Note: This is the sixth installment in a seven-part series Brian Doyle prepared to help colleagues make the most of an emergency medicine rotation Down Under.
Part VI:
Utilization of technology
Australians tend to rely more upon the clinical exam rather than advanced imaging. I have yet to see anyone in the Emergency Department order a CT scan to rule out appendicitis except after they have been seen by the surgeon. And most surgeons would rather take a patient straight to “theatre” (no… not a movie theatre… the operating theatre!) and take out their appendix rather than get a CT. I usually call the surgeon to see a patient with abdominal pain rather than order the CT scan. However, I don’t think I have changed my practice much for head CTs as compared to the USA.
It is not often that I get emergent ultrasounds (especially after hours) but I will get them if I think they are emergently indicated. After hours, low-risk rule-out ectopics, and rule out DVTs generally come back the next day. Many EDs have ultrasound machines now… but ultrasound is not really considered part of the core curriculum for EPs like it is in the USA. They may actually be amazed by your ultrasound skills… (assuming you have these skills…)