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 same polarity(is in the same direction) as the preceding T wave(1). It is usually seen in the anterior leads V2-V3. It may be present in normal individuals and is sometimes ignored…… beware. Here is a quick look...
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 old male involved in a high speed motor vehicle accident. He has come off the...
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 anatomy and physiology The sensitivity of the foetus to hypotension and hypoxia. Issues of radiation...
Capnography
Understanding capnography and being able to decipher the waveforms, can give us critical information on a patient’s condition, early. Below are 3 cases, where we look at some of the potential waveforms we might encounter in the intubated patient in the emergency department. What does it tells us? Capnography gives information on: Metabolism: Responsible for the...
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...
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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