Clinical Conversations

• Paediatric acute behavioural disturbance

  In this episode of Clinical Conversations, we explore the complexities of managing acute behavioural disturbance (ABD) in children and adolescents—a small but increasingly common and high-risk cohort. Host James Oswald and AV Medical Director Dr. David Anderson are joined by paediatric emergency physician Dr. Claire Wilkin, who brings deep expertise in paediatric critical care. Together, they discuss the causes of ABD in younger patients, differences from adult presentations, principles of de-escalation, the role of sedation, and how to assess and manage risk.Get in touch⁠[email protected]⁠ X / Twitter / BluskyDavid: ⁠@expensivecare⁠ | @expensivecare.bsky.socialJames: ⁠⁠⁠@JamesOz1⁠⁠ | LinkedinJamesDavid

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• Clinical Update

  Your monthly clinical update covering:Clinical Practice 03:10 – Respiratory CPG Update: Pulmonary edema, COVID, ILI, paediatric asthma changes coming soon.04:00 – First Responder Analgesia: Supply challenges beingaddressed; updates coming. 05:10 – Button Batteries: New blue dye marker—importantvisual sign but not universally present.06:00 – Mushroom Season Warning: Watch for toxidromes; VPIC support emphasized.06:40 – VVED changes: Easier access to emergency physicians.Patient Safety 08:30Case: Declined transport with adverse outcome.Consent must be truly informed—document clearly, especially under cognitive load or red flags.Guideline monitoring 11:15Sedation Safety Update: Improved safety with guidelinechanges.Case Reports & Engagement 13:10Case reports welcome—CPG team happy to assist.Paper of the month 13:40Comparison of demand valve vs. standard BVM. No differencein oxygenation delivery in healthy volunteers. Nasal prongs speed time to oxygenation saturation. Continue using both tools in RSI prep.New ACS Guidelines Summary (ft. Andrew Bishop) (18:30)ACOMI terminology replaces STEMI/Non-STEMI binary. Key ECG findings added. Serial ECGs every 10 mins; prehospital thrombolysis within 30mins.Equipment 23:50Asset Numbers: Include in Riskman reports to aid faultresolution.Professional Development 24:30AICG Highlight: Leadership training relevant across paramedicine—CPD eligible and recommended.Small Steps to Transform Practice 26:30Get in touchX / Twitter / BlueskyJames: ⁠⁠⁠@JamesOz1⁠⁠ | @jamesoz1.bsky.socialBen: ⁠@ben_meadley⁠LinkedinJamesBen

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• Paediatric assessment, consultation and virtual emergency care

  James Oswald and Dr David Anderson explore how consultation has evolved from a perceived weakness to a hallmark of clinical maturity. They discuss the growing role of virtual emergency care, particularly the Victorian Virtual Emergency Department (VVED), in supporting paramedics with decision-making—especially when assessing young infants. Joined by pediatric emergency specialist Dr Harith Al-Rawi, the episode dives into the challenges of remote pediatric assessment, the value of collaboration between paramedics and virtual care clinicians, and the structured information required during remote consultation to safely support care at home. The conversation highlights that newborns are a uniquely high-risk group, and outlines why VVED consultation is now a must for infants aged 28 days or younger.   Get in touch⁠[email protected]⁠ X / Twitter / BluskyDavid: ⁠@expensivecare⁠ | @expensivecare.bsky.socialJames: ⁠⁠⁠@JamesOz1⁠⁠  LinkedinJamesDavid Producer: Liam Hennebry

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• Clinical Updates: April 2025

  Your monthly clinical update covering:VVED Consultations for small infantsNew requirement: VVEDconsultation for non-transport of infants ≤28 daysStrong recommendation for 29days–3 monthsDriven by patient safety reviewand expert consensusNot about removing autonomy —it’s about adding clinical supportRSI Checklist UpdateAddition of a pop-off valve checkfollowing a critical safety eventPrevents misdiagnosis of failedventilationReinforces value of checklists,even for experienced cliniciansAdvanced Paramedic PracticeProposalPublic consultation openFramework for advanced practiceregistration in primary care and critical careFacilitates further advancementssuch as prescribing rights and scope self-determinationBig implications for AVparamedics — see link in show notes to respondSTEMI Transfer PilotALS paramedics trialing regionalSTEMI transfersTarget: stable patientspost-thrombolysisReflects data showing most STEMIpatients are low riskPatient Safety FocusStanding height falls in theelderly: don’t underestimate riskRhythm misinterpretation:shockable rhythms missed or misidentifiedNo link between junior staff anderror rates — we all share responsibility, we are all vulnerableGuideline Monitoring:Palliative Care CPG9.9% increase in patients dyingat home — great outcomeNo major change in meds given —possibly due to barriers in the current CPGEvidence supports simplifying CPGCase Reports on Viva EngageRecent cases: paediatricrespiratory failure, polypharmacy overdose, snake biteSubmit your own case via the Vivatemplate Paper of the Month: PACKMaNTrialRCT comparing ketamine vsmorphine for trauma painFound no difference ineffectivenessPoints to multimodal analgesia asa next step in research, which is already AV’s approachEquipmentCheck Pop-off Valve position atstart of shift“Resus Ready” campaign comingsoonCardiac Monitor ReplacementProgram- New device comingDiscussion underway: do we needto carry everything all the time? Professional DevelopmentOpportunitiesCritical Care Summit – May 15–16,EssendonGrand Rounds (CPG + RMH collab) –May 27, Sunshine Hub or virtualTrauma Grand Rounds – June 18 atRoyal Children’s or online Small steps to transform youpracticeDeliberate practice = highperformance, visualisation and mental rehearsal make a differencePractice rhythm recognition Rehearse SITREPsResourcesParamedic analgesia comparing ketamine and morphine in trauma (PACKMaN): a randomised,double-blind, phase 3 trialPalliative paramedicine: An interrupted time series analysis of pre-hospital guideline efficacyProposal to regulate advanced practice paramedicsRhythm recognitionGet in touchX / Twitter / BlueskyJames: ⁠⁠⁠@JamesOz1⁠⁠ | @jamesoz1.bsky.socialBen: ⁠@ben_meadley⁠LinkedinJamesBenProducer: Liam Hennebry

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• Sedation safety for acute behavioural disturbance (Part 2)

  In Part 2 of their sedation safety conversation, hosts James Oswald (paramedic and clinical guidelines specialist) and Dr. David Anderson (Medical Director of Ambulance Victoria) cover preparation for sedation and how to recognize and respond to deterioration. They break the problem into three evidence‑backed pillars:Prevent deterioration (have a listen to Part 1)Prepare for side‑effects – if you plan to sedate, you must plan to resuscitate Recognise & Respond when things go wrongFurther resourcesAPIC Session: https://paramedics.org/recordings/acpic24-spotlight-on-sedationClinical Conversations – Acute Behavioural Disturbance https://open.spotify.com/episode/2ahoO2WWHc27zOLocqoQR8?si=u4Sr_RjeQj-_lzPUWkUelQSafer Care Victoria ABD guideline: https://www.safercare.vic.gov.au/best-practice-improvement/clinical-guidance/emergency/acute-behavioural-disturbance Get in touch⁠[email protected]⁠ X / Twitter / BluskyDavid: ⁠@expensivecare⁠ | @expensivecare.bsky.socialJames: ⁠⁠⁠@JamesOz1⁠⁠ |@jamesoz1.bsky.social LinkedinJamesDavid

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