Unstable Pelvic Fractures

Pelvic Fracture

Pelvic fractures are most often associated with massive trauma. In terms of skeletal injuries they account for about 3% of all injuries. However they have the potential to result in haemodynamic instability, leading to significant mortality. Approximately 10 years ago the mortality from multi trauma with pelvic ring disruptions and haemorrhagic shock approached 60% (J [...]  Read More »

Memories of the Fellowship Exam

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We recently had a face to face day for our 6 Month Fellowship Course and the emotions and the feelings and even some of the stress of those days resurfaced in me, as we all sat around the table learning and reviewing key topics like ‘every ECG ever asked’,  ‘every X-ray you could ever see’ [...]  Read More »

The Oculocephalic Reflex

Doll's Eyes

What is the Oculocephalic Reflex and how do you use it? This reflex is brainstem mediated and keeps the eyes looking straight ahead when the head is turned, in an unconscious patient. It’s a test to use on the unconscious patient to see if the brainstem is intact. The best way to remember this is by [...]  Read More »

Pericarditis, BER or STEMI

ST DEPRESSION

A 35 yo male presents with palpitations and pleuritic chest pain. He’s recently had a viral illness but has no other medical history. At 1am in the morning, the patient was woken by palpitations. He now complains of left sided chest pain and dyspnoea. His vitals are normal. This is his ECG: What does he [...]  Read More »

Stylet or Bougie for Intubation

The Stylet

As many of you will know, I’ve been teaching airway workshops now for many years, and have put over 3500 doctors through the Advance Airways Workshop.     I teach equipment in the following way:Your weapon of choice is the size 3 curved blade.Everyone gets a 7.5 tube in the emergency situationAlways use a stylet [...]  Read More »

Hypothermia In Cardiac Arrest In Children

warm-child-in-cold-weather

  Hot of the press this week, a study in the NEJM (25th April 2015) by Moler et al. ‘Hypothermia in Out of Hospital Cardiac Arrest in Children’.  We know that hypothermia works in adults and more recently studies showed that we don’t need to cool patients to extremely low temperatures. In fact it is important [...]  Read More »

Do you rule out DVT with a D-Dimer?

Well's Score

Deep Venous Thrombosis(DVT) occurs in approximately 1-2 per 1000 of the population. Our great concern is not the DVT as such, but the potential for other sequelae, especially a pulmonary embolism. What I see and what I’m also guilty of, on several occasions is that these patients are simply sent to ultrasound and we don’t [...]  Read More »

Pseudo vs real seizure

Seizure

If you’ve worked in the emergency department for a few years, you will have seen a pseudo-seizure and hopefully have picked it. I know I was terrified of these in the early days, as I had trouble making the diagnosis and I had seen neurologists get it wrong. Now, they are a little easier to [...]  Read More »

A New Way to Give Adenosine in SVT

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I’ve been speaking and writing about Supra Ventricular Tachycardia(SVT)  a lot recently. Perhaps because of the number of cases coming in. Someone mentioned a new way to give adenosine for SVT. A recent post on Academic Life in Emergency Medicine, also mentioned this approach.   Traditionally we administer the adenosine in a 6mg  dose via [...]  Read More »

Hip Relocation Made Easy

Hip Relocation

Here is a 3 minute video on the Whistler technique for putting in hips. Its quick and easy and really doesn’t allow you to hurt yourself. You use your legs to give you the traction. Just watch and see. Try it for yourself. I call it the under-over technique: I put my arm UNDER the [...]  Read More »