Zealand College of Urgent Care who is in Nepal on assignment. He is volunteering for the Himalayan Rescue Association as one of the Everest ER base camp doctors for the 2019 climbing season. This blog follows his experiences in the high alpine of the Everest region.
So ordering too many tests is learned behaviour. It’s also learned early. ow can we unlearn this behaviour? How to we teach rational investigation? What is an essential test, or treatment, or investigation.
Neuro stimulation testing. Or level of consciousness testing. A painful stimuli. B Nasal tickle and corneal reflex. If you suspect pseudoseizures are you helping the patient or hurting the patient? Perhaps start with B then move to A for PNEA.
Follow three patients’ journeys as they learn about non-epileptic attack disorder (NEAD).
Welcome to this week’s Urgent Bite. Today we look at a recent BPAC article on Mycoplasma Genitalium and its association with Urethritis, Cervicitis and PID.
Dr Dinesh Deonarain is a Fellow of the Royal New Zealand College of Urgent Care who is in Nepal on assignment. He is volunteering for the Himalayan Rescue Association as one of the Everest ER base camp doctors for the 2019 climbing season. This blog follows his experiences in the high alpine of the Everest region.
Dr Dinesh Deonarain is a Fellow of the Royal New Zealand College of Urgent Care who is in Nepal on assignment. He is volunteering for the Himalayan Rescue Association as one of the Everest ER base camp doctors for the 2019 climbing season. This blog follows his experiences in the high alpine of the Everest region.
More on the formula or milk debate. Is change a good thing? Or is it change for the sake of change? We should talk more often
Welcome to Episode 9 of the official podcast of the Royal New Zealand College of Urgent Care. Today I am joined by Dr Dave Sorrell to look back at recent Urgent Bites regarding Segond fractures, the Simmonds/Thompson test and using Antibiotics for UTI in the Elderly. We also look at an interesting case of sub tarsal foreign body, talk about why kids are swallowing more foreign bodies than they used to and we talk about how the Junior Doctor Strikes affect Urgent Care. We are then joined by Dr Afrax Adams to look at some college news including the upcoming Urgent Care Boot Camp.
Welcome to a CME specialist interview. Today we speak with Professor Tony Attwood who is the adjunct Associate Professor of Psychology at Griffith University in Queensland, Australia and has 40 years experience as a Clinical Psychologist specialising in Autism and in particular Aspergers Syndrome.
Tramadol, tramadon’t so what do we do? Everything is awesome but every action has a reaction. https://rebelem.com/tramadol-or-tramadont/Tramadol or Tramadont – REBEL EM – Emergency Medicine BlogBecause of Tramadol’s multiple mechanisms of action, potential drug-drug interactions, and lowering of the seizure threshold, the safety of tramadol has been brought to question.
Dr Dinesh Deonarain is a Fellow of the Royal New Zealand College of Urgent Care who is in Nepal on assignment. He is volunteering for the Himalayan Rescue Association as one of the Everest ER base camp doctors for the 2019 climbing season. This blog follows his experiences in the high alpine of the Everest region.
Dr Dinesh Deonarain is a Fellow of the Royal New Zealand College of Urgent Care who is in Nepal on assignment. He is volunteering for the Himalayan Rescue Association as one of the Everest ER base camp doctors for the 2019 climbing season. This blog follows his experiences in the high alpine of the Everest region.
Dr Dinesh Deonarain is a Fellow of the Royal New Zealand College of Urgent Care who is in Nepal on assignment. He is volunteering for the Himalayan Rescue Association as one of the Everest ER base camp doctors for the 2019 climbing season. This blog follows his experiences in the high alpine of the Everest region.
We will now have regular medical history pages since I discovered this website. This ones about ECG and a long suffering dog,Jimmy.
How do you approach the CP child who is just not right? An approach to irritability and pain in the severely neurologically impaired child.
Logan is a 6yo who is presented to ED by his mother, one Tuesday evening as “just not himself”. Logan is well known to your local paediatric team for manag ….
Welcome to this week’s Urgent Bite. Today we look at a simple acronym that you can use to assist in handing over patients or asking for advice, either in person or over the phone.
Dr Dinesh Deonarain is a Fellow of the Royal New Zealand College of Urgent Care who is in Nepal on assignment. He is volunteering for the Himalayan Rescue Association as one of the Everest ER base camp doctors for the 2019 climbing season. This blog follows his experiences in the high alpine of the Everest region.
You give me fever? Probably the most common presentation to urgent care under 15 yrs of age will be fever. How important is fever? What is important about fever? A combination of commentary and clinical content for primary care clinicians, giving useful medical morsels about child health care.
Welcome to this week’s Urgent Bite. Today we look at the Eponymous fracture of the knee – the Segond Fracture. What is it and what does it mean?
Welcome to this week’s Urgent Bite. Today we look at the Simmonds/Thompson test for Achilles Tendon rupture. What is the positive and what is the negative outcome of this test?
Important news for registrars – the College research paper is now called the Medical Literature Project , and the instructions have been refined slightly.
In line with the Supervision Policy, we have finalised the online training for supervisors. It is available here for viewing. You will need to log in to the website to view this material.
Welcome to Episode 8 of the Official Podcast of the Royal NZ College of Urgent Care. This episode was recorded live at the Goodfellow Symposium and is a discussion with Emergency Medicine Specialist and President Elect of the ACEM – Dr John Bonning. Together with Dr Dave Sorrell (DCT for RNZCUC) we discuss investigating Pulmonary Embolism, Chest Pain and Head injury.
Dr. Dinesh Deonarain is a Fellow of the Royal New Zealand College of Urgent Care who is in Nepal on assignment. He is volunteering for the Himalayan Rescue Association as one of the Everest ER base camp doctors for the 2019 climbing season. This blog follows his experiences in the high alpine of the Everest region.
Welcome to this week’s Urgent Bite. Today we take a quick look at the Choosing Wisely initiative.
https://choosingwisely.org.nz
Welcome to this week’s Urgent Bite. Today we look at next week’s podcast recording that is happening on stage at the Goodfellow Symposium. It will be an interview with Emergency Medicine Specialist and President elect of the Australasian College of Emergency Medicine, Dr John Bonning.
Welcome to the Second Profile in Urgent Care. This episode we talk with Dr Claire Russell, an Urgent Care Physician in Hamilton, NZ, whose career has quite literally taken her around the world.
Welcome to this weeks Urgent Bite. Today we look at a recent open access paper in the BMJ that looked at the effect immediate antibiotics had on bloodstream infections and all cause mortality in the elderly with UTI, compared to no antibiotics or delayed antibiotics. It is worth reading.
Welcome to Episode 7 of the Official Podcast of the Royal New Zealand College of Urgent Care.
Owing to illness and other scheduling problems there is no main talk this episode. We will endeavour to release the talk at a later date when recorded.
Coming Soon – our next Profile in Urgent Care will feature Dr Claire Russell.
We learn about Claire’s Journey to Urgent Care via Emergency Medicine and Rural General Practice, whilst also pursuing a love of sailing, travel and adventure. We learn how with the right team you can take on the world and how that team might not be what convention or the establishment expects.
Welcome to this week’s Urgent Bite. Today we ask the question – do you prescribe an antidepressant on the first visit to an Urgent Care?
Welcome to this week’s Urgent Bite. Today we look at the Pronator Quadratus Fat Pad Sign – an indicator of possible wrist fracture that is worth looking for on a lateral wrist radiograph.
Welcome to this week’s Urgent Bite. Today we look at the Pronator Quadratus Fat Pad Sign – an indicator of possible wrist fracture that is worth looking for on a lateral wrist radiograph.
Welcome to this week’s Urgent Bite. Today we look at BPAC advice from October 2018 regarding the prescribing of Zopiclone and ask the question – Should we prescribe Zopiclone in Urgent Care? https://bpac.org.nz/report/snippet/zopiclone.aspx www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc Music licensed from www.premiumbeat.com Full Grip by ScoreSquad This podcast is intended to assist in ongoing medical…
Welcome to Episode 6 of the Official Podcast of the Royal New Zealand College of Urgent Care. Below you will find time stamps for each segment and links to articles discussed. What is involved in getting different XR views commonly used in Urgent Care – with Radiographer Katie from River Radiology (2.14) http://www.riverradiology.co.nz Discussion with…
Author: Dr Ivan Koay
Type: Other research
Date: 23 Jan 2019
Abstract: There has been varying and divergent methods in the treatment of paediatric and
adult wrist fractures. Current opinion and evidence suggest that in paediatric torus
distal radius fractures, management with splinting is as comparable a method of
treatment to the traditional plaster or Paris (POP) casting. This is a retrospective
look at the safety of using the EXOS® thermoplastic (TP) splint to treat wrist
fractures
Welcome to this week’s Urgent Bite. Today I review a book that I have used for a number of years to assist me in managing fractures.
Welcome to a podcast extra. Today we hear from the Director of Professional Development for the RNZCUC, Dr Afraz Adam, about what you can expect from the RNZCUC in 2019. RNZCUC Bootcamp – save the date – Saturday September 14th 2019 – Cordis Hotel, Auckland Find the Quiz here – https://rnzcuc.org.nz/quiz/trauma-and-resuscitation-quiz/ Goodfellow Symposium 2019 – https://www.goodfellowunit.org/symposium Choosing…
Welcome to this week’s Urgent Bite. How do you reduce the sting of a local anaesthetic injection? Reducing Local Anaesthetic pain article https://www.ncbi.nlm.nih.gov/pubmed/?term=A+users+guide+for+reducing+the+pain+of+local+anaesthetic+administration Principles of Office Anaesthesia article https://www.ncbi.nlm.nih.gov/pubmed/?term=Principles+of+Office+Anesthesia%3A+Part+II.+Topical+Anesthesia Ice to reduce pain of injection article https://www.ncbi.nlm.nih.gov/pubmed/?term=Principles+of+Office+Anesthesia%3A+Part+II.+Topical+Anesthesia Swearing article https://www.ncbi.nlm.nih.gov/pubmed/?term=Swearing+as+a+response+to+pain%3A+A+cross-cultural+comparison+of+British+and+Japanese+participants www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc Music licensed from www.premiumbeat.com Full Grip by ScoreSquad This podcast is…
The ExC has developed a strategy for RNZCUC. The latest draft version can be viewed here…
Welcome to this week’s Urgent Bite. It is a brand New Year so today we look back at the first 4 months of the podcast and look forward to what we have planned for 2019. Please contact the podcast if you have any ideas, suggestions, corrections or questions. If any of you want to contribute…
Welcome to the Twelfth Bite of Christmas. Have you enjoyed a Fortnight off or Fortnite this Christmas? BMJ abstract https://www.ncbi.nlm.nih.gov/pubmed/25515525 JAMA abstract https://www.ncbi.nlm.nih.gov/pubmed/25868006 www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc Music licensed from www.premiumbeat.com Christmas Elves by Francesco D’Adrea This podcast is intended to assist in ongoing medical education and peer discussion for qualified health professionals. Please ensure…
Welcome to the Eleventh Bite of Christmas. Dr Dave Sorrell discusses injuries to be aware of following a FOOSH. www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc Music licensed from www.premiumbeat.com Christmas Elves by Francesco D’Adrea This podcast is intended to assist in ongoing medical education and peer discussion for qualified health professionals. Please ensure you work within your…
Welcome to the Tenth Bite of Christmas. https://www.nzrc.org.nz www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc Music licensed from www.premiumbeat.com Christmas Elves by Francesco D’Adrea This podcast is intended to assist in ongoing medical education and peer discussion for qualified health professionals. Please ensure you work within your scope of practice at all times. For personal medical advice always…
Welcome to the Ninth Bite of Christmas. https://www.telegraph.co.uk/topics/christmas/6858790/Eyelids-stuck-to-zips-on-Christmas-jumpers-among-bizarre-hospital-injuries.html www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc Music licensed from www.premiumbeat.com Christmas Elves by Francesco D’Adrea This podcast is intended to assist in ongoing medical education and peer discussion for qualified health professionals. Please ensure you work within your scope of practice at all times. For personal medical advice always consult your…
Welcome to the Eighth Bite of Christmas. https://www.dermnetnz.org/topics/rosin-allergy/ https://www.dermnetnz.org/topics/radiata-pine www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc Music licensed from www.premiumbeat.com Christmas Elves by Francesco D’Adrea This podcast is intended to assist in ongoing medical education and peer discussion for qualified health professionals. Please ensure you work within your scope of practice at all times. For personal medical advice…
Welcome to Episode 5 of the Official Podcast of the Royal New Zealand College of Urgent Care. This month we recap some of the topics discussed in the 12 Bites of Christmas along with this month’s Urgent Bites. We wish you all a Happy New Year and look forward to continuing the podcasts in 2019.…
Welcome to the Seventh Bite of Christmas. Be mindful of all the festive plants that we place around the house at Christmas. https://poisons.co.nz/articles-and-info/seasonal-poisonings/view/christmas-holiday-safety-and-poisoning-prevention-tips/ www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc Music licensed from www.premiumbeat.com Christmas Elves by Francesco D’Adrea This podcast is intended to assist in ongoing medical education and peer discussion for qualified health professionals. Please ensure you work…
Welcome to the Sixth Bite of Christmas. Beware the ingested battery. www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc Music licensed from www.premiumbeat.com Christmas Elves by Francesco D’Adrea This podcast is intended to assist in ongoing medical education and peer discussion for qualified health professionals. Please ensure you work within your scope of practice at all times. For personal…
Welcome to the Fifth Bite of Christmas. How do you manage an oesophageal Food Bolus impaction. https://bestbets.org/bets/bet.php?id=405 https://bestbets.org/bets/bet.php?id=2608 www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc Music licensed from www.premiumbeat.com Christmas Elves by Francesco D’Adrea This podcast is intended to assist in ongoing medical education and peer discussion for qualified health professionals. Please ensure you work within your scope…
Welcome to the Fourth Bite of Christmas. Be wary of ingested magnets and caution is needed even if only one magnet has been swallowed. https://journals.lww.com/jpgn/Pages/articleviewer.aspx?year=2012&issue=09000&article=00003&type=Fulltext www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc Music licensed from www.premiumbeat.com Christmas Elves by Francesco D’Adrea This podcast is intended to assist in ongoing medical education and peer discussion for qualified health professionals.…
Welcome to the Third Bite of Christmas. Beware of coins in the Christmas pudding. www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc Music licensed from www.premiumbeat.com Christmas Elves by Francesco D’Adrea This podcast is intended to assist in ongoing medical education and peer discussion for qualified health professionals. Please ensure you work within your scope of practice at all times.…
Welcome to the Second Bite of Christmas. Make sure you chose the correct antibiotics when managing mammalian bites (and don’t use Cephazolin) https://bpac.org.nz/antibiotics/guide.aspx#bites Always consider adopting when adding a pet to your family. https://www.spca.nz https://www.stuff.co.nz/life-style/cutestuff/109116499/12-days-of-spca-christmas-pets-meet-lizzie-the-cat-from-taupo?rm=m www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc Music licensed from www.premiumbeat.com Christmas Elves by Francesco D’Adrea This podcast is intended to assist in…
Welcome to the First Bite of Christmas. Always be careful when popping the cork on a bottle of Sparkling wine. http://eyewiki.aao.org/Commotio_Retinae https://radiopaedia.org/articles/orbital-blowout-fracture-1 https://emedicine.medscape.com/article/1190165-overview www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc Music licensed from www.premiumbeat.com Christmas Elves by Francesco D’Andrea This podcast is intended to assist in ongoing medical education and peer discussion for qualified health professionals. Please ensure you…
The Royal Australasian College of Physicians (RACP) says that the 2018 report from the Child Poverty Monitor shows that one in five children in Aotearoa are suffering unacceptable levels of hardship and deprivation. “Like our Prime Minister, we want Aotearoa New Zealand to be the best place in the world for children,” said Dr Jeff…
Welcome to this week’s Urgent Bite. Today we look at using gut instinct when safety netting your consultations. Many thanks to Professor Bruce Arroll for sharing his story. Article from the European Journal of General Practice – https://www.tandfonline.com/doi/full/10.3109/13814788.2015.1092516 www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc www.goodfellowunit.org Music licensed from www.premiumbeat.com Full Grip by Score Squad Christmas Elves by Francesco D’Andrea…
Welcome to this week’s Urgent Bite. Today we look at a paper from the British Journal of General Practice regarding the use of Antibiotics in Children with Cough to prevent deterioration or re-consultation. The Pubmed link below features the abstract and the full paper is linked from there. https://www.ncbi.nlm.nih.gov/pubmed/?term=Impact+of+antibiotics+for+children+presenting+to+general+practice+with+cough+on+adverse+outcomes%3A www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc Music licensed from www.premiumbeat.com…
We are keen to send a registrar representative to participate in the DiTC trainee forum on behalf of the College. We are looking for a volunteer – registrar or senior registrar – who is preferably based in Wellington. Note that this is on the same day as the Goodfellow Symposium and AGM, so it’s more…
Revised guidance and resources for collegial relationships The Medical Council of New Zealand (Council) recently undertook a review of the nature and effectiveness of collegial relationships for doctors who require this as part of their recertification programme. Council considered the needs of all doctors requiring a collegial relationship including: Doctors registered in a general scope…
Welcome to Episode 4 of the Official Podcast of the Royal New Zealand College of Urgent Care. Gout with Professor Bruce Arroll (1.28) http://gouthappyfeet.com https://www.goodfellowunit.org http://www.saferx.co.nz/assets/Documents/full/ddcb1e2e8c/colchicine.pdf Nurses Station with Amor Kisling NP (33.07 ) – Nail Trephination https://www.embeds.co.uk/2018/05/09/nail-trephination/ https://emedicine.medscape.com/article/82926-overview Urgent Bite Review (53.19) Music Licensed from www.premiumbeat.com Full Grip by Score Squad This podcast…
Welcome to this week’s Urgent Bite. In Episode 3 Dr Kevin Bell mentioned Vestibular Rehab in relation to concussion management. So to find out what this involves and how it works I have spoken with Physiotherapist Ronen Buser. Many thanks to Ronen for his time and to Lisa Hansen for getting us together https://www.lisahansenphysio.co.nz/index.php/about-us/ www.rnzcuc.org.nz…
Welcome to a Podcast Extra feature. Last week we sat down with three doctors who are based in Ireland but were in Auckland to sit the UCPEX exams. We talk to them about their experiences studying the course from the other side of the world, flying all this way for an exam, their plans for…
Welcome to this week’s Urgent Bite. Today we reflect on a recent article in BPAC concerning topical antibiotics. The use of these treatments in the last year has halved but there are calls to reduce the use still further. So when should we use them? BPAC article 2018 – https://bpac.org.nz/2018/topical-antibiotics.aspx 2 part BPAC article from 2017…
Welcome to this week’s Urgent Bite. Today we look at recent comments in the BMJ from 2 of the UK’s Medical Defence organisations regarding the use of online translation tools in clinical practice. Should we use them in consultations with patients when there is a language barrier? https://www.bmj.com/content/363/bmj.k4546 https://www.bmj.com/content/349/bmj.g7392 Thanks to Dr Danny Liao for…
Author: Dr P. Wimalasena
Type: Other research
Date: 09 Nov 2018
Welcome to this week’s Urgent Bite. Today we look at a gentle yet effective way to reduce Anterior Shoulder Dislocations. It is a single operator technique and requires no sedation so could prove handy in the Urgent Care setting. It is called the Cunningham Technique and you can see it explained by the creator in…
Welcome to Episode 3 of the Official Podcast of the Royal New Zealand College of Urgent Care. Today we talk about concussion with Sports Physician Dr Kevin Bell. Please find below links to all relevant articles and information discussed along with time codes for each segment. Concussion with Dr Kevin Bell – (1.52) SCAT5 – https://bjsm.bmj.com/content/bjsports/early/2017/04/26/bjsports-2017-097506SCAT5.full.pdf https://healthpages.co.nz/directory/listing/sports-medicine-kevin-bell…
Welcome to this week’s Urgent Bite. Today we revisit NSAIDs, this time looking at their use in acute soft tissue injury. We hear briefly from Sports Physician Dr Kevin Bell. When should we use NSAIDs for acute soft tissue injuries? Physical Therapy Journal Article – https://academic.oup.com/ptj/article/97/8/807/3826991 https://healthpages.co.nz/directory/listing/sports-medicine-kevin-bell www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc Music Licensed from www.premiumbeat.com Full…
Welcome to this week’s Urgent Bite. Today we look at an alternative to the often used Double Dorsal Ring Block for digital anaesthesia. YouTube Clip – https://www.youtube.com/watch?v=G6jyw7l3bZs Academic Life in Emergency Medicine Article – https://www.aliem.com/2010/09/trick-of-trade-single-digital-block/ Emergency Medicine Australasia Study 2016 – https://www.ncbi.nlm.nih.gov/pubmed/26991958 Plastic and Reconstructive Surgery Article 2006 – https://www.ncbi.nlm.nih.gov/pubmed/17016190 Emergency Medicine Journal Article 2010 – https://www.ncbi.nlm.nih.gov/pubmed/20360491 www.rnzcuc.org.nz podcast@rnzcuc.org.nz…
Welcome to this week’s Urgent Bite. Today we hear from Dr Kevin Bell, Sports Physician, who has a special interest in Tendinopathy. Here he talks briefly about the best treatment options and the things to avoid when managing tendinopathy. https://healthpages.co.nz/directory/listing/sports-medicine-kevin-bell podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc www.rnzcuc.org.nz Music Licensed from premiumbeat.com Full Grip by Score Squad
Welcome to Episode 2. Please find below the contents of this podcast along with time marks for each section. You will also find links to studies and articles discussed. Interview with Dr Jack Drummond (2.21) – FRNZCGP, M Forensic Medicine (Monash), FRACGP, FFCFM (RCPA). National Coordinator of Forensic Medicine for New Zealand Police – jd.em.drummond@xtra.co.nz Nurses…
Welcome to our first Profile in Urgent Care. In this Profile we talk to Dr Dinesh Deonarain about how he became an Urgent Care Physician and how it has allowed him to maintain a work life balance and pursue his passion for wilderness medicine.
Welcome to this week’s Urgent Bite. Today we ask the community whether they use Non Steroidal Anti-inflammatory drugs for fracture pain.
You all asked for it! Dizzy spells and vertigo. How to do HINTS! What is central! What are you looking for. You may have to watch this a few times. It is very good. Vertigo the Big 3
Welcome to this week’s Urgent Bite. Today we are asking how you go about obtaining MSU in children who cannot void on command. Given Urine Bags are not suitable for sending accurate MSU what are the other options in Urgent Care? Please email your thoughts to podcast@rnzcuc.org.nz Starship Hospital Guidelines – https://www.starship.org.nz/for-health-professionals/starship-clinical-guidelines/u/urinary-tract-infection/ BPAC NZ guidelines -…
Welcome to the first Urgent Bite podcast. NEJM link – https://www.nejm.org/doi/full/10.1056/NEJMoa1806842 Please share your thoughts via podcast@rnzcuc.org.nz www.rnzcuc.org.nz Music Licensed from www.premiumbeat.com Full Grip by Score Squad
Our first inaugural Fellowship ceremony was an immense success. Forty Fellows received their certificates featuring our new coat of arms. The event was held at the Crystal room in the Cordis Hotel and we had almost a hundred people attending this event. Our guests of honour included Professor Des Gorman (Health Workforce New Zealand), Professor…
Welcome to Episode One of the official podcast of the RNZCUC. Below you will find a running order for the episode including links to articles and news items discussed. podcast@rnzcuc.org.nz www.rnzcuc.org.nz Discussion on Finger, Hand and Wrist injuries with Lisa Hansen, www.lisahansenphysio.co.nz PIPJ Volar Plate sprains – (2.26) UCL thumb injuries – (12.30) TFCC injuries of…
Welcome to Episode Zero of the Official Podcast of the Royal New Zealand College of Urgent Care. On this episode we talk about this new venture from the RNZCUC and outline what you can expect in the future. Please take this opportunity to subscribe to the podcast so you will automatically receive all new releases.…
Cum sociis natoque penatibus et magnis dis parturient montes empor quis congue in, interdum eget tortor. Vivamus aliquam dictum lacus quis tincidunt. Phasellus rhoncus ante sollicitudin nisl consectetur ultricies.
Author: Dr Muhammad Asim
Type: MLP-case study
Date: 26 December 2017
Abstract: The Scaphoid is the most commonly injured bone amongst carpal bones at the wrist. It accounts for 10% of all hand fractures, 50-80% of all carpal fractures and is one of the most common injuries seen by doctors working in Urgent care clinics. Risk of non-union is up to 10% in all non-displaced fractures. There are serious consequences such as non-union, avascular necrosis and arthritis if this fracture is missed during the initial evaluation. When a high index of suspicion based on the mechanism of injury and clinical exam exists the current protocol is for immobilization with delayed (10+ days) x-rays. Is another imaging strategy more sensitive and cost effective?
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