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Minh L., Dr -

Loved this episode segment! thankyou!

Jarrod Anderson MD CCFP(EM) -

Bicarb in most machines I have come across is calculated based on the pH and pCO2. Can you explain the good agreement between VBG and ABG in terms of bicarb but not in terms of pCO2 when the bicarb is dependent on the pCO2.

EMCrit -


Dr. Marie-Kelly is of course correct that there will be variance between VBG and ABG in shock states and cardiac arrest. The cool thing is in these situations, the VBG is actually better representative of the patient's clinical status. For instance, see:
http://goo.gl/75LzV and http://circ.ahajournals.org/content/74/5/1071.full.pdf

Margaret P. -

Dr. Weingart, the link supplied in the comment no longer works. Could you write out the name of the article/study so that I may find it via pubmed. Thank you

Benjamin S., M.D. -


It appears you editor needs to be a bit more compulsive in fact checking. This segment lists "Anne Marie-Kelly" as a contributor. That seemed like an odd hyphenated last name, as referenced in Scott's note above. All the citations I found when searching her work refer to Dr. Anne-Maree Kelly.

Also, you allowed Dr. Kelly to dodge your question about staffing Australian EDs with residency trained EM specialists. You asked about ED staffs, as I heard it, and she answered about ED directors or "leaders". I'm still curious to know the answer about how well the stringent residency requirements have served the demand for emergency specialists.

Mel H. -

Benjamin - fixed the error on the name - thanks. Regards EM specialists, on our next interview I will try and remember to follow-up. It will be a very long time before every ED in Oz has only residency trained ER docs 24/7...

Deniz T., M.D. -

Thanks for the good segment .... to respond further to Benjamin's comment:

I'm a fellow in both countries, and split my time working in both the US and Australia as an EM specialist. I feel very fortunate to be able to work in both systems, as both have interesting and different advantages.

I see a real trade-off between the academic standard of FACEM's (really high) and the staffing problem (not enough of them). Most non remote ED's have a FACEM director, but are staffed by various types of non-EM trained docs. In metropolitan areas, most day and evening shifts are supervised by an EM specialist. In Australia, FACEM's dont work nights, although they fear that this is coming.

Most EM trained specialists in Australia do a combination of academics, teaching, supervision and admin, but unlike the US, are generally unable to personally man the trenches.

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