In Rapid Sequence Intubation(RSI), there is that period of apnoea that occurs following delivery of paralytics and prior to attempting laryngoscopy and intubation. It’s a period of 40 to 50 seconds, before we attempt to do anything. “Don’t bag!” we often scold. “It’ll fill the stomach and cause regurgitation and aspiration”…… In the background the patient’s saturations...

For years I’ve been speaking about the SIC KID Mnemonic. It’s time to see where we are at in 2017. When was it to be used? To be used as a memory aid in the crying child, where we weren’t sure of the diagnosis. Let me remind you of what the letters stand for: S –...

I’ve spoken on awake intubationat the EMCORE Conferences, especially at the last Masterclass. I also spoke about the potential benefits of intubating patients in the ramped positionie., head of the bed up at 25-30 degrees. Mostly this is based Off studies, using operating theatre patients that have already been intubated, then disconnected from oxygen sources and observed to see how long...

Minimal Handling Stop touching the patient.  Often enough in paediatrics, more is not better. This is of key importance in the younger age group. The more lights/monitors and hands on assessment – the more distressing to the child. The more distress – the greater the effort of breathing becomes.  Most children with wheeze are best...

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...

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...

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...

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...