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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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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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