Reflections from my last shift: Reversing factor Xa inhibitors like Rivaroxaban in life-threatening bleeding is tricky. - Prothrombin complex concentrate 50u/kg IV - Tranecamic acid 30mg/kg IV - use ROTEM to guide - source control!

More reflections... Advocating for patients is best done at the end of their bed. If you work in the ED, it is often helpful to try and get the hospital doctor to the bedside if possible. It may prevent multiple frustrating phone calls!!!

Reflections from my last clinical shift: Paediatric Status Epilepticus - Ensure airway patent and oxygenate - Benzo IV/IM/IN - Repeat benzo - 2nd line agent, likely levetiracetam 40mg/kg - Check BSL - Prepare to intubate to maintain airway for 3rd/4th line agents Debrief team

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Reflections from my last shift 40yo F with sudden onset severe LIF pain. My main ddx ovarian torsion vs renal colic Some learning points for me: - bedside urinalysis was v helpful - I need to improve my USS skills - torsion a lot less likely if normal ovarian architecture

Reflections from my last clinical shift: The ED is always busy. Sometimes that leads us to focus more on disposition. Our goal should always be good assessment and management. This sometimes get lost in the need to keep patients moving through the department.

Reflections from my last clinical shift: Infective endocarditis is often missed because its presentation is insidious and non-specific. Temp is often mildly elevated only RFs: IVDU Rheumatic heart disease DM Severe renal disease Post invasive procedures, not just valves!!!

Reflections from my last clinical shift The Bier block - often frowned upon in the ED world - is a very effective method of providing regional anaesthesia for wrist # reductions. Max Prilocaine dose 2.5mg/kg (0.5ml/kg of 0.5%)

Reflections from my last shift Ive noticed a growing trend of getting formal USS to rule out collections for every cellulitis case Why? This is a great ED skill-bedside USS in soft tissue infections: - confirm cellulitis (cobblestoning) - define collection - look for nec fasc

Listening to Ben Symon talking at #QPEM19 and realising I’m a very task-oriented listener! And that there are many different types of listening. Understanding all of these and recognising when to switch between them will help us care for our patients better.

Reflections from my last clinical shift. It’s been 7 years since I obtained my Fellowship. Despite my interest in teaching,lots of clinical knowledge drops out of my head. Sometimes on shift my ‘juniors’ are brimming with that knowledge. I am lucky to have such a team around me

Reflections from my last clinical shift The first & most important step in good advanced airway management in the ED: Good basic airway management Watch the chest and neck to assess ventilation, proper positioning, ETCO2 on your BVM +/- adjuncts

Reflections from my last shift...as a patient Amazed at the care recently shown to me and my family, but in particular the high level of professionalism. As clinicians, our professionalism is ALWAYS on show, in everything we say & do.

Reflections from my last clinical shift Paediatric intubation tips 1. Expect rapid desaturation-consider bagging through induction 2. Have a NGT ready and watch for stomach insufflation 3. The cords are not as obvious as adults-aim for the glottic inlet

Reflections from my last clinical shift. Spont Bacterial Peritonitis often presents with non-specific abdominal pain, ABSENCE of fever & systemic symptoms in patients with ascites. Have a low threshold for grabbing your ultrasound and doing a diagnostic tap in the ED

Reflections from my last shift ED already inundated with worried well Coronavirus pts. When we are inundated with critically unwell pts, we will truly have to consider how we rationalize our care and resources. We need: clear guidelines true collaboration More PPE! #COVIDー19

So what do people think of 360 feedback for senior clinicians? Any pearls and pitfalls? And any suggested tools?

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