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Special catch

10 Apr

Hi all,

Yesterday a 10yo boy presented to our ED after fishing with his friend, who managed to catch him, instead of the Barramundi, with the fish-hook up his nose. The hook was situated just below the cartilage of the nasal septum, in the columella. XRays showed only 1 spike which didn’t cross the midline. We aimed for retracting the hook with a topical anesthetic and Nitrous Oxide, which seemed to work quite well but the hook was firmly anchored in the nose and we were unable to retract the hook without distressing the boy. Eventually we involved the ENT doctor who injected Lignocaine/Adrenalin in the soft part under the septum, the area you can feel with two fingers on either side – the columella again. Approached from the unaffected side with a small needle, a small amount of anaesthetic was deposited in the centre causing diffusion up on either side of the septum. A small nick overlying the spike and preparation of the surrounding tissue off the spike while holding the hook under light tension with a needle driver released the hook from the nose without complications or any pain!




Lipid emulsion for LAST

19 Oct

Hi all,

We (registrars ED) wanted to know what evidence and recommendations are available about the use of Intralipid for local anesthetic toxicity, so I did some study and put my findings in a PPP, for whom might be interested.

Cheers, Laura



28 Sep

Dear colleagues,

I didn’t post for a long time, due to moving to Australia. But tomorrow I will do a presentation about envenomations in The Northern Territory…. Which is a bit cynical because I’m probably the least experienced in this hospital regarding envenomations. However, I thought it would still be fun to dive into it (there’s a first time for everything) and to share it with you.

Attached the result: my PPP. A lot of slides because I wanted it to be my summary for Evernote also.

Please don’t hesitate to comment if you need to, especially if you happen to know a bit more about these creatures and envenomations.

Cheers, Laura

Envenomations RDH 09.2015



12 May

As promised but a bit later: some tips about how to prepare for the AMC multiple choice exam. Other / practical information about the exam you can find on the website The reason I want to share this information is that it worked for me, and I am not a quick learner, do not have an excellent memory and to be honest: I did not even recognise a lot of the basic stuff anymore, which I studied more than 13 years ago. So, it was a challenge for me.

The AMC recommends a few books to study before you sit the exam. The most important two Continue reading


18 Jan

As promised: the first part about trying to get a job in Australia for a longer period of time.

As a Dutch EP, SEH arts KNMG, you are not recognised as a consultant EM in Australia ( The primary reason is that, to be eligible for ‘the specialist pathway’ (, you need to be an overseas qualified specialist, which we are not with our ‘profiel-specialisme’. Our training is not comparable anyway, neither in duration as in content.

From our current position, we can work temporarily in Australia (2 years) as specialist-in-training via the Specialist Pathway (weird but yes!), or Continue reading