A great question came through the website this week. The question went something like this: “There is confusion around the need to turn off oxygen during defibrillation or cardioversion. I’ve been told by a few FACEMS and Anaesthetists that it’s a myth and there has never been a spark explosion. Is that true?” Just [...] Read More »
I’m giving the talk on vertigo at the EMCORE, however several people have asked, after reading the blog on the HINTS study, for a quick summary of my approach to the patient with dizziness. Here is a very, very quick summary in the form of a 4 minute video. More detail at the conference. My approach [...] Read More »
The patient with acute vestibular syndrome can present a major diagnostic challenge. The patient with dizziness can be a tricky case to diagnose. In my preparation for the ‘Vertigo’ talk I get to give at this year’s EMCORE I came across the HINTS study (Stroke 2009; 40 3504-3510). It’s one you have to read. I have [...] Read More »
OK here it is. The final word in investigating the pregnant patient with suspected pulmonary embolism. Well, it’s my final word anyway. I’ve spent the last month or so reviewing the literature on this. What amazes me, is that two people can quote the same study and come up with a different conclusion. The confusion appears [...] Read More »
I’ve done blogs on early depolarisation and infarction in the past. The story isn’t complete unless we also discuss pericarditis. In acute pericarditis the ST elevation that occurs reflects abnormal repolarization that develops secondary to pericardial inflammation. PR depression is very specific for pericarditis. It is a result of subepicardial injury. PR depression occurs in all leads [...] Read More »
Our obsession with adrenaline continues. We want to prove it works. It must! If it doesn’t what do we have? We’ve been running arrests in this way for the last 50 odd years. If they took adrenaline away, what’s left? I ran a resus two days ago on a patient with refractory pulseless VT. When [...] Read More »
Question 1 A mother brings her 2 year old child into the emergency department. She is distressed at the lesions that have appeared on her childs arms and are now spreading to his torso. They appeared 24 hours ago and are still there. The child is well looking, feeding well with normal vitals. The [...] Read More »
Early repolarization in the right precordial leads(V1-3) occurs in up to 5% of the population (AMJ Med 2003) and is considered as benign. The same repolarization pattern in the inferior leads is not and has been associated with increased arrhythmogenicity ie., ventricular fibrillation. Studies now show that elevation of the J-point in the inferior + lateral [...] Read More »
Patients presenting with sudden onset of headache, must have a subarachnoid haemorrhage(SAH) ruled out. If missed, the potential consequences of a rebleed can be devastating. The warning leak or sentinel headache is a window of opportunity to make the diagnosis. The approach so far, is to perform a non-contrast CT head. If this is normal, then [...] Read More »
Exercise stress testing has been around for some time now. We use it for those low risk patients after exclusion of an AMI. We know the results aren’t great and that the pickup for single vessel disease is very low. In fact the overall sensitivity is about 68% and specificity of 77% (Lee NEJM 2001). [...] Read More »
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