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The 6 Human Needs

As part of a talk on ‘Dealing with Difficult People’, I gave at EMCORE Hong Kong this year, I spoke about the 6 Human Needs and how they determine behaviour. This was all in the context of dealing with difficult colleagues and the potential psychopathic behaviour we sometimes see. The key here was that, although their behaviour is…

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Should we bring Bretylium back in cardiac arrest?

Following a brief presentation at EMCore Hong Kong in April of this year, that challenged our thinking, I have asked our expert colleague, Dr Will Davies, to expand on an argument he put forward, (in our clinical topics series), that we should revisit the use of bretylium tosylate in cardiopulmonary resuscitation, especially in the treatment of…

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Upright T wave in V1

A 65 year old woman presents with a 20 minute episode of chest pain. Her ECG is shown below. Are there any concerning features for ischaemia? Significance of an upright T wave in V1 Normally the T wave is inverted or flat in lead V1. An upright T wave in V1 may be considered a…

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Syncope in Children

Syncope is not uncommon, occurring in up to 25% of children. Most causes are benign, however we need to be aware of the of 3 major groups as these can be very serious diagnoses: Those with a cardiac cause Those with a neurological cause Very young children, as syncope shouldn’t occur in this group. Making…

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Smith’s Fracture Diagnosis and Management

Smith's Fracture

A 15 yo male with a Smith’s Fracture. The patient had fallen onto his flexed left wrist during a football match. There were no other injuries, however there was a history of a right sided wrist fracture in the recent past. On examination, the wrist appeared deformed in a classic ‘garden spade shape’, however the patient…

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Apnoeic Oxygenation in Resuscitation: Is it time?

We are finally seeing the years of airway in resuscitation dogma being challenged. The original approach to airway which mandated intubation and probably led to significant delays in CPR and an increase in mortality, are now gone. Bag-valve-mask vs supraglottic vs intubation The literature that compares intubation, laryngeal mask(LMA) and bag valve mask(BVM) has given…

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Head-Up CPR

You may have heard of Head-Up CPR as a new approach to patient positioning during CPR. It may not be totally prime-time yet(although it is being used right now), but it is, thinking outside the box and concentrating on the most important part of what cardiac resuscitation is about…. saving the brain. If we go…

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Phlegmasia Cerulean Dolens

CASE A 35 yo woman presents with a painful blue swollen leg, that occurred rapidly, the evening before. There is little relevant past history and the patient is on the oral contraceptive pill. Examination reveals a dusky, blue left leg, that is swollen in comparison to the other side. Pulses are present and the patient in neurologically…

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Resuscitation:The Outer limits

Resuscitation is reaching new limits, with new techniques and technologies giving results that we never thought possible. In Lazarus-like fashion, patients that a few years ago, would have been pronounced deceased, are now leaving hospital to resume their lives, with their families and their work and with very little, if any, deficit. About 8 years ago I…

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The ‘Lightbulb Sign’ doesn’t always mean a posterior dislocation

A 35 yo woman presents to the emergency department with a complaint of shoulder dislocation. There is a previous history of multiple dislocations, including two posterior dislocations. There has been no trauma, or seizure or other major force, as might be expected to cause a posterior dislocation, although posterior dislocation can occur in the absence…

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Will Paramedic-2 change my practice?

If you haven’t caught the newly published Paramedic-2  trial, here’s a brief rant that tells you everything you need to know. The ostensible reason for the publication has been the ongoing debate about the role of adrenaline in cardiac arrest. In fact the very first line of the paper reads “concerns about the use of…

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