Thursday, December 11, 2014

Saving the world one coffee pod at a time ...

Attention all coffee lovers - if you use coffee pods, take the time to recycle them as far as possible. Nespresso pods are made from aluminium and can be returned for recycling. All you have to do is collect them and drop them off at your nearest Nespresso boutique (whilst enjoying a complimentary coffee) or other authorised collection point.

All other brands with a plastic pod and plastic or aluminium top can be opened up with a good pair of scissors and the coffee grounds extracted. The coffee makes a wonderful free (yes, free as you have already paid for and enjoyed the pod) organic fertiliser and your plants will love it. You can then choose whether to wash and recycle the plastic pod (if accepted by your local recycling program) or bin it if you are feeling lazy or the pods are not accepted for recycling. You will be surprised at how much free fertiliser you can collect! Even IKEA puts out its used coffee grounds for people to take home and use on their gardens.

If you use an espresso machine, it is even easier to collect the used coffee grounds for your plants (or someone else's). Help reduce waste, encourage plant growth (which helps the environment) and feel good about your actions!

Sunday, November 23, 2014

Condolences for Gough Whitlam - Australian Labor Party

If you are a member of the generation who directly benefited from the educational and other reforms of the Whitlam Government, there is still an opportunity to pass on your condolences and thanks:

Condolences for Gough Whitlam - Australian Labor Party:

For many of us from poorer backgrounds, the advent of free tertiary education provided us with an opportunity to go to university and pursue professional careers. I for one will be always grateful for this.

'via Blog this'

SnowSafe: A guide to safety in the alpine areas

For those of you planning a trip to the alpine areas, either for snowsports or summer activities, this is an excellent web site developed by the Australian Ski Patrol Association with loads of useful information:

SnowSafe | A guide to safety in the alpine areas:
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Snowsports on Pinterest

For keen skiers and boarders, there are a couple of interesting recent postings on Pinterest:

Snowsports on Pinterest:

'via Blog this'

Thursday, October 16, 2014

Things to love and hate about Aldi

Probably like a lot of other people, I have mixed feelings about Aldi.

Firstly, things I don't like:

(a) the credit card surcharge (in general I regard these as being a tax-deductible cost of doing business which should not be passed on to consumers); and

(b) the checkout system. This requires you first to empty your entire trolley onto the conveyor belt. The cashier then passes the goods over a scanner at lightning speed onto a small area (the size of a postage stamp (well actually around the size of an A4 sheet of paper) on the other side of the scanner. There is not enough room to pack the goods into bags, and instead you are required to put the goods back in the trolley in a haphazard fashion as fast as you can in order to avoid the postage stamp becoming overwhelmed. You then need to wheel your trolley over to a packing shelf, take all the goods out of the trolley again and re-pack them into bags to take home. This is exhausting just thinking about it, let alone doing it!

The check-out system might work wiith minimum inconvenience for a few things, but it definitely does not work for a full-sized 'shop', where a full trolley can take up the whole conveyor belt and take a lot of time to re-pack. I tried this once, but never again!!

Moral of the story: if you want to do all your shopping at once and have it neatly packed in bags when you exit the cash register, do not go to Aldi. Go to one of the other supermarkets, which still have people who will help you pack as well as self-service checkout machines (which I also hate, but for different reasons, as their programming is inflexible and they 'chuck a hissy fit' if you put your own bags in the packing area if you have not pre-selected this option, and expect you to pack at superhuman speed, saying repetitively "please take your goods" when you are nowhere near ready to do so!).

Anway, the good things about Aldi are its goods and prices (and the weekly specials wilth all sorts of cool things).

I have previously sung the praises of the Aldi Expressi coffee range, but today I will just mention a couple of other things which are well priced and good quality.

The first is the Bakehouse premium bread range. It comes in a similar range and presentation to the much more expensive Helga's range, but tastes just as good.

The other is the Brooklea Joi creamy light probiotic yoghurt range (Strawberry, Mixed Berry and Peach Mango). For me the pick of the range is the Mixed Berry. It is flavoursome, creamy without being too sweet, and has that lovely slightly 'bitey' tartness familiar to berry lovers. It actually has stawberries, raspberries, bluberries and blackcurrant juice in it. At $3.59 for one litre, this sure beats the competition.

Thursday, August 14, 2014

An apple a day can have surprising health benefits!

The Australian CHOICE consumer magazine publishes a great deal of useful health information, both in the main magazine and in the separate Choice Health Reader.

This small article about the health benefits of an apple a day appeared in the February 2014 issue of CHOICE:

For further interesting health news and research articles, see the following board on Pinterest:

Friday, August 8, 2014

St Francis' Choir, Melbourne sings at the Holy Trinity Festival on Saturday 16 August

Members of St Francis' Choir are looking forward to performing at the "Sounds of Joy" concert as part of the Holy Trinity Festival on Saturday 16 August 2014. For further details see:

Tuesday, July 22, 2014

Opposing the Australian Federal Budget proposed $7 GP co-payment

My own view (and that of many others) is that the introduction of this proposed impost would be a public and preventative health disaster and an administrative nightmare for GPs and other direct service providers.

A website has been set up to collect signatures for a petition opposing the co-payment (which still has a chance of being defeated in the Senate) and to share people's stories as to why they disagree with this measure.

Sign and/or share your story at

Wednesday, June 18, 2014

Australian Federal Budget: Medical co-payment belongs on the scrap heap

There is a terrific article on page 20 of "The Age" (Melbourne) today from Professor Brian Owler, President of the AMA which includes many of the reasons I had thought of as to why the medical co-payment proposed in the Federal Budget is a bad idea if we are advocating for our patients.

Saturday, June 7, 2014

Bouquets and Brickbats: When is "travel insurance" not travel insurance?

Caveat emptor - beware of travel insurance which is underwritten by Allianz. This includes CHI and Aussietravelcover.

My iPod Touch was stolen during a trip on 'The Ghan'. Not only did Allianz first try to deny liability (alleging that the iPod had been "left behind" (no cover if you leave anything behind anywhere during your travels) but then after getting a supporting letter from the Terminal Manager they agreed to pay, but only wanted to pay a pittance for an iPod that was in 'as new' condition (applying a savage level of depreciation). As this would not come anywhere near the replacement cost for the iPod I argued with them, and they increased it a bit, but still nowhere near enough to buy a new one. At this point I was exhausted and gave up and had to settle for a second-hand one with a tiny bit of marginal screen damage (sourced through EB Games

As a result I would never ever insure anything with Allianz. Never, ever!

This is also a lesson for people purchasing travel insurance to read the terms and conditions carefully to make sure you are covered for accidental loss. To my mind, so-called travel insurance that does not cover you for accidental loss or leaving things behind is not travel insurance at all and does not deserve your business. Also, if you have an expensive piece of technology in good condition, you will want replacement value, not just their arbitrary depreciated value.

For terrific value and more generous terms and conditions try this one instead provided by ACE Insurance (and available in three levels of cover):
(The medium level of cover is also available through with a 10% discount for an online quote, but it is cheaper through the Fairfax website.)

Thursday, May 29, 2014

Medical Book Review: Talley and O'Connor - Clinical Examination (Seventh Edition 2014)

Medical Book Review – Clinical Examination. A systematic  guide to physical diagnosis. Seventh Edition.Nicholas J Talley and Simon O’Connor
Churchill Livingstone/Elsevier
ISBN: 9780729541473 Publication Date: 2014 RRP: $125.96 (free delivery in Australia/NZ).
(Bonus online resources (videos, ECGs and images) are available to purchasers of this book through the Student Consult portal.)

The book is also available in two other formats: a standard eBook containing the content from the print edition plus four additional chapters covering the history and examination of gynaecology, obstetrics, neonatology and paediatrics, and an interactive enhanced eBook which contains the four additional chapters together with OSCE videos, ECG case studies, an imaging library and MCQs.

I purchased the fourth edition of this book (together with the pocket guide) when I was a medical student. This paperback edition comes in at around 600 pages, and is physically larger than its predecessor, and, unlike my earlier edition, contains an impressive number of colour photographs and other illustrations and tables. I was literally ‘blown away’ by the quality of the book (and its contents) as an educational resource, and it is a book in which even a highly experienced practitioner can find learn something from.

The Contents section follows straight on from the Foreword, and is well set out with bolded headings which make it easy to identify the topic of interest at a glance.

The book is divided into several key sections:
1.            The general principles of history taking and physical examination;
2.            The cardiovascular system;
3.            The respiratory system;
4.            The gastrointestinal system;
5.            The genitourinary system;
6.            The haematological system;
7.            The rheumatological system;
8.            The endocrine system;
9.            The nervous system; and
10.          Specialty examinations.

The ‘specialty examinations’ have been considerably expanded from my earlier edition, with seven topics covered as opposed to the earlier three. These now include:
Chapter 38: The eyes, ears, nose and throat;
Chapter 39: The breasts;
Chapter 40: The skin, nails and lumps;
Chapter 41: A system for infectious disease examination;
Chapter 42: Assessment of the geriatric patient;
Chapter 43: Assessment of the acutely ill patient; and
Chapter 44: Assessment of death.

There are three appendices which were also present in my earlier edition (‘Writing and presenting the history and physical examination’,’ A suggested method for a rapid screening physical examination’ and ‘The pre-anaesthetic medical evaluation (PAME)’. The book concludes with an extensive Index.

Most chapters conclude with two useful and practical components, ‘T&O’C essentials’ and ‘OSCE revision topics’, and a list of references.

The Preface (written by the two authors) summarises their approach to this new edition:
“… we cover the core clinical skills from the basics to an advanced level. We have taken an approach that is patient-centric and evidence-based; the patient must always come first. The edition has been brought right up to date with the latest clinical data, including new research specially commissioned for this edition. Learning should also be fun and the book is deliberately laced with humour and historical anecdotes that generations of students have told us enhance the learning experience.”

Further information concerning the evidence-based approach which has been taken in this edition appears in the Acknowledgments section, together with a list of the highly credentialed reviewers who have also contributed to the manuscript.

I particularly enjoyed the next two sections: ‘Clinical methods: an historical perspective’ and ‘The Hippocratic Oath’. In keeping with the evidence-based approach, these are followed by a section detailing ‘Credits: figures, boxes and tables’.

Section 1 (general principles of history taking and physical examination) provides a structured approach to both these elements together with abundant resources in terms of photographs, tables and practical advice (including about OSCEs). There is a specific section on evidence-based clinical examination.

In my work as a medical educator, the clinical history and examination topic that we have most recently covered with our students was the gastrointestinal system, so I have elected to look at this chapter in some more detail as an example of the system-based chapters.

As is customary, this chapter begins with a pertinent quotation, this time from Shakespeare. A short section on ‘examination anatomy’ follows, containing a detailed colour illustration and descriptions of the major areas in the abdomen of anatomical interest. The correct positioning for examination is then described, and a systematic approach to examination follows. This begins with jaundice and weight and wasting, and a very thorough section on skin follows, together with several photographs and a very detailed table setting out relevant diseases with skin and gut associations. The general introductory section concludes with ‘mental state’. The next section covers the examination of the upper limbs, beginning with the hands (nails and palms) and a discussion of the most common relevant findings, proceeding to an explanation of hepatic flap and then possible findings on the arms. Several illustrative photographs and a table for assessing malnutrition are included in this section.  The next topic looks at the face and head, and includes discussions around the eyes, salivary glands and mouth. Several photographs and tables are included. After a brief section on ‘Neck and chest’, the chapter moves on to examination of the abdomen. This section begins with detailed information on inspection and then a systematic approach to palpation of the abdomen, including assessment of the major abdominal organs and possible causes of other abdominal masses. Once again several helpful illustrations and tables are included. Sections follow on percussion, ascites and auscultation. These are also well supported by additional resources. A section follows on hernias (including how to examine for these) with useful illustrations. Next is a detailed section on rectal examination, including proctosigmoidoscopy. There is a brief section on other areas of the body which may be relevant to examine, and then the chapter concludes with a section on ‘Examination of the gastrointestinal contents’ (including faeces, vomitus and urine. There is a helpful illustration of the bilirubin pathway and a table listing the changes in urine and faeces with jaundice.  The final three elements are the ‘T&O’C essentials (nine key points from the chapter), ‘OSCE revision topics’ (five points) and the references.

There is also a complementary chapter immediately following on ‘Correlation of physical signs and gastrointestinal disease’. This covers examination of the acute abdomen, signs commonly associated with chronic liver disease and portal hypertension, hepatic encephalopathy and dysphagia, an approach to assessment and diagnosis of gastrointestinal bleeding, a discussion of inflammatory bowel disease and finally, malabsorption and nutritional status (signs, causes and classification).

Both these chapters are very thorough but well-organised and laid out and are as a result easy to follow. The plentiful illustrations and tables support the written text and enable the reader to gain a better understanding of the subject matter. These additional resources essentially make the book a ‘one stop shop’ so that in general it is not necessary to look elsewhere for supporting materials to aid comprehension.

This is a magnificent book, which is one of those references which will well and truly ‘stand the test of time’ and the authors are to be congratulated on their efforts. Whilst the amount of detail is probably in excess of that required for junior medical students, for those undertaking their clinical training, and indeed for junior clinicians in training it would provide an invaluable resource. It is also a well-loved resource for medical educators. This is a book which has ‘something for everyone’ and it is not hard to imagine that even highly experienced medical practitioners would find it useful to turn to from time to time.

Verdict: Highly recommended!

Wednesday, May 21, 2014

Book review: 'Hypothermia' by Arnaldur Indridason

This is one of a series of crime novels concerning Icelandic detective Erlendur. At 314 pages I managed to read it during a two-hour 'plane flight. Published in 2009, it came into my hands from a colleague who thought that I might be interested to read it. Having been to Iceland in 2006, its haunting landscape was familiar to me, and had visited Thingvellir national park and seen the view over the lake Thingvallavatn, where much of the action takes place.

Like any detective story, there are a number of threads which initially appear to be unrelated, but are drawn together in the last few pages of the book. Erlendur fits the Scandinavian mould of the somewhat tortured middle-age male detective who is divorced and has a fractured relationship with his family. The story is almost a morality play about the negative consequences of infidelity and how both anger and the desire to be free can drive murderous intent and a fabric of lies and deception. It is also a story about an innocent love story that ends in tragedy, the impact of tragedy and loss over a lifetime, the ghosts that live on, the question of life after death and its intersection with medical madness. It is somewhat poignant that tragedy and loss also enveloped Erlendur's own family in his childhood.

The book is clever in terms of its twists and turns and the way in which the various clues are gradually revealed, and 'putting it all together' really does come down to the last few pages when our suspicions that an apparent suicide was really a murder are confirmed. There is of course a certain element of 'willing suspension of disbelief' as the elements of the plot are spun together, and we are left wondering whether the murderers will in fact 'get away with it'. I was left feeling very sorry that the victim, who was on the verge of getting her life back together again, was so cruelly robbed of this opportunity, and did wonder about things like why would the police not check the plastic rope in the noose for fingerprints, and why would someone who was so afraid of the dark and hated being left alone voluntarily go to stay in an isolated cottage on the edge of Thingvallavatn without the author making more of this inconsistency?

Since I love Iceland, and this is a reasonably good yarn that allowed me to have a few stabs at where it was all heading towards the end, which is always fun, I am going to recommend it! There are apparently several other novels in the series by the same author if you are interested in reading more.

Friday, May 9, 2014

Outstanding Fish and Chips - St Georges Fish & Chips (Melbourne)

In my exacting search for the best local fish and chips, there is a new leading contender.

St Georges Fish and Chips
350 St Georges Road
North Fitzroy
Open 6 days (Wed to Mon) 11am to 9pm

The pieces of blue grenadier were large, sweet and succulent, with a crispy outer coating. Both the potato cakes and the calamari rings were very generously sized (the calamari actually being the biggest i have ever seen) with the same crispy coating. 'Minimum chips' is $3.00, but this also erred on the generous side, with a crispy golden outer coating and a light and fluffy interior.

The Friday night traffic was a bit of a challenge, but it was worth it!

Highly recommended!

There are also a number of special deal packs on the menu, and they also serve hamburgers, steaks and souvlaki.

Sunday, April 27, 2014

Movie Review: Captain America - The Winter Soldier

This second instalment in the Captain America franchise and the Marvel universe is, in short, a 'kick-arse' movie. It is so action-packed that at times it borders on sensory overload, and you wonder if, in their desire to please, the creators have perhaps tried a little too hard.

The plot is complex, in the "who can you truly trust?" genre. The Captain is having trouble integrating into modern times and embracing modern values. He makes a new friend, who turns out to be 'The Falcon'. His somewhat unlikely working partner is Natasha Romanoff, 'The Black Widow', whom he does not initially trust. They rescue some hostages from a SHIELD ship that has been taken over by pirates, and Romanoff downloads some Shield data onto a flash drive, which then plays a key role in the remainder of the plot.

The Captain challenges Nick Fury, head of Shield, about openness and honesty, and Fury reveals a secret project called 'Insight', which is building three airbone massive troop carriers with impressive firepower and the capacity to wipe out threats before they occur. the Captain is not impressed, and after their discussion Fury requests his associate, Alexander Pierce, to request the world security council (of which he is secretary) to delay the initiation of the project.

Shortly afterwards, thre is a spectacular car chase and assassination attempt on the life of Nick Fury, head of Shield. He barely escapes with his life and winds up in the Captain's apartment, telling him "to trust no-one". He is promptly shot by an unknown assailant, who we presume is the 'Winter Soldier'. Fury is transported to hospital, where he dies (the doctor in me was wondering, does he?).

After Pierce comsiders that the Captain is being evasive about why Fury was in his apartment, Rogers becomes a wanted man on the run. He goes underground with Romanoff to try to find out from whence the evil stems. In shades of the new movie 'Transendence', they discover that a mad (and evil) German scientist has embedded his consciousness into some remarkably old computer equipment in a bunker and has developed an algorithm that identifies people who will be a threat before they a actually become a threat. His goal (and that of Hydra, the many-headed serpent embedded within Shield) is that humanity will at last give up its freedom to avoid living in fear (Project Insight).

The Captain and Romanoff manage to avoid become barbeque by-products when missiles predictably strike the bunker, and when Rogers comes face to face with the Winter Soldier, he realises that this is his best friend Bucky, who was presumed to have died in the 1940s, but has also survived in an enhanced form courtesy of the mad scientist.

In the central part of the movie Rogers also has a poignant reunion with his now-aged former 'best girl' Peggy, who is still alive in a nursing home.

The Captain and Romanofff enlist the help of The Falcon, and work with a small band of trustworthy allies to try to save the day. My medic's gut feeling is proved correct when Fury emerges alive from the shadows.

Now unhindered by Fury, Pierce presses ahead with the initiation of Project Insight, and our small band of intrepid heroes must board each troop carrier in time to replace one of the data chips with an inert one which sever the connection with orbiting satellites and prevent millions of hapless people from being exterminated.

We are treated to some superbly choreographed chase scenes and fight scenes, in a variety of locations, including in the air, and it all comes down to the final chip and a 'Wild West' style showdown between the Captain and the Winter Soldier. The chip nearly falls to Earth at least twice, but somewhat miraculously Rogers manages to avoid being smashed to smithereens and replaces the final chip as the Earth-bound controllers are about to fire on their 20 million unsuspecting targets. The Winter Soldier, now trapped under a girder, is rescued by Rogers, who reminds him of the brotherly bond between them. Both survive the troop carrier crashing out of the skies.

The Captain's demand, prior to the final assault, of both Hydra and Shield being dissolved, "as something is rotten in the state of Denmark", is duly met, and new career paths are needed all-round. Fury stays officially dead, but continues his work behind the scenes, Romanoff feels a need to invent a new cover (but has won the respect and trust of Rogers), and The Captain and The Falcon make it their next mission to find the Winter Soldier.

In the now traditional 'teasers' at the end, we see one of the remaining offshoots of Hydra with an advanced weapon, which has at its core the eerie blue glow of the Frost Giants (first intalment of 'Thor'), and twin mutants kept in separate rooms with very different powers, who appear to be intended as future challenges for our protagonists.

More poignantly, we see a glimpse of the incognito Winter Soldier at the Smithsonian reading about Captain America's best friend, Bucky.

This really was a terrific movie, much better than I expected, and because of the pace and intensity you would probably need to watch it at least a couple of times to pick up all the finer points.

Highly recommended!

I am totally "over" the 'Spiderman' franchise, as there can be too much of a good thing, but I look forward to both a new 'X-Men' movie, which goes back to their roots, and forthcoming next installment of 'The Avengers'. Also look out for a fabulous documentary which was on TV recently about the origins of the relatively new Marvel Studios and their vision of the Marvel universe.

Saturday, April 26, 2014

A bouquet for Virgin Australia (Melbourne to Perth)

I recently flew to Perth and back within twenty four hours (for work purposes) with Virgin Australia.

Travelling economy on this occasion was more pleasant than most. Although the flight was about two hours late in leaving Melbourne (allegedly due to bad weather over the past couple of days) and the in-flight entertainment system was not working, it was a pleasant surprise to be offered complimentary beverages and then a hot evening meal (which was reasonably nice). I commented on this and was told that it is standard practice on transcontinental flights. The flight attendants were polite, friendly and helpful.

It was also nice that an announcement asking people to raise teir seats to an upright position was made when the meal was about to be served.

The return flight the next day left on time (and arrived early), the (free) entertainment system was working, and we had the same crew and same food and beverage service. It was nice to be remembered by the friendly flight attendant from the previous day!

Well done to Virgin for making our long trip as pleasant as possible.

Coffee Review - Lavazza Torino Qualita Oro

Lavazza Torino Qualita Oro, 100% Arabica coffee beans.
Medium roasting, strength: 4

"Qualita Oro has an intense taste with the rich flavour and aroma expected from a true Italian espresso."

I have been grinding the beans at home (on a fine setting) and then brewing the coffee in a standard large coffee plunger.

When drunk black, this coffee has a full-bodied, nutty flavour with a hint of sweetness. It is smooth on the tongue rather than being noticeably bitter, but there is an underlying sense of that warm and rich bitterness that you get with a good dark chocolate. The aftertaste decays gradually.

Adding milk dampens down the sense of bitterness and enhances the smoothness, and it would be quite easy to drink a lot in one sitting!

Verdict: a pleasant, smooth and sophisticated cup of coffee.

Wednesday, April 16, 2014

Steig Larsson: The Girl who kicked the Hornet's Nest (A brief review!)

Having bought all three books in the Millenium trilogy a few years back, I had previously had an abortive attempt at reading this final massive volume of 602 pages.

On a recent long trip I started again from the beginning and succeeded in getting to the end.

For the most part, it is tightly and cleverly written, and reveals the attention to detail in the underlying research. Of course it helps to know the back-story, and the legendary sexual prowess of protagonist Mikael Blomkvist is a little tedious at times, but all the threads of the story are woven together in a masterful and largely satisfying way.

One gets the feeling that it could have been edited a little more tightly, but it is what it is. It portrays strong women, resourceful hackers who it seems can do anything, and a group of elderly men who seemingly have been puppeteers for the Swedish State over many decades.

Given Larsson's untimely demise, it is fitting that it concludes with a raprochement between Blomkvist and Salander.

If you can stay the distance, a worthwhile read!

Music for Easter, St Francis' Choir, Melbourne

If you live in Melbourne and would like to experience some fabulous music in conjunction with the traditional Easter church services, then look no further than St Francis' Choir, Melbourne. Yours truly is back on the Music Repertoire Sub-Committee this year (a one year on, one year off policy) and was especially excited to get some wonderful English and continental polyphony on the program:

All welcome!

Red Rooster Fish and Chips "rip-off"

Red Rooster recently started advertising what appeared to be thick chunky succulent and generously sized fillets of flathead with a correspondingly generous service of golden thick cut chips.

The family pack of ten fillets with chips costs $25.00 and I foolishly thought that this would do for a couple of meals. Nothing could have been further from the truth.

The fish fillets were tiny and looked nothing like the picture, also several being a brownish colour on the verge of being burnt, and the chips were soggy and anaemic and definitely not a family serve.

As a result ,this package is literally a "rip off" and much better value can be found by purchasing directly from your local fish and chips shop. Do not be seduced by the misleading advertising! This would definitely be one for the 'pack comparison' segment on The Checkout on the ABC.

Shame on you Red Rooster!

Friday, January 24, 2014

Medical Book Review - Emergency Medicine. The Principles of Practice. Sixth Edition. Authors: G and S Fulde.

Medical Book Review – Emergency Medicine. The Principles of Practice. Sixth Edition.
Gordian Fulde and Sascha Fulde.

Churchill Livingstone/Elsevier Health Sciences
ISBN: 9780729541466 Publication Date: 27-09-2013 RRP: $109.93 (free delivery in Australia/NZ).
For further information see:

I have a previous fourth edition of this book by the highly credentialed Professor Fulde, which I was given whilst at medical school and has done good yeoman service over the years, but this new edition is an impressive replacement. It is also nice to see that Sascha Fulde is carrying on the family tradition. Professor Fulde recently appeared on the news bemoaning the prevalence of alcohol-fuelled violence, and is obviously still very much a ‘hands-on’ clinician as well as an academic writer. This bodes well for the practicality of the contents.

The new edition is considerably heavier, coming in at around 1,030 thin pages, but does have an in-built protective plastic cover which can be wiped clean, which is a definite advantage in terms of infection control. The old book was monochromatic and contained some tables and diagrams, but no photographs. The new edition has a blue, white and black colour scheme, and includes a number of black and white photographs as well as tables and diagrams.

Being a Basic and Advanced Life Support instructor, as soon as I opened the book I loved the fact that it has both the BLS and Adult ALS algorithms inside the front cover, and if you flip it over and look inside the back cover both the Choking and Infants and Children ALS algorithms can be found there. How easy is that!

Turn over another page and you find the “Quick Reference”, compiled by Fiona Chow. This section of 115 pages (with a list of Abbreviations at the end) is a handy little guide. An index is provided on the first page, but with white text on a blue background it is a little difficult to read in less than optimal lighting conditions. The two ALS algorithms are followed by that for newborns and a summary of suggested drug usage in adult and paediatric cardiac arrest. Sections follow on miscellaneous drugs used in adults and children. As well as recommended dosages and route of administration, some indications are also given. There are helpful sections on cardiology and ECGs, respiratory medicine, trauma, metabolic equations and electrolytes, thromboembolism and coagulopathy, neurology, important procedures, toxicology, drug infusions, paediatrics, orthopaedics, obstetrics and gynaecology, dental, common conversions, antibiotic prescribing and normal values. There is potentially some overlap with the discussion of antibiotics as common antibiotics are also listed in the earlier drugs section.

The book proper commences after the Quick Reference section.  The Contents sets out a  summary of what is in the following forty-eight chapters. These have been written by an impressive list of contributors, and the book has been reviewed by a shorter but equally impressive list of personnel.

As you would hope with an emergency medicine textbook, the chapters have a strong practical orientation and provide a lot of ‘how to’ guidance as well as enough of the ‘why’. Chapter 2: Securing the airway, ventilation and procedural sedation, is very comprehensive and detailed, and would provide a lot of comfort to the inexperienced practitioner. Chapter 3: Resuscitation and emergency procedures, provides a very helpful step-by-step guide to several common procedures such as IV cannula insertion. Chapter 4: Diagnostic imaging in emergency patients would probably have benefitted from some illustrations to go with the descriptions provided. The same might apply to the following chapter on ultrasound. A number of chapters dealing with cardiac and respiratory emergencies follows, including a thorough effort to explain the nemesis of many a student and doctor, the ECG.

It is nice to see a separate chapter on pain management in the ED, which is appropriately followed by a chapter on trauma. The chapters then jump around a bit. For instance, neurosurgical emergencies are some distance away from neurological emergencies. In the interim, the book travels through aortic and vascular emergencies, orthopaedics, hand injuries, urological emergencies, burns, patient transport and retrieval , mass casualty incidents and a handy chapter on ‘The seriously ill patient – tips and traps’. As someone who works in the pre-hospital setting and has trained in disaster medicine, I thought it was great to see both the retrieval and mass casualty chapters in this book as coverage of disaster medicine is certainly very common in American emergency medicine textbooks. (Upon checking, they were in the earlier edition also.) Following neurology, the book moves on to chapters on gastrointestinal  and endocrine emergencies and then acid-base and electrolyte disorders (another subject which strikes fear into many hearts but is comprehensively and clearly covered here). The very pertinent topic of poisoning, overdosage, drugs and alcohol follows. This is very detailed and provides advice and information for a number of commonly abused substances.

The final third of the book also jumps around quite a bit in terms of topics and ordering. Common orphans drowning and Envenomation follow next, then electrical injuries, hypothermia and hyperthermia, childhood emergencies, geriatric care, gynaecological emergencies, ophthalmic emergencies, ENT, dental, psychiatric presentations, dermatology, infectious diseases, the immunosuppressed patient and ED haematology.

The book concludes with a collection of six practical and interesting chapters which contain “something for everyone”. These are rural and indigenous emergencies, advanced nursing roles (which should enhance understanding  of what nurses actually do and thus team work), the general practitioner; working with IT (which deals with the vexed issue of interactions between GPs and EDs and provides a template for that essential discharge letter), administration, legal matters, governance and quality care in the ED (a catch-all chapter which contains some important advice on legal issues, including “How do you avoid a law suit?”), and two final chapters of immeasurable worth to residents and medical students: a guide for interns working in emergency medicine, and a student’s guide to the emergency department. It is nice to see that Sasha and Tiffany Fulde and Richard Sullivan, all doctors-in-training, have between them contributed to the pearls of wisdom in these chapters.

Whilst writing this review in the late afternoon and the transition to artificial light, I did find the pale blue headings in the chapters a bit difficult to read as they do not stand out well against the bright white of the pages. Paragraphs of pale blue text fortunately do not occur frequently in the book, but they are even harder to read in artificial light, especially as the pages are a bit shiny and the light source reflects off the surface of the page.

Another small criticism that I would have from recently ‘road-testing’ the book out on location is that the Index at the back could be better. For instance, I went to look up “penetrating eye injury” under E for eyes but it wasn’t there (not there under ‘penetrating’ either). I knew it would have to be in a book about emergency medicine, so went to the Contents and found the chapter on Ophthalmic Emergencies and of course it was there. There was one other similar example that I came across during testing.

My only other comments about things that ideally I might have liked to see is more intuitive chapter groupings and perhaps a few more diagrams and pictures where these could contribute to better understanding. Even if that is not possible, are there online resources that people could be referred to, such as YouTube? For instance, knowing how to reduce a shoulder dislocation is much easier if you can see it done properly first. (Apparently there is a separate eBook available for purchase which contains enhanced content, but this does not assist the purchaser of the print edition.)

As a review of the section on penetrating eye injuries demonstrates, this is a book grounded in emergency department practice rather than a first aid manual. It assumes that the first aid has been done and that the patient has come into the department and that you are getting on with history, examination and management. It is an enormously impressive resource, even though it did not always have quite as much detail as I would have liked on a particular topic. I guess everyone’s needs will vary in this regard, depending on your pre-existing knowledge and level of training and inquiry, but the authors have done a very good and solid job in covering the basics. Some chapters do drill down into a lot of detail.

The authors are also to be commended for including cutting-edge and imaginative topics amongst the chapters that are really going to provide practical value for doctors at the front line.

I feel this is a “must have” book for any Australian doctors interested in or involved in practising emergency medicine. It is written for local conditions by local authors from a variety of clinical backgrounds.

It is probably a bit thick and heavy to carry around in your pocket, but indispensible to keep in your bag for ready reference. For those with smartphones and tablets, the back cover of the book refers to standard and enhanced eBook versions and a PocketED app.

Verdict: Highly recommended!