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...
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 year old chef who woke up at 6am unable to speak or move the right...
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 adrenaline which initially came from canine models, was introduced at this time and has been...
Intraosseous Access Results In Decreased Survival In Cardiac Arrest
A new study shows a decreased survival in out of hospital cardiac arrest(OHCA) when intraosseous(I/O) access is used instead if intravenous(IV) access as a means of delivering fluids and medications. I/O lines provide rapid access where IV is not available and are progressively being used as the first line of access, primarily because they are quick, easy, don’t interfere...
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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