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Hypertensive Emergencies and how to treat them
Hypertensive emergencies are defined as sudden and prolonged increases in the arterial blood pressure, with associated organ damage. The degree...
The U wave and the ECG: Don’t miss this
The U wave is an often ignored deflection on the ECG. It is usually < 1mm, upright and has the...
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? Source: The west journal of EM 18(4):601-606 · June 2017(1) Significance of an upright...
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...
Using Adrenaline the right way in Cardiac Resuscitation
ADRENALINE AND CARDIAC RESUSCITATION How much to use, when to use it and when not to use it. The resuscitation guidelines were born in the black-and-white television era, at the end of the 1950's. The use of 1 mg of...
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The U wave and the ECG: Don’t miss this
The U wave is an often ignored deflection on the ECG. It is usually < 1mm, upright and has the...
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...
Syncope in Children
Syncope is not uncommon, occurring in up to 25% of children. Most causes are benign, however we need to be...
Using Adrenaline the right way in Cardiac Resuscitation
ADRENALINE AND CARDIAC RESUSCITATION How much to use, when to use it and when not to use it. The resuscitation...
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Get notified on all upcoming Conferences PLUS our Webcasts, Education Newsletters, and more!
Honey for Button Battery Ingestion?
A 25-year-old patient presents with recurrent lithium button battery ingestion. She had been admitted with the same presentation 3 week...
Why are we still doing log roll, FAST and rectal exams?
In the blunt trauma patient, where we are considering a pan-scan, is there a role for the log roll, the FAST scan or the rectal examination any more? Case The ambulance phone rings: “ETA 15 minutes. We have a 25 year...
Pregnancy and Trauma
Trauma in pregnancy is a much more complex topic than simply, ’tilt them on their side’. Trauma in the obstetric patient is a leading cause of non-obstetric mortality. The complexity of the obstetric trauma scenario relates to: Alterations in maternal...
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...
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Honey for Button Battery Ingestion?
A 25-year-old patient presents with recurrent lithium button battery ingestion. She had been admitted with the same presentation 3 week...
Why are we still doing log roll, FAST and rectal exams?
In the blunt trauma patient, where we are considering a pan-scan, is there a role for the log roll, the FAST...
Pregnancy and Trauma
Trauma in pregnancy is a much more complex topic than simply, ’tilt them on their side’. Trauma in the obstetric...
Fixed Dilated Pupils
Head injury with fixed dilated pupils: Are we done? We have looked at the pupillary response before on this blog...
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Phenytoin and Levetiracetam: EcLIPSE and ConSEPT trials
There has been a longstanding discussion over which is the best second-line agent to use in paediatric seizures and more...
The Patient with Diplopia
A 58 yo male presents to the emergency department with an 8 hour history of diplopia. He has no past medical history, has no allergies and is on no medications. He denies any recent illness or trauma. Recently a great...
A new DAWN for stroke treatment
Last week we looked at a case study involving a patient who awoke with stroke symptoms. In these cases there has been little to offer patients. Thrombolysis has no application here, given its 3-4 hour window. Endovascular mechanical thrombectomy has...
MCA Stroke management. It’s time for a rethink
Dealing with acute major vessel occlusion stroke in a peripheral hospital setting is not what it used to be. Nor should it be! This is a recent case from one of the team. This is a case of a 55...
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Phenytoin and Levetiracetam: EcLIPSE and ConSEPT trials
There has been a longstanding discussion over which is the best second-line agent to use in paediatric seizures and more...
The Patient with Diplopia
A 58 yo male presents to the emergency department with an 8 hour history of diplopia. He has no past...
A new DAWN for stroke treatment
Last week we looked at a case study involving a patient who awoke with stroke symptoms. In these cases there...
MCA Stroke management. It’s time for a rethink
Dealing with acute major vessel occlusion stroke in a peripheral hospital setting is not what it used to be. Nor...
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Get notified on all upcoming Conferences PLUS our Webcasts, Education Newsletters, and more!
A new DAWN for stroke treatment
Last week we looked at a case study involving a patient who awoke with stroke symptoms. In these cases there...
BP Control in Intracerebral Bleeds
A/Prof Peter Kas looks at the topic, of how tightly we must control the blood pressure intracranial bleeds.
Not SAH: Are We Done?
A/Prof Peter Kas looks at the patient who has presented with sudden onset of headache and you have ruled out subarachnoid haemorrhage. He asks the question “Are We Done?” The answer is no. Watch to see the other diagnosis, that...
Status Epilepticus: Get the Ketamine
A/Prof Peter Kas looks at the status and refractory as well as super refractory status epilepticus. He covers traditional therapy, talks about efficacy and also discusses the new found use for Ketamine in these patients.
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Get notified on all upcoming Conferences PLUS our Webcasts, Education Newsletters, and more!
A new DAWN for stroke treatment
Last week we looked at a case study involving a patient who awoke with stroke symptoms. In these cases there...
BP Control in Intracerebral Bleeds
A/Prof Peter Kas looks at the topic, of how tightly we must control the blood pressure intracranial bleeds.
Not SAH: Are We Done?
A/Prof Peter Kas looks at the patient who has presented with sudden onset of headache and you have ruled out...
Status Epilepticus: Get the Ketamine
A/Prof Peter Kas looks at the status and refractory as well as super refractory status epilepticus. He covers traditional therapy,...
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Get notified on all upcoming Conferences PLUS our Webcasts, Education Newsletters, and more!
5 Things to Think About in a Wheezy Child
Minimal Handling Stop touching the patient. Often enough in paediatrics, more is not better. This is of key importance in...
The Crashing Asthmatic Patient
The Crashing Asthmatic Patient is perhaps one of the most frightening of patients to treat. I'm not talking about the patient that has wheeze and gets five or six nebs and gets better in an hour. I'm talking about the...
Which Patients with Pulmonary Embolism should get Thrombolysis?
The diagnosis of pulmonary embolism(PE) is an almost common occurrence in the emergency department. The question of which patients to thrombolyse can be a difficult one to answer. Certainly there is consensus over patients with massive PEs needing thrombolysis. The same...
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5 Things to Think About in a Wheezy Child
Minimal Handling Stop touching the patient. Often enough in paediatrics, more is not better. This is of key importance in...
The Crashing Asthmatic Patient
The Crashing Asthmatic Patient is perhaps one of the most frightening of patients to treat. I'm not talking about the...
Which Patients with Pulmonary Embolism should get Thrombolysis?
The diagnosis of pulmonary embolism(PE) is an almost common occurrence in the emergency department. The question of which patients to thrombolyse...
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Get notified on all upcoming Conferences PLUS our Webcasts, Education Newsletters, and more!
A 29 yo male with sudden onset of flaccid paralysis
The Case A Previously well 29 year old male awoke at 0630hrs unable to move his torso or limbs. His...
Hyponatremia
Hyponatremia is a common electrolyte abnormality. It can be acute or chronic. It can occur in isolation or as part of other disease processes. Diagnosing its cause can be challenging in the Emergency Department and there may be some confusion...
Diabetic Ketoacidosis in Children: Management
CEREBRAL OEDEMA: DO WE REALLY KNOW THE CAUSE? We recently had a child with (diabetic ketoacidosis)DKA in our department and the subject of fluid resuscitation came up. Also the Queensland Government guidelines on the Emergency Management of children with DKA...
DKA and Cerebral Oedema – Do we really know the cause?
Cerebral oedema is the most feared complication in children presenting with Diabetic Ketoacidosis (DKA). It occurs in about 1% of cases but has a mortality rate of up to 90% (Waldorf J et al Diabetes Care 2006; 29:1150-9). Patients will...
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A 29 yo male with sudden onset of flaccid paralysis
The Case A Previously well 29 year old male awoke at 0630hrs unable to move his torso or limbs. His...
Hyponatremia
Hyponatremia is a common electrolyte abnormality. It can be acute or chronic. It can occur in isolation or as part...
Diabetic Ketoacidosis in Children: Management
CEREBRAL OEDEMA: DO WE REALLY KNOW THE CAUSE? We recently had a child with (diabetic ketoacidosis)DKA in our department and...
DKA and Cerebral Oedema – Do we really know the cause?
Cerebral oedema is the most feared complication in children presenting with Diabetic Ketoacidosis (DKA). It occurs in about 1% 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,...
Massive Propranolol Overdose
Massive propranolol overdose is perhaps one of the most challenging overdoses to manage. In 2009 we posted a case we had. We have progressed in our management since then. CASE A 26 yo woman is brought to the ED by...
A Man Walks Into a Hole.
We often start with a case and talk about a single topic. This case is a little different. It is a real-time case. What would you do with this patient every step along the way? In real life, things are...
Treating Patients on Stimulants
Here is a case, you are probably all familiar with: The police arrive with a patient that was "out of control". He is known to take illicit substances. He went home earlier today, where he lives with his mother and 'punched...
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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,...
Massive Propranolol Overdose
Massive propranolol overdose is perhaps one of the most challenging overdoses to manage. In 2009 we posted a case we...
A Man Walks Into a Hole.
We often start with a case and talk about a single topic. This case is a little different. It is...
Treating Patients on Stimulants
Here is a case, you are probably all familiar with: The police arrive with a patient that was "out of...
Subscribe for FREE regular updates in your inbox.
Get notified on all upcoming Conferences PLUS our Webcasts, Education Newsletters, and more!
Ciguatera Toxicity and Allodynia
The Case: A 60 yo male presents to the emergency department with Ciguatera Toxicity. He is frightened by the symptoms...
Snake Bite
This year at EMCORE 30-31st May, we are proud to have Dr Ken Winkel, Toxicologist and Director of the Australian Venom Research Unit at the University of Melbourne, talking about cold blooded bites. Here is a recent article by Dr Winkel...
Box Jellyfish stings: To vinegar or not?
The call came: a case of Box Jellyfish(Chironex fleckeri) envenomation in a young girl and her father. The father was stable and pain was under control, however the daughter had such significant pain that, anti-venom had to be used. The wound had...
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Get notified on all upcoming Conferences PLUS our Webcasts, Education Newsletters, and more!
Ciguatera Toxicity and Allodynia
The Case: A 60 yo male presents to the emergency department with Ciguatera Toxicity. He is frightened by the symptoms...
Snake Bite
This year at EMCORE 30-31st May, we are proud to have Dr Ken Winkel, Toxicologist and Director of the Australian...
Box Jellyfish stings: To vinegar or not?
The call came: a case of Box Jellyfish(Chironex fleckeri) envenomation in a young girl and her father. The father was stable and...
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Get notified on all upcoming Conferences PLUS our Webcasts, Education Newsletters, and more!
The man with the croaky voice
A 42 year old male presents following having been punched to the throat. He is sitting comfortably in a chair,...
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The man with the croaky voice
A 42 year old male presents following having been punched to the throat. He is sitting comfortably in a chair,...
Subscribe for FREE regular updates in your inbox.
Get notified on all upcoming Conferences PLUS our Webcasts, Education Newsletters, and more!
The man with the croaky voice
A 42 year old male presents following having been punched to the throat. He is sitting comfortably in a chair,...
Subscribe for FREE regular updates in your inbox.
Get notified on all upcoming Conferences PLUS our Webcasts, Education Newsletters, and more!
The man with the croaky voice
A 42 year old male presents following having been punched to the throat. He is sitting comfortably in a chair,...
Subscribe for FREE regular updates in your inbox.
Get notified on all upcoming Conferences PLUS our Webcasts, Education Newsletters, and more!
Lateral Canthotomy
When and How to Perform a Lateral Canthotomy A 35 yo woman presents to your rural emergency department. She has recently...
Aschner Phenomenon in Traumatic Enucleation of the Eye
Introduction Aschner phenomenon or oculocardiac reflex is characterised by an episode of dramatic bradycardia following manipulation of extra-ocular muscles or dramatically raised intraocular pressure. The phenomenon was first described by Aschner and independently by Dagnini in 1908 (1,2). The phenomenon...
The Relative Afferent Pupillary Defect
This is an important part of the neurological examination of the eye. The Relative Afferent Pupillary Defect (RAPD), is also called the Marcus Gunn pupil, after the ophthalmologist that described the defect in 1883. The sign causes much confusion, but...
Sudden visual loss
Sudden loss of vision is a potentially disastrous event. It is stressful, in fact, may be significantly debilitating for the patient. But it can also change your ‘state’, as a doctor. Especially if you don’t see this often……..and none of...
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Lateral Canthotomy
When and How to Perform a Lateral Canthotomy A 35 yo woman presents to your rural emergency department. She has recently...