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Zipper Injuries

This blog is often full of new evidence from high quality trials and literature reviews as well as clinical pearls to help enable us to choose wisely with our sickest patients, usually those in the resus bay. That being said, for most emergency physicians, perhaps up to a third of their clinical time, may be…

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Contrast Induced Nephropathy: Is it Real?

You are managing a trauma and request a CT abdomen to exclude an intra-abdominal injury. The radiology registrar asks about the patients’ renal function. Sound familiar? The good news is that the scan go ahead without knowing the renal function. This is supported by the current guidelines of the Royal Australasian and New Zealand College…

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Fixed Dilated Pupils

Head injury with fixed dilated pupils: Are we done? We have looked at the pupillary response before on this blog in terms of the Doll’s Eye Reflex in brainstem death and the oculocephalic reflex. However, what if the pupils are fixed and dilated? We seem to learn quite early in our medical careers that fixed…

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The Unstable Atrial Fibrillation Patient

THE CASE A 75 yo man is brought into your small rural ED after 3 hours of ischemic chest discomfort.  His background is significant for hypertension, a CVA 5 years ago for which he is on aspirin/dipyrimidole, and 2 coronary artery stents in 1995.  The ambulance officers found the patient to be in AF, with…

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Are You Still Feeling For A Pulse? Stop It!

I remember years ago when we used to manage cardiac arrests and everyone was asked to stop compressions while someone felt for a pulse. Do you remember that? “I think I feel one. I wonder if that’s mine? Can someone else feel please?” Meanwhile time with no CPR passed. Today with the push for cardiocerebral resuscitation…

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Pulseless Electrical Activity

Pulseless Electrical Activity(PEA) occurs in about 30% of cardiac arrest cases. Given that it’s not a shockable rhythm, it has a very poor prognosis, especially when associated with acute myocardial Infarction(MI)(1). More recently, the term pseudo-PEA, is used for those patients where we can’t find an output by feeling for a pulse, but there may in fact be…

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The Cervical Spine: The Iconoclasm Continues

In recent blogs I suggested that clinically significant C spine injuries can be excluded by CT scan in the intoxicated patient and Luke Lawton raised the suggestion that the hard collar may not be as efficacious as we were led to believe in our youth. One of the questions that the C spine blog attracted…

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How Important is a C-Spine Collar….really?

In preparation for EMCORE Hong Kong 2018, I took some time to sit down and revisit how and why we do one of the oldest rituals in trauma medicine – applying a rigid c-collar. I still remember as a junior doctor being taken through the rigorous method of application….measure up properly, hold the head steady,…

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Cervical spine clearance in the intoxicated patient

The most commonly used c spine clearance rules exclude or mandate imaging in the case of the “intoxicated” patient, and there is debate as to whether a normal CT C spine is adequate to clear the neck of the intoxicated patient in blunt trauma.(1,2) Many clinicians advocate either waiting for intoxicants to clear before clinically…

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Postobstructive Diuresis

Postobstructive diuresis can occur following relief of urinary obstruction. It isn’t rare and can be potentially lethal. CASE A 65 year old male presents to the emergency department with a one day history of dysuria. He is diagnosed with a urine infection,  commenced on oral antibiotics and has an appointment made the next day for…

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A patient with nausea, vomiting and lethargy

(Please note this is a free view of this week’s ‘own the ecg‘ blog. Enjoy). A 79 year old man presented to the emergency department with a 2 day history of nausea, vomiting, lethargy and left abdominal pain. He appeared pale, clammy and unwell. His initial observations revealed a pulse of 50/min, BP 170/87, sats of…

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Cyanosis or Something Else?

A 75 year old gentleman presented with acute on chronic abdominal pain. His triage noted that he was “centrally cyanosed, but comfortable” and that his daughter had reassured the concerned triage nurse that his skin was usually that colour and there was nothing to be concerned about. When I called the patient from the waiting…

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