Doll’s Eyes and Brainstem Stroke

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Here’s the case: An 80 year old male is brought in by ambulance. GCS = 3, spontaneously breathing, laryngeal mask in place. Normally well man, past medical history of diabetes and hypertension. Following dinner that evening, his wife heard him call out. He said he couldn’t see and then lost consciousness. According to the ambulance, when [...]  Read More »

Clinical Pearl- Hypertrophic Cardiomyopathy

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A 24 year old male presents following a syncopal episode. On cardiovascular examination you believe there is a systolic murmur. Given his history and a family history of his father having a ‘large’ heart, you are suspicious of cardiomyopathy. How can you assess on clinical examination if the murmur is that of cardiomyopathy? I know [...]  Read More »

Christmas and Ralph Waldo Emerson

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As I sit here after a fantastic Christmas Day and I think of all the things I’m grateful for in this last 12 months, I write to thank you all for your continued commitment to excellence and learning. I thank you for the opportunity to teach and for the time you give to read the [...]  Read More »

Supracondylar Fracture

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Hi everyone. I wanted to spend a few moments on supracondylar fractures in children as this is one fracture that seems to be missed, when it’s not obvious and when first reading the Xray. It’s actually a pretty straightforward view of the elbow joint. The only catch is that the elbow must be at right [...]  Read More »

The Slam Dunk ECG!

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Hi all. This is a case from a few days ago. I loved it, as it was one of those slam dunk diagnosis, even when everything looked normal, thanks to the ECG. A 63 year old woman presents with sudden onset of shortness of breath. It began, whilst she was in the supermarket, shopping. The [...]  Read More »

Where’s the lesion?

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Good clinical examination is so important in what we do. I say, just have a look, sometimes you’ll be surprised what you pick up. In this month’s NEJM‘s image challenge, this image was presented. Where is the lesion?   Is it: (a) Left facial nerve (b) Left glossopharyngeal nerve (c) Left hypoglossal nerve (d) Right [...]  Read More »

Video Laryngoscopy- let’s get out of the dark ages!

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I recently ran another of our Advanced Airway Workshops at ACEM’s 2011 ASM and invited the guys from Verathon, to bring in the Glidescope and let people have a play with it. I hope they will be at our June Airway workshop in 2012 as part of the EM CORE Conference. ( I have no [...]  Read More »

Left Ventricular Hypertrophy

Left Ventricular Hypertrophy(LVH) can cause all sorts of problems in terms of ECG diagnosis. There is a straightforward and simple approach to diagnosing it. Here is the ECG in 20 Seconds Approach. The criteria for diagnosing LVH are very specific(>90%) but not sensitive(50%). That means that if the criteria are met, it’s probably there. If [...]  Read More »

2 new studies to look out for – ‘CIRC’ and ‘ARCTIC’

STUDY 1 : THE CIRC TRIAL This is a Zoll funded study that looks at Zoll’s ‘autopulse’. I reviewed the autopulse back in 2007. The study commenced in 2007 and had a total of 4231 patients recruited. The results were just presented at the American Heart Association’s, Resuscitation Science Symposium. The results reported, were that [...]  Read More »

Guidelines Schmidelines – how do i apply them?

Hi everyone.  Just finished a great week at the ASM 2011 conference in Sydney. Thanks to all the people that came up and said “hi”. One of the talks I gave was on “Guidelines Schmidelines”. A lot of people came up after the talk and asked if I could write it up. So here it [...]  Read More »