The 6 Human Needs
As part of a talk on ‘Dealing with Difficult People’, I gave at EMCORE Hong Kong this year, I spoke about the 6 Human Needs and how they determine behaviour. This was all in the context of dealing with difficult colleagues and the potential psychopathic behaviour we sometimes see. The key here was that, although their behaviour is...
Should we bring Bretylium back in cardiac arrest?
Following a brief presentation at EMCore Hong Kong in April of this year, that challenged our thinking, I have asked our expert colleague, Dr Will Davies, to expand on an argument he put forward, (in our clinical topics series), that we should revisit the use of bretylium tosylate in cardiopulmonary resuscitation, especially in the treatment of...
Upright T wave in V1
A 65 year old woman presents with a 20 minute episode of chest pain. Her ECG is shown below. Are there any concerning features for ischaemia? Significance of an upright T wave in V1 Normally the T wave is inverted or flat in lead V1. An upright T wave in V1 may be considered a...
Syncope in Children
Syncope is not uncommon, occurring in up to 25% of children. Most causes are benign, however we need to be aware of the of 3 major groups as these can be very serious diagnoses: Those with a cardiac cause Those with a neurological cause Very young children, as syncope shouldn’t occur in this group. Making...
Smith’s Fracture Diagnosis and Management
A 15 yo male with a Smith’s Fracture. The patient had fallen onto his flexed left wrist during a football match. There were no other injuries, however there was a history of a right sided wrist fracture in the recent past. On examination, the wrist appeared deformed in a classic ‘garden spade shape’, however the patient...
Apnoeic Oxygenation in Resuscitation: Is it time?
We are finally seeing the years of airway in resuscitation dogma being challenged. The original approach to airway which mandated intubation and probably led to significant delays in CPR and an increase in mortality, are now gone. Bag-valve-mask vs supraglottic vs intubation The literature that compares intubation, laryngeal mask(LMA) and bag valve mask(BVM) has given...
Head-Up CPR
You may have heard of Head-Up CPR as a new approach to patient positioning during CPR. It may not be totally prime-time yet(although it is being used right now), but it is, thinking outside the box and concentrating on the most important part of what cardiac resuscitation is about…. saving the brain. If we go...
How long do we have, to pick up that an ECG is abnormal? Usually it’s about 20 seconds. I developed ‘The ECG in 20 Seconds Approach‘, a simple method, to help you read ECG’s.
Head Thrust Test
In a patient with rotational vertigo and nystagmus, where we suspect, or wish to prove a peripheral lesion, this test is of assistance. It relies on the vestibulo-occular reflex, which is responsible for bringing the eyes back to the centre.
In unilateral nystagmus and rotational vertigo, the peripheral lesion is opposite to the direction of the fast nystagmus. When the head is turned towards the lesion, the eyes move with the head, for a brief moment and the vestibular-occular reflex then returns them to the centre. If this occurs it is a positive test indicating a peripheral cause.
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