The HEART Score for sorting Low Risk Chest Pain Patients

The HEART Score

The patient with chest pain is the most common presentation to Emergency Departments.  And certainly the low risk chest pain patients seem to take up a large degree of our resources, including time, laboratory testing, and follow up.  In the past, we’ve used scoring systems such as TIMI, PURSUIT and GRACE.  These scoring systems have [...]  Read More »

Thromboembolism in the Post-Partum Period


Patients presenting to the Emergency Department with signs or symptoms which might be indicative of a DVT or  pulmonary embolism in the postpartum period are treated with increased suspicion because there is in fact an increased risk. HOW LONG DOES THIS INCREASED RISK LAST FOR? The postpartum period is defined as 6 weeks following delivery.  [...]  Read More »

Chest Pain: How Sure Are We at Predicting?


Here’s a scary problem …. If I was a paramedic, not an emergency physician with all my resus cubicles, serial troponins and all the serum rhubarbs I could order and I was called out to see someone with chest pain, who would I take to the ED and who would I leave? The answer is [...]  Read More »

Priapism: How To Treat It.

I can fix it.

CASEA 46 year old man presented to our ED mid morning complaining of a persistent erection since 10pm the night before, when he had injected 20ml of alprostadil (“Caverject”) into his penis. He had not experienced any detumescence, and was quite distressed. We all know the solution to the problem – just drain the corpus [...]  Read More »

Pigbel, Clostridial Enteritis Necrotans, Much Nastier than C diff Diarrhoea

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Case: On 1st May 2014 a 6 year old male was brought to a remote clinic in the Papua New Guinea Highlands from a very remote village. In the preceding 3 hours he had experienced “more than 6” episodes of copious black diarrhoea tainted with blood and one episode of bloody, dark vomit. He had [...]  Read More »

Trans-venous pacing of bradycardia.


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 »