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


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


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 »

The Crashing Atrial Fibrillation Patient- Part 2- What inotrope to use?

Frank Starling Curves

Let me remind you of the patient we had in part 1 of this blog. The patient had presented in rapid atrial fibrillation at a rate of 170-180.  His BP was about 60mmHg systolic. Cardioversion was attempted( x 3) with Metaraminol used to support blood pressure, however it was unsuccessful. An Amiodarone infusion was commenced [...]  Read More »

Bilateral Hemianopia in Pregnancy

Screen Shot 2014-02-09 at 4.12.45 pm

Here’s the Case A 31 year old female patient at term P2G1, had noticed tunnel vision whilst watching her children in the garden. Soon after this she developed a bi-temporal headache. No other symptoms were present. The only past medical history was of a hearing impairment and hypertension early in the pregnancy. The clinical examination [...]  Read More »

The Many Faces of Tuberculosis

The many faces of TB

    As many of you who regularly read this blog will know, I have a bit of a thing for TB. I hate it. It offends me. I am frustrated that a disease that was thought to be on its way to eradication a generation ago has fought back and we may soon find [...]  Read More »

Back-stabbing: A case of Brown-Sequard Syndrome

Stab wound to the back

Introduction Brown-Sequard syndrome is one of those cases that we are all aware of, have studied for exams and have pondered the anatomy of, but few have ever seen. First noted by Charles-Édouard Brown-Séquard in 1851 who, despite having some rather eccentric ideas about sexual prowess and the eating of primate testes, was a renowned [...]  Read More »

The Crashing Atrial Fibrillation Patient: Part 1

Crashing Atrial Fibrillation Patient

You know this patient. You’ve probably seen a patient, just like this. They are old, they have rapid atrial fibrillation(AF) and their blood pressure is sinking to their boots. What do you do? Let’s look at a case we had recently. Case An 82 year old male with a past medical history of hypertension and [...]  Read More »