Unstable Trauma Patient: The Surgeon wants a CT


What if we had a tool that allowed identification of haemorrhage source, in trauma patients with no obvious primary source or with potentially multiple sources of bleeding? Who would gain the most from this?…..The sickest and most unstable patients. Well we do have such a tool!…….It’s the CAT Scanner. Who are the sickest patients? The [...]  Read More »

Clearing the Cervical Spine in Children


This is both a straightforward and an extremely difficult area to write on.  Much of what we do,  in young children is based on our clinical judgement. The evidence on clearing cervical spines, in those older than 18 years, is clear, validated, accepted and is duty of care. The evidence for clearing the C-spine for [...]  Read More »

What’s Holding You Back?

The Thinker

This is not my usual blog and I must admit, a difficult blog to write. Why is it difficult? It’s about the very topic we are discussing. I found it difficult because I thought of what people might say, about an educator and clinician talking about success and what might be holding you back. We [...]  Read More »

Is Bigeminy Benign?

Ventricular Bigeminy

Here is the Case: A 76 yo woman presents to the Emergency Department/ is on the ward/ comes to your rooms, and is complaining of palpitations. She states that they sometimes make her dizzy. You perform an ECG, the rhythm strip is shown below. What do you do? The patient is in Ventricular Bigeminy.Is this [...]  Read More »

Severe Acidosis, Renal Failure and Metformin


THE CASE The call comes in just after midnight. A 67 year old male has been brought to the Emergency Department. He had complained of lower back pain, feeling unwell, with a couple of episodes of vomiting. He arrived in the Emergency Department, aggitated, with the ambulance already having given 370mcg of Fentanyl. His past history [...]  Read More »

Airbag Injuries: Don’t forget the Carotids


CASEA 50 yo woman presents to the Emergency Department following a high speed deceleration injury, where she crashed her car into a tree. The patient complains of severe sternal chest pain, and is finding it hard to breath. The ambulance have given 20mg of Morphine. No other injuries are obvious. Airbags have had a significant [...]  Read More »

Predicting The Fellowship Exam


Every year, I give my predictions of the top questions for the Fellowship Exam. Usually, my hit rate is good. One of my students recently said, “I should have just studied your top 30 list”. I don’t recommend this, but here is another year’s predictions. The predictions are based on: Questions that have been asked [...]  Read More »

Management of DKA in Children

4ts od Type 1 DM

CEREBRAL OEDEMA: DO WE REALLY KNOW THE CAUSE? We recently had a child with DKA in our department and the subject of fluid resuscitation came up. Also the Queensland Government guidelines on the Emergency Management of children with DKA has recently been produced. I thought it was timely to revisit a blog I wrote in [...]  Read More »

Should We Lower BP in Inra-Cerebral Haemorrhage- ATACH-2


Two days after speaking at the EMCORE Conference on blood pressure control in intra-cerebral bleeds the ATACH-2 trial (Antihypertensive Treatment of Acute Cerebral Haemorrhage II) has been published. We know that intra-cerebral bleeds are dynamic, with up to 40% of patients having growth in haemorrhage volume, in the first 3 hours(Stroke 1997:28:1-5). We also know [...]  Read More »

The Penumbra Conundrum

Screen Shot 2016-04-22 at 11.33.21 am

…or How to Control Blood Pressure in Brain Bleeds The scenario is this:A 62 year old male is brought in to your emergency department by ambulance. He has had a sudden onset of headache and has decreased use of left side. His vitals are:GCS 14, HR 92, BP 210/100, Sats 95% on room air. A [...]  Read More »