Trans-venous pacing of bradycardia.

Seldinger

This case study involves an elderly gentleman who needed trans-venous pacing. Here is a simple how to. A 65 yo male is brought in by ambulance. They were called as he had a syncopal episode. When they arrived he was bradycardic and had a slightly depressed conscious state. His systolic BP was 60 mmHg and [...]  Read More »

A Case of Valproic Acid Overdose

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The Case We saw quite an interesting toxicology case in the emergency department the other day, which highlights some of the major issues in an increasingly common toxic presentation to departments: valproic acid toxicity.  A 28 year old man presented to ED at about 10am claiming to have taken an overdose of 200 “Epilim” tablets [...]  Read More »

My Rules for Getting the Airway

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There are all these fancy terms out there in respect to airway. There’s apnoeic oxygenation, delayed sequence intubation, the vortex etc….. Let me tell you something, you already know. This stuff has been around in one form or another for a while, but we have discovered its application to emergency medicine only recently. After giving [...]  Read More »

How Big is that Pneumothorax?

Pneumothorax size

Can you easily calculate the size of a pneumothorax? Does the size matter? Calculating the size has been difficult, as it requires formulas we don’t necessarily carry around in our heads; like the figure on the left. In most cases we approximate and say it’s about such and such a percent. I know in many [...]  Read More »

The Deep Sulcus Sign and more.

image from learning radiology

Have you ever had a chest X-ray in someone that might have a pneumothorax, but you couldn’t see it? I know I have. Today I wanted to mention three signs that might help: The first is the Deep Sulcus Sign. This is the more widely known. The other two signs are the Etched Diaphragm and [...]  Read More »

DKA and Cerebral Oedema – Do we really know the cause?

Osmolytes

Cerebral oedema is the most feared complication in children presenting with Diabetic Ketoacidosis (DKA). It occurs in about 1% of cases but has a mortality rate of up to 90% (Waldorf J et al Diabetes Care 2006; 29:1150-9). Patients will have a decreased conscious state and may also have cranial nerve palsies, headache and/or bradycardia [...]  Read More »

The ECG’s of Syncope

Causes of Syncope

I’m not sure about you, but I seem to be seeing more patients with syncope than ever before. This year at EMCORE, I spent over an hour going into the ECG’s of syncope. Syncope is difficult because it is a symptom, not a condition and it’s up to us to find the cause. My approach [...]  Read More »

Delayed Sequence Intubation

Superdoc

There’s been a lot of talk around about Delayed Sequence Intubation and a little bit of confusion about it, so I thought I’d clear up a couple of things. Is there a lot of evidence for it? No- there is very little, but we will see the evidence coming out soon. The current evidence is [...]  Read More »

3 Essential things to do to get the Airway

Obese Patient Positioning

Well, I’m now writting the lectures for the EMCORE Conferences for Hong Kong,  Melbourne and Fiji and I was quite excited about this content and wanted to share some of it with you. Today I wanted to spend a little time talking about one of the three things I’ll be discussing at the EMCORE. This is point 2, of the 3 [...]  Read More »

‘A Doctor’s Touch’

Dr Abraham Verghese

Who are you inspired by in Medicine? My clinical heroes are certainly the classics: William Osler and Hamilton Bailey. Last night whilst working a busy shift, I was reminded(whilst performing a clinical examination on a patient, that gave us the answer to what was wrong, when nothing else made sense) of the power of the [...]  Read More »