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Is SVT an ischaemic arrhythmia?

We often see patients presenting with SVT. They often have ST changes, so we have to ask; Is SVT an…

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resus founder: dr. peter kas

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Clinical Topics

Is SVT an ischaemic arrhythmia?

We often see patients presenting with SVT. They often have ST changes, so we have to ask; Is SVT an...

Dextrocardia: Can you pick it on ECG?

This is a great case that highlights how important it is, to know how to check if your ECG lead placement is correct. It also includes a rare case of dextrocardia. CASE A 39 yo male presented to the Emergency...

An Ominous ECG Sign

This is a fantastic case to learn from for a recent Circulation article(1) titled 'An Ominous ECG Sign in Critical Care'. THE CASE A 35 year old woman, who is a known intravenous drug user, is admitted with septic shock...

Double Sequential External Defibrillation for Atrial Fibrillation

We know that Double Sequential(DSED) External Defibrillation has been used primarily for the treatment of resistant ventricular arrhythmias. Here is a case study proposing its use in refractory atrial fibrillation(1) The case discussed is of a 56 year old patient...

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Is SVT an ischaemic arrhythmia?

We often see patients presenting with SVT. They often have ST changes, so we have to ask; Is SVT an...

Dextrocardia: Can you pick it on ECG?

This is a great case that highlights how important it is, to know how to check if your ECG lead...

An Ominous ECG Sign

This is a fantastic case to learn from for a recent Circulation article(1) titled 'An Ominous ECG Sign in Critical...

Double Sequential External Defibrillation for Atrial Fibrillation

We know that Double Sequential(DSED) External Defibrillation has been used primarily for the treatment of resistant ventricular arrhythmias. Here is...

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Tranexamic Acid: Did We Find Another Use?

Tranexamic Acid: Did we find another Use? So, picture a case. A 45 year old man presents to your Ed...

CRASH-3 Trial

The CRASH-3 Trial has been published. CRASH-2 demonstrated that early administration of tranexamic acid(within 3 hours of injury) reduced bleeding deaths by one third(1). In CRASH-3, the investigators looked at the effects of tranexamic acid in patients with potential traumatic...

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 before and had undergone urgent endoscopic removal of the button battery. It was noted on the operation note, that the...

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...

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Tranexamic Acid: Did We Find Another Use?

Tranexamic Acid: Did we find another Use? So, picture a case. A 45 year old man presents to your Ed...

CRASH-3 Trial

The CRASH-3 Trial has been published. CRASH-2 demonstrated that early administration of tranexamic acid(within 3 hours of injury) reduced bleeding...

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...

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Transient Ischaemic Attack

A recent clinical practice article in the NEJM(1) on Transient Ischaemic Attack (TIA) gave a nice summary of this topic....

Diplopia

A patient presenting to the Emergency Department with diplopia can be a diagnostic challenge. Which patients need urgent imaging and which patients can be referred to outpatients? What is the imaging of choice? A recommended approach is shown below(1): As...

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 specifically in convulsive status epilepticus. We now have two trials that have tried to answer this question by comparing Phenytoin...

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...

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Transient Ischaemic Attack

A recent clinical practice article in the NEJM(1) on Transient Ischaemic Attack (TIA) gave a nice summary of this topic....

Diplopia

A patient presenting to the Emergency Department with diplopia can be a diagnostic challenge. Which patients need urgent imaging and...

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...

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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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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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Guidelines for the Diagnosis and Management of DVT and PE

This is a review of the updated guidelines on Diagnosis and Management of DVT and PE, which were released in...

Let’s MacGyver some equipment for COVID-19

We all remember MacGyver. He'd had a toothpick and a piece of thread and voila, he's create a rocket launcher out of it. Far-fetched and fun. Well there are a lot of very clever and inventive Critical Care docs out...

How to Read the CTPA

CTPA's are sometimes quite confusing to read. A simple approach, based on differentiating the anatomy is the approach to take. Below Dr Kas takes us through the reading of the CTPA. https://vimeo.com/313498557

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 younger age group. The more lights/monitors and hands on assessment – the more distressing to the child. The more...

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Guidelines for the Diagnosis and Management of DVT and PE

This is a review of the updated guidelines on Diagnosis and Management of DVT and PE, which were released in...

Let’s MacGyver some equipment for COVID-19

We all remember MacGyver. He'd had a toothpick and a piece of thread and voila, he's create a rocket launcher...

How to Read the CTPA

CTPA's are sometimes quite confusing to read. A simple approach, based on differentiating the anatomy is the approach to take....

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...

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  • We respect your privacy
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Thyrotoxicosis

A 50 year old female presented to the emergency department with anxiety, palpitations and feeling generally unwell.  She had no...

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...

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...

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Thyrotoxicosis

A 50 year old female presented to the emergency department with anxiety, palpitations and feeling generally unwell.  She had no...

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...

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I’ve Got this ‘Nanging’ feeling: Nitrous Oxide Abuse

'Nanging' is the recreational use of nitrous oxide. That cylinder you have in your emergency department and use for some...

Cyanosis or Something Else?

A 75 year old gentleman presented with acute on chronic abdominal pain. His triage noted that he was “centrally cyanosed, but comfortable” and that his daughter had reassured the concerned triage nurse that his skin was usually that colour and...

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...

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I’ve Got this ‘Nanging’ feeling: Nitrous Oxide Abuse

'Nanging' is the recreational use of nitrous oxide. That cylinder you have in your emergency department and use for some...

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...

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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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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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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,...

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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,...

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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,...

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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...

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...

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...

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...

Sudden visual loss

Sudden loss of vision is a potentially disastrous event. It is stressful, in fact, may be significantly debilitating for the...

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  • We respect your privacy
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Compartment Syndrome

Compartment Syndrome, is usually straightforward to pick up. How do we measure Compartment pressures? Below is a MacGyver setup. CASE...

Gilula’s Carpal Arcs

Gilula's carpal arcs are used to determine carpal alignment. They can assist in identifying ligamentous injury, dislocations and fractures of the carpus on X-ray. They are of used in the sometimes difficult to interpret x-rays of the carpal bones. As...

Smith’s Fracture Diagnosis and Management

A 15 yo male with a Smith’s Fracture. The patient had fallen onto his flexed left wrist during a football match. There were no other injuries, however there was a history of a right sided wrist fracture in the recent...

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...

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Compartment Syndrome

Compartment Syndrome, is usually straightforward to pick up. How do we measure Compartment pressures? Below is a MacGyver setup. CASE...

Gilula’s Carpal Arcs

Gilula's carpal arcs are used to determine carpal alignment. They can assist in identifying ligamentous injury, dislocations and fractures of...

Smith’s Fracture Diagnosis and Management

A 15 yo male with a Smith’s Fracture. The patient had fallen onto his flexed left wrist during a football...

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...

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  • We respect your privacy
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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...

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...

Paediatric Heart Conditions You MUST KNOW

Congenital heart conditions present at birth, but can also present within the first month of life. We look at a simplified approach to the assessment and management of patients presenting with symptoms of congenital heart disease. In this video Dr...

Myocarditis

Myocarditis is simply an inflammation of the heart muscle, that can lead to myocardial cell damage, myocardial dysfunction and heart failure. A Recent Case A 15 yo male presents to the emergency department with sharp central chest pain that is...

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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...

Syncope in Children

Syncope is not uncommon, occurring in up to 25% of children. Most causes are benign, however we need to be...

Paediatric Heart Conditions You MUST KNOW

Congenital heart conditions present at birth, but can also present within the first month of life. We look at a...

Myocarditis

Myocarditis is simply an inflammation of the heart muscle, that can lead to myocardial cell damage, myocardial dysfunction and heart...

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  • We respect your privacy
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Exam Resources

FELLOWSHIP EXAM

The Written Fellowship Course is the definitive course to help you prepare for your fellowship examination. If you want structure and a trusted way to pass the examination, then look at the course.

Learn More

OSCE EXAM

This is the 2 days OSCE Course for the Emergency Medicine Fellowship. PASS THE OSCE, with total preparation. Seats are capped in number to allow better teaching.

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PRIMARY EXAM

What if you could learn the most important parts of the Primary Exam? What if you had over 3000 MCQs to practice with? You do. The Primary Exam Course is here.

Learn More

ECG Topics

Is SVT an ischaemic arrhythmia?

We often see patients presenting with SVT. They often have ST changes, so we have to ask; Is SVT an ischaemic arrhythmia? The answer is no, but beware as it can trigger ischaemia. Let's look at some cases. ST segment...

Dextrocardia: Can you pick it on ECG?

This is a great case that highlights how important it is, to know how to check if your ECG lead...

An Ominous ECG Sign

This is a fantastic case to learn from for a recent Circulation article(1) titled 'An Ominous ECG Sign in Critical...

ECG predictors of Cardiac Arrhythmias in Elderly with Syncope

CASE A 72 yo woman presents to your emergency department following an episode of syncope. There was a brief 2-3...

ECG Topics

Airway Topics

Should we intubate in the ramped position?

I’ve spoken on awake intubationat the EMCORE Conferences, especially at the last Masterclass. I also spoke about the potential benefits of...

5 Things To Help You Get The Airway

1. Know When To Intubate The Advanced Airway is not just about doing, but also about thinking. It may sound...

Difficult Airway Cases: What would you do?

Airway management is frightening, especially if you don't do it often. Having a plan when we approach an airway is important. My plan involves: Maximising oxygenation with apnoea oxygenation Using...

Should we intubate in the ramped position?

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...

5 Things To Help You Get The Airway

1. Know When To Intubate The Advanced Airway is not just about doing, but also about thinking. It may sound strange, but we should have an approach that allows us...

My Rules for Getting the Airway

There are all these fancy terms out there in respect to airway. There's apnoeic oxygenation, delayed sequence intubation, the vortex...

3 Essential things to do to get the Airway

Well, I'm now writting the lectures for the EMCORE Conferences for Hong Kong,  Melbourne and Fiji and I was quite excited about this content and wanted...

An Unusual Foreign Body in the Airway

During a recent stint at a regional base hospital in NSW I was faced with an interesting clinical challenge that, at the time, I thought was most unusual. It appears...

My Rules for Getting the Airway

There are all these fancy terms out there in respect to airway. There's apnoeic oxygenation, delayed sequence intubation, the vortex etc..... Let me tell you something, you already know. This...

3 Essential things to do to get the Airway

Well, I'm now writting the lectures for the EMCORE Conferences for Hong Kong,  Melbourne and Fiji and I was quite excited about this content and wanted to share some of it with you. Today I wanted...

Airway in COVID-19

I have a lot of questions. Here are some answers and a few resources for you. This is all uncharted territory....

VAPOX and Ventilation During the Apnoeic Period

In Rapid Sequence Intubation(RSI), there is that period of apnoea that occurs following delivery of paralytics and prior to attempting...

Effectiveness of Apnoeic Oxygenation Questioned

Everyone knows I'm a huge fan of apnoeic oxygenation. I use it for sedation, for intubation, heck I sprinkle some on my cereal in the morning. But here is a...

Airway in COVID-19

I have a lot of questions. Here are some answers and a few resources for you. This is all uncharted territory. We have some evidence from SARS and  other instances that...

VAPOX and Ventilation During the Apnoeic Period

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...

Apnoeic Oxygenation in Resuscitation: Is it time?

We are finally seeing the years of airway in resuscitation dogma being challenged. The original approach to airway which mandated...

Effectiveness of Apnoeic Oxygenation Questioned

Everyone knows I'm a huge fan of apnoeic oxygenation. I use it for sedation, for intubation, heck I sprinkle some...

The BURP, the Sellick and the bimanual – which is better?

Which is better? BURP or bimanual? Is cricoid pressure of any use? Sellick described cricoid pressure in 1961. How useful is it? Well it's purpose is to minimise the passive...

Apnoeic Oxygenation in Resuscitation: Is it time?

We are finally seeing the years of airway in resuscitation dogma being challenged. The original approach to airway which mandated intubation and probably led to significant delays in CPR and...

Effectiveness of Apnoeic Oxygenation Questioned

Everyone knows I'm a huge fan of apnoeic oxygenation. I use it for sedation, for intubation, heck I sprinkle some on my cereal in the morning. But here is a...

Apnoeic Oxygenation in Resuscitation: Is it time?

We are finally seeing the years of airway in resuscitation dogma being challenged. The original approach to airway which mandated...

Effectiveness of Apnoeic Oxygenation Questioned

Everyone knows I'm a huge fan of apnoeic oxygenation. I use it for sedation, for intubation, heck I sprinkle some...

3 Essential things to do to get the Airway

Well, I'm now writting the lectures for the EMCORE Conferences for Hong Kong,  Melbourne and Fiji and I was quite excited about this content and wanted to share some of it with you. Today I wanted...

Apnoeic Oxygenation in Resuscitation: Is it time?

We are finally seeing the years of airway in resuscitation dogma being challenged. The original approach to airway which mandated intubation and probably led to significant delays in CPR and...

Effectiveness of Apnoeic Oxygenation Questioned

Everyone knows I'm a huge fan of apnoeic oxygenation. I use it for sedation, for intubation, heck I sprinkle some on my cereal in the morning. But here is a...

Stylet or Bougie for Intubation

As many of you will know, I've been teaching airway workshops now for many years, and have put over 3500...

Rapid Sequence Intubation

Practicing your technique at least every 6 months is very important if you do not regularly intubate. Even if you...

Advanced Airway – How useful is predicting the difficult airway?

We often talk about being able to predict the difficult airway. How useful is this really? In the scheme of things the Emergency Airway is just that, an emergency. Working...

Stylet or Bougie for Intubation

As many of you will know, I've been teaching airway workshops now for many years, and have put over 3500 doctors through the Advance Airways Workshop. I teach equipment in...

Rapid Sequence Intubation

Practicing your technique at least every 6 months is very important if you do not regularly intubate. Even if you do, the ability to practice on different manikins and in...

5 Things To Help You Get The Airway

1. Know When To Intubate The Advanced Airway is not just about doing, but also about thinking. It may sound...

My Rules for Getting the Airway

There are all these fancy terms out there in respect to airway. There's apnoeic oxygenation, delayed sequence intubation, the vortex...

Delayed Sequence Intubation

There's been a lot of talk around about Delayed Sequence Intubation and a little bit of confusion about it, so I thought I'd clear up a couple of things. Is...

Airway in COVID-19

I have a lot of questions. Here are some answers and a few resources for you. This is all uncharted territory. We have some evidence from SARS and  other instances that...

VAPOX and Ventilation During the Apnoeic Period

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...

An Unusual Foreign Body in the Airway

During a recent stint at a regional base hospital in NSW I was faced with an interesting clinical challenge that,...

The GuideIN tube seeks out the trachea

What's this? A device that seeks and finds the trachea and intubates the patient?......enter the GuideIN tube. Reported this week...

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, writing in a journal. No-one is really concerned. I’m asked...

An Unusual Foreign Body in the Airway

During a recent stint at a regional base hospital in NSW I was faced with an interesting clinical challenge that, at the time, I thought was most unusual. It appears...
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