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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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Cerebral Venous Thrombosis

You’ve just seen a patient with sudden onset of headache. They have presented within 6 hours and your super-sliced scanner spits out a normal CT brain. Are you done? You apply shared decision making with your patient and decide against a lumbar puncture. Are you done? Beware the mimics; amongst them cerebral venous thrombosis and…

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Cardiogenic Shock: Which Vasopressor to use

In the patient who presents with cariogenic shock, the cath lab and a stent or a CABG is probably the treatment of choice, however we don’t always have those luxuries. What inotrope(s) do we use in cariogenic shock? How do we approach those patients for the best outcome? Here is a recent case. It is…

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Asymptomatic Cervical Fractures in The Elderly

A new study is about to be published which questions the use of current cervical spine clearance criteria in the elderly(1). It goes further, recommending  “liberal c-spine imaging for older trauma patients with significant mechanism of trauma”. Here is a typical case: 74 year old patient from home, has had a mechanical fall from a…

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BRUE and ALTE

A BRUE is a Brief Resolved Unexplained Event and has somehow replaced the old term of ALTE, allowing us to identify a lower risk group amongst children. It is a ‘consensus’ decision and although appears helpful may not be so. CASE: A 3 month old is brought in by his parents. He had an episode where…

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Syncope

Syncope is one of those conditions you either love or hate. I certainly have at least five presentations of patients with syncope per shift. Having an approach to those patients certainly helps minimise missing the big stuff. Remember that syncope is a symptom and we need to find the diagnosis. The detective work is about…

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Wellen’s Syndrome

Wellen’s Syndrome is one of those syndromes that all emergency physicians know about. It’s probably also one of those syndromes that the emergency community introduced to clinicians everywhere. It was first described as an inverted U wave as early as 1980 and then introduced by Wellen in 1982 as Wellen’s syndrome, the name by which…

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Spodick’s Sign and Pericarditis

Spodick’s Sign appears in Stage I of Pericarditis and is a downsloping of the TP line ie., the baseline. It is said to be present in some 80% of cases of acute pericarditis and is best visualised in lead II and the lateral precordial leads(1).       The ECG findings of pericarditis are important…

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Which Patients with Pulmonary Embolism should get Thrombolysis?

The diagnosis of pulmonary embolism(PE) is an almost common occurrence in the emergency department. The question of which patients to thrombolyse can be a difficult one to answer. Certainly there is consensus over patients with massive PEs needing thrombolysis. The same cannot be said for those patients with a submissive PE, because our greatest fear is…

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