Beware the ECG mimic


You have a patient in the emergency department with a history of high fevers and cough. He is initially, very dehydrated, tachycardia and hypoxic on room air. The nurse calls you and says that the patient is going into ventricular tachycardia(VT). His ECG is as below.What do you do now? Scroll down for the answer… [...]  Read More »


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It occurs in about 0.3% of the population (1), although this is an underestimate, as evidence of pre-excitation on the ECG my be transient.  The characteristic delta wave indicates that the accessory pathway conducts faster than the Atrioventricular (AV) node, thus resulting in pre-excitation. However, the refractory period of the accessory pathway may change meaning [...]  Read More »

The New Paracetamol Guidelines

Paracetamol guidelines

We have an update on the Management of Paracetamol Poisonings (MJA 203(5). 7 September 2015) (last update was in 2008) and it covers six main areas: Risk Assessment Charcoal Use Modified Release Paracetamol Large/Massive Ingestions Liquid paracetamol in children less than 6 years old. Consulting a Liver Transplant Unit Some Notes: In children less than 6 [...]  Read More »

Effectiveness of Apnoeic Oxygenation Questioned

Apnoeic oxygenation might not work

Everyone knows I’m a huge fan of apnoeic oxygenation. I use it for sedation, for intubation, heck I sprinkle some on my cereal in the morning. But here is a study published this week, whose conclusions do not support the use apnoeic oxygenation during endotracheal intubation of critically ill adults.Semler et al of the Fellow investigators [...]  Read More »

Difficult Airway Cases: What would you do?

Neck CT

Airway management is frightening, especially if you don’t do it often. Having a plan when we approach an airway is important. My plan involves: Maximising oxygenation with apnoea oxygenation Using the right drugs Performing epiglottoscopy, rather than looking for the cords Having a fallback plan. For me this means thinking about the 3 elements that [...]  Read More »

A New way to perform Valsalva for Supraventricular Tachycardia(SVT)


Last month, August 25th, the REVERT Trial was published in the LANCET. This study used a slight modification on the classic Valsalva manoeuvre, to more than DOUBLE the reversion rate from SVT. I’m excited about this. I don’t like giving drugs to patients if I don’t have to. Until Now… The normal cardioversion rates in [...]  Read More »

Roc Rocks, I’ll miss you Sux


Rocuronium vs Suxamethonium(Succinylcholine) I remember teaching the Advanced Airway Workshop and having one slide with “SUX is KING”. Times have changed!Which is the better paralytic agent to use in the Emergency Department; Suxamethonium(Succinylcholine for our US colleagues) or Rocuronium? This argument has been ongoing for some time, with debates, podcasts and written reviews by proponents [...]  Read More »

De Winter’s T waves

De Winter's T waves

De Winters T Waves were first described by the author in an article to the editor of the New England Journal of Medicine(1) in 2008. They are considered an ST-elevation myocardial infarction(STEMI) equivalent and a myocardial infarction can be missed in a patient as they do not have the classic ST-elevation appearance..   Using ECG’s [...]  Read More »

Unstable Pelvic Fractures

Pelvic Fracture

Pelvic fractures are most often associated with massive trauma. In terms of skeletal injuries they account for about 3% of all injuries. However they have the potential to result in haemodynamic instability, leading to significant mortality. Approximately 10 years ago the mortality from multi trauma with pelvic ring disruptions and haemorrhagic shock approached 60% (J [...]  Read More »

Memories of the Fellowship Exam

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We recently had a face to face day for our 6 Month Fellowship Course and the emotions and the feelings and even some of the stress of those days resurfaced in me, as we all sat around the table learning and reviewing key topics like ‘every ECG ever asked’,  ‘every X-ray you could ever see’ [...]  Read More »