Roc Rocks, I’ll miss you Sux


Rocuronium vs Suxamethonium(Succinylcholine) I remember teaching the Advanced Airway Workshop and having one slide with “SUX is KING”. Times have changed!Which is the better paralytic agent to use in the Emergency Department; Suxamethonium(Succinylcholine for our US colleagues) or Rocuronium? This argument has been ongoing for some time, with debates, podcasts and written reviews by proponents [...]  Read More »

De Winter’s T waves

De Winter's T waves

De Winters T Waves were first described by the author in an article to the editor of the New England Journal of Medicine(1) in 2008. They are considered an ST-elevation myocardial infarction(STEMI) equivalent and a myocardial infarction can be missed in a patient as they do not have the classic ST-elevation appearance..   Using ECG’s [...]  Read More »

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

Screen Shot 2015-06-18 at 4.01.11 pm

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


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


  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


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 »