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Lateral Canthotomy

When and How to Perform a Lateral Canthotomy A 35 yo woman presents to your rural emergency department. She has recently had eye surgery at a large tertiary centre and has been allowed home. Her presentation to the emergency department is: Increasing Headache Left Eye Pain There is proptosis of the eye Restricted Extra-Occular Eye Movements…

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VT vs SVT with Aberrancy

The following ECG was sent to me recently. It’s a great case and a situation that we can all be faced with. The question is: Is this VT or SVT with Aberrancy? The further question is; What do you do when your treatment isn’t working? An 80 year old male presents feeling unwell with palpitations….

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A 9 year old girl with syncope

The Case A 9 yo girl is brought into the emergency department, following an episode of syncope. She has a current viral illness and looks miserable. She was walking into the Emergency Department with her mother, when she collapsed. She recovered quickly with no post ictal component but also had no memory of the event, although the…

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The Crashing Asthmatic Patient

The Crashing Asthmatic Patient is perhaps one of the most frightening of patients to treat. I’m not talking about the patient that has wheeze and gets five or six nebs and gets better in an hour. I’m talking about the sweaty, drowsy, tiring, non-responsive patient that you know has a good chance of dying. Here…

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Treating Patients on Stimulants

Here is a case, you are probably all familiar with: The police arrive with a patient that was “out of control”. He is known to take illicit substances. He went home earlier today, where he lives with his mother and ‘punched her in the face’, before running off. Police were called and he was later found naked,…

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The ECG of Athletes: Normal variations you must know.

The ECG of the athletes can pose a challenge in distinguishing pathological changes from those physiological changes, that are associated with physical training and cardiac remodelling. We don’t want to erroneously attribute heart disease to those with normal variants and more importantly, we don’t want potentially life threatening cardiac conditions being erroneously dismissed as normal…

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Passing the Fellowship MCQ Exam

How to pass the Fellowship MCQ Exam. That’s the question on everyones lips as we head towards the pointy end of studying for the exam. If you have never sat this exam before, let me tell you, the ACEM Fellowship exam, is a long day, so be rested. 3 hours of SAQ exam and 3…

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Hyponatremia

Hyponatremia is a common electrolyte abnormality. It can be acute or chronic. It can occur in isolation or as part of other disease processes.  Diagnosing its cause can be challenging in the Emergency Department and there may be some confusion over how to initially manage these patients. Let’s clear up that confusion, with a simple…

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Important Studies in Emergency Medicine

Below are some important studies in Emergency Medicine. There certainly are more, however these are the most recent and relevant. More will be added to this page regularly. TRAUMA Sherren PB et al. Algorithm for the resuscitation of traumatic cardiac arrest patients in a physician-staffed helicopter emergency medical service. Critical Care 201317(Suppl 2):P281 The authors here looked…

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Status Epilepticus

Convulsive Status Epilepticus accounts for up to 75% of all status epilepticus(1). We recognise it in patients where they have a depressed conscious state accompanied by tonic clonic movements of the extremities. The length of status epilepticus is important in terms of patient survival. About 5% of adults and up to 25% of children with epilepsy…

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Carotid Artery Dissection

Patients can present to us with a sudden severe headache, also known as a thunderclap headache. Although there are several potential causes of sudden headache(shown below), the main aetiology we try to exclude in the emergency department, is aneurysmal rupture. When we do rule this out, we still need to consider the other possible causes…

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