@TovaOBrien mentioned 'dominoes falling' in her tongue-in-cheek article today on NZ's occasionally #DoctorlessHospitals.

Funny if it wasn't true:

1) Rawene Hospital 2022
2) Kaitaia Hospital (LPS only)
3) Dargaville Hospital
Upcoming...
Bay of Islands Note that the canaries in the coal mine are more often poor, Maori, isolated, rural, underserved, and impoverished.
But that the disease of #austerity spreads to the whiter, richer areas eventually.

I did a little session on bluebottle #jellyfish stings today on @RNZ. You can't cover too much in 3 minutes so here's a bit more info.
Physalia utriculus (actually not a jellyfish but an absolutely amazing *colony* of creatures!)
1/ In New Zealand we have bluebottles. Not deadly, but painful.
And for ages we've had more incorrect information than correct information spread about them.

National's getting rid of the 2023 Smokefree legislation: it was going to prevent an estimated 8,000 deaths and save 1.3 billion dollars in health costs over 20 years. The smokefree legislation was going to do three main things: reduce addictive nicotine levels in cigarettes, lower the number of tobacco-selling shops from 6,000 to 600, and...

A summary thread from the great Emergency Medicine Australasia issue I finally read on the plane; @EMAJournal #foamed

Thom study in EMA: patients with unstable cervical #fractures can sit (29%), walk (63%), lack midline tenderness (27%), and have delayed presentation (20%). @EMAJournal #emergencymedicine

surf injuries were mostly lower c-spine

NEXUS underperformed compared to Canadian C-spine.

#drowning and cervical CTs are not inextricably linked: don't automatically image unless signs of axial loading/very specific concerns

Measles kills roughly 1 in 1,000 cases. Mostly unvaccinated kids. (Also cancer patients and pregnant people).

109 countries
(plus many more territories, regions, and states)
require childhood #vaccination.

NZ does not.
🧵

@nzherald @NZStuff NZ does quite badly on childhood immunisations, even compared to many lower-income countries.

There is virtually no comparing the harms of tobacco/cigarette smoking and vaping.
Cigarettes are a one-way trip into a world of emphysema, heart disease, stroke and cancer.
I treat these conditions every day.

That we allow corporations to profit off this is repulsive. At the same time we have a teen vaping explosion.

It's an 'adult only' product but of course that's just fiction.

Youth, especially teenagers (and even younger), are a vast and avid market for one of the fastest growing business sectors in New Zealand: vape sales.

I'll offer up one possible answer.

But first, some comments 😀 For-profit health care will always neglect poor and working class folks.

Pvt biz will suck up health money treating the profitable patients. They'll avoid the sick, elderly, poor, and infirm like the plague.
🧵

https://twitter.com/nz_voter/status/1632495676729987072

So any health system that is predicated upon turning sick people into profits is doomed to failure.

The smart, profits are not in treating people with actual health needs.

It's probably worth people learning about Epstein-Barr virus (human herpes virus 4).
It's a virus that pretty much everyone gets, the one that causes glandular fever, also known as #mononucleosis. 🧵 For many it's a simple cold, but for others it causes hepatitis, immunosuppression, autoimmune disease, and sometimes, several decades later, the neurodegenerative condition known as #MultipleSclerosis...

healthline.com/health/epstein…

Guideline summary for #ED docs on early pregnancy loss/miscarriage:
acog.org/clinical/clini…
10% of all #pregnancies end in #miscarriage, though the rate approaches 80% by maternal age 45yrs.
Half of early pregnancy loss (AKA miscarriages) are due to chromosomal abnormalities. 🧵 Crown-rump length (CRL) 7mm or greater and no heartbeat. Mean sac diameter (MSD) 25mm and no embryo.
Each one is an #ultrasound feature diagnostic of early pregnancy loss.
#POCUS
#medtwitter

Ok, so he owns or part-owns investment companies, and private medical practice Whangarei doctors, and Primecare.
I'd really like to know that he does not own a stake in White Cross urgent care, who get taxpayer $ directly.
Maybe he'll address that. He's a recent follower.

https://twitter.com/GaryPayinda/status/1626274526207303680

In the past, Whangarei GPs have part-owned White Cross urgent care corporation. Is that still the case?

I can't believe this abomination of a law passed. It deserves to get destroyed in court.
Saliva drug testing is so inaccurate as to be untenable.
And you can be 100% sober, last sleeping pill days ago, or joint weeks ago, and you'll still test positive.

knowyourstuff.nz/2022/03/16/roa… I'm no fan of drugs. I've never used drugs. I'm just a doctor telling you this "drug testing of drivers" is, scientifically speaking, rubbish.
People are pretending it's accurate, pretending it works, pretending it saves lives.
Mostly it penalises people who smoked marijuana.

Are we in a health crisis? Certainly.
Is it new? No, it’s been brewing for a long time.
What we’re seeing is the end-game of four decades of neoliberal policies feeding on the corpse of civil society. Finally it seems to have played itself out. We’ve reached a point in time where the common man actually thinks taxes are bad. The same taxes that pay the surgeon who performs his gallbladder surgery, the teacher that educates his children, and the firefighters who protect his home.

I'm going to give @AndrewLittleMP the benefit of the doubt here. I did not hear his quote or read its context.

I hope he's not suggesting it's "totally safe" for any patient in an ED to wait 8, 12, or 24 hours for admission.

In fact, it is deadly.

i.stuff.co.nz/national/polit… Australasian researchers have shown beyond any reasonable doubt, that prolonged bed block and boarding in EDs (being stuck in an ED when there is no inpatient bed available upstairs) kills patients.

@theRavenApp
Check this out, a techie emergency doctor made it.
Crowdsourced CO2 levels.
Would be great if it could be automated.
@KashPrime said he's working on it.
Have a browse and you can get a feel for levels.

https://twitter.com/StephMcNZ/status/1593019995348664321

What I found is that shops are definitely not our greatest worry; nowhere near it.
If you want rank filthy air if you want to rebreathe other people's breath, there's nothing finer than a bar full of people talking, a restaurant, or a lunchroom.

Drones are popular, but most fatal great white attacks are described as sudden surprise attacks occurring from below.

Drones cannot spot sharks who pop up out of the deeper water.

'Drone effort to ward off shark attacks' stuff.co.nz/national/30074… Good reasonable advice from Chaz here.