The Penumbra Conundrum

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…or How to Control Blood Pressure in Brain Bleeds The scenario is this:A 62 year old male is brought in to your emergency department by ambulance. He has had a sudden onset of headache and has decreased use of left side. His vitals are:GCS 14, HR 92, BP 210/100, Sats 95% on room air. A [...]  Read More »

5 Things To Help You Get The Airway

endotracheal tube

1. Know When To Intubate It may sound strange, but we should have an approach as to when it’s appropriate to intubate. My choice is when there is failure of ( whether this is now or imminent) of oxygenation and ventilation, maintenance of airway or airway protection. I then also ask the questions:1. Will I [...]  Read More »

Scapholunate Dissociation

Scapholunate dissociation

The typical case is a patient presents with trauma to the wrist and wrist pain. You do an x-ray. What do you think? This is a Scapholunate dissociation, also called rotatory subluxation of the scaphoid and sometimes knows as the Terry Thomas sign. It is a disruption of the scapholunate ligament with resultant instability. The [...]  Read More »

Thoracic Aortic Dissections: 5 things to know to make the diagnosis


CASEA 70 year old man, is brought to the Emergency Department by ambulance. He was drinking a coffee with friends and developed sudden severe chest pain. His past medical history is coronary artery disease and hypertension. He became hypotensive in the ambulance and was in some distress. He has had a bolus of fluid and [...]  Read More »

The ECG of PE


A CASE A 36 yo male presents to the emergency department with sharp central chest pain and shortness of breath. He works as a truck driver. He has no past medical history, is on no medications and normally very well, with no significant family history. An ECG is handed to you. What is the diagnosis? [...]  Read More »

Sudden Headaches in 2016: Let’s start to question


Here I am, in front of a 43 year old female patient who tells me that she had a sudden onset of headache 4 hours ago. It’s like someone hit her on the back of the head. She is not distraught, nor upset, but texting hurriedly on her smartphone. The headache occurred whilst she was [...]  Read More »

More Non-Invasive Ventilation


Following the video, I was asked to briefly again explain in graphical form how I see non-invasive ventilation. This is a very basic view. In terms of Non Invasive Ventilation, we can start by thinking about CPAP (Continuous Positive Air Pressure) Ventilation. We can set this at a minimum of 5cm H20. It provides a [...]  Read More »

Galeazzi Fracture


A young man presents following a dirt bike accident. He has a deformed distal radius clinically and neurovascularly intact. His X-rays are shown. This is the classic Galeazzi fracture. There is a fracture of the distal radius(usually distal third, with dorsal angulation) and a dislocation of the distal radioulnar joint. They can be split into [...]  Read More »

Reflex Sympathetic Dystrophy

Reflex Sympathetic Dystrophy

CASE A 45 year old woman presents with a swollen, red and painful forearm. Her recent past history is that she sustained a forearm fracture 6 weeks ago. Her plaster was removed a week ago. This morning she woke with a swollen, erythematous and painful forearm as in the photo. What is the diagnosis? It [...]  Read More »

Case: Leg Weakness and a Sensory Level


THE CASE A 35yo patient presents with multiple complaints which include: lower abdominal pain retrosternal chest pain lumber back pain and numbness and weakness in both legs This is a previously well patient who no significant history. There were some mild flu-like symptoms in the morning on waking. During the day the patient felt severe [...]  Read More »