The ‘Lightbulb Sign’ doesn’t always mean a posterior dislocation
A 35 yo woman presents to the emergency department with a complaint of shoulder dislocation. There is a previous history of multiple dislocations, including two posterior dislocations. There has been no trauma, or seizure or other major force, as might be expected to cause a posterior dislocation, although posterior dislocation can occur in the absence...
The unstable patient with massive PV bleed
The Case It was a quiet Sunday afternoon in a small ED (sounds like the start to a bad story, doesn’t it?) I picked up the next chart…30-year-old, 13/40, light PV bleeding History – otherwise healthy 30 year old, no medications, G2P1, 13/40, light bleeding since yesterday, some cramping low abdominal pain, USS at 10/40...
Will Paramedic-2 change my practice?
If you haven’t caught the newly published Paramedic-2 trial, here’s a brief rant that tells you everything you need to know. The ostensible reason for the publication has been the ongoing debate about the role of adrenaline in cardiac arrest. In fact the very first line of the paper reads “concerns about the use of...
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 journal article was brought to my attention and I thought everyone should hear about it....
A 51 year old with collapse
The case A 51 year old male is brought into ED after collapsing at work. He had been lifting a box of shopping from the floor to a table when he collapsed. A colleague had heard a thud and entered the room to find the patient unresponsive on the floor with what sounds like agonal...
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 initial complete paralysis had lessened somewhat after 2 hrs and he had managed to reach the phone and call for help. When the ambulance service arrived and forced entry he was found on his bed...
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 been hailed as the new treatment. Until January of 2018, trials in this area demonstrated...
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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