Ciguatera Poisoning


Case:A 60 yo male presents to the emergency department as he has been frightened, by the symptoms he has developed. This morning he had developed some paraesthesia around the mouth He noticed that when he picked up a cold bottle of water it ‘burnt’ his hand. Also when he splashed cold water on his face [...]  Read More »

Flexor Tendon Sheath Infections of The Hand

Flexor Tenosynovitis

Infection of the flexor tendon sheaths of the hand, represents a potential surgical emergency, due to these being closed compartments and swelling can result in necrosis. The same does not tend to occur in extensor tendons as they are open compartments.Infections to the flexor tendon sheath usually occur following a penetrating injury to the hand. [...]  Read More »

Pulmonary Embolism in Patients With Syncope

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HOT OFF THE PRESS Prandoni P et al. Prevalence of Pulmonary Embolism among Patients Hospitalised for Syncope. NEJM 375:16 Oct 20 2016. This is a big study in the NEJM, that a lot of people will pay attention to. The finding in a nutshell, was that Pulmonary Embolism(PE) occurs in 1 in 6 patients hospitalised [...]  Read More »

How Dangerous is Pulmonary Embolism?


The diagnosis of and then management of pulmonary embolism(PE), is like most things in emergency medicine; it’s about risk stratification. In chest pain, the low risk patient is approached very differently to the high risk, ST elevation chest pain patient. It is exactly the same in PE. There is that group of patients who are [...]  Read More »

Amiodarone vs Procainamide for Ventricular Tachycardia


The PROCAMIO Study(1) was recently published. This was a randomised (non-blinded) open labelled study, where 62 haemodynamically stable patients with sustained, monomorphic, Ventricular Tachycardia(VT), were assigned to receive either:(i) intravenous procainamide (single dose 10 mg/kg over 20 min) or (ii) intravenous amiodarone (single dose 5 mg/kg over 20 min). The study period was 40 min [...]  Read More »

Unstable Trauma Patient: The Surgeon wants a CT


What if we had a tool that allowed identification of haemorrhage source, in trauma patients with no obvious primary source or with potentially multiple sources of bleeding? Who would gain the most from this?…..The sickest and most unstable patients. Well we do have such a tool!…….It’s the CAT Scanner. Who are the sickest patients? The [...]  Read More »

Clearing the Cervical Spine in Children


This is both a straightforward and an extremely difficult area to write on.  Much of what we do,  in young children is based on our clinical judgement. The evidence on clearing cervical spines, in those older than 18 years, is clear, validated, accepted and is duty of care. The evidence for clearing the C-spine for [...]  Read More »

What’s Holding You Back?

The Thinker

This is not my usual blog and I must admit, a difficult blog to write. Why is it difficult? It’s about the very topic we are discussing. I found it difficult because I thought of what people might say, about an educator and clinician talking about success and what might be holding you back. We [...]  Read More »

Is Bigeminy Benign?

Ventricular Bigeminy

Here is the Case: A 76 yo woman presents to the Emergency Department/ is on the ward/ comes to your rooms, and is complaining of palpitations. She states that they sometimes make her dizzy. You perform an ECG, the rhythm strip is shown below. What do you do? The patient is in Ventricular Bigeminy.Is this [...]  Read More »

Severe Acidosis, Renal Failure and Metformin


THE CASE The call comes in just after midnight. A 67 year old male has been brought to the Emergency Department. He had complained of lower back pain, feeling unwell, with a couple of episodes of vomiting. He arrived in the Emergency Department, aggitated, with the ambulance already having given 370mcg of Fentanyl. His past history [...]  Read More »