Fever in the ED
Fever In The Emergency Department We like to see things as binary in the ED, troponins, d-dimers, CTPA they all give yes no answers. We often treat fever in a similar way, fever = infection just like our mothers taught us. But are we any better than a hand on the forehead, can we use temperature...
Syncope Rules
Patients presenting with syncope to the Emergency Department can pose a significant diagnostic challenge. The two main reasons for this are: Syncope is a symptom, not a diagnosis. We need to search for the underlying cause. Adverse events can occur, when none are obvious or predictable during our Emergency Department evaluation. We know that the rate...
Diagnosing Ventricular Tachycardia in 5 easy steps
Here is a simple case of potential ventricular tachycardia(VT) How do you manage this? A patient has been brought into your resuscitation cubicle with the a complaint of palpitations. His ECG is as follows: The patient is obviously unstable, so the management decision is easy: ELECTRICITY. What if the patient is stable with a BP...
Rapid IV Fluid Administration Does NOT Affect Neurological Outcome in Children with DKA
HOT OFF THE PRESS: A new clinical trial showing that rapid IV fluid administration does not affect neurological outcome in children with DKA, as has previously been thought. Clinical Trial of Fluid Infusion Rates for Pediatric Diabetic Ketoacidosis. N Engl J Med 2018; 378:2275-2287 The Numbers This was a randomised controlled trial in 13 centres....
Pericardiocentesis
How to Perform Pericardiocentesis Pericardiocentesis is used to treat symptomatic pericardial effusions and cardiac tamponade. It was first described in the 1650’s and since the introduction of the subxiphoid approach in 1911, has been used very successfully, with significant reduction in morbidity and mortality. The use of echocardiography and other guidance techniques have reduced the...
How to Diagnose the Patient with Vertigo in 5 steps
How to Diagnose the Patient with Vertigo in 5 steps This week it’s all about the ‘dizzy’ patient, or that patient with vertigo. I recently spoke at EMCORE Melbourne and went through my step by step approach of sorting, in my mind at least, the potential causes of the ‘dizzy’ patient. Below is a summary...
Neuro Exam Pearls: Upper limb
I don’t know about you, but I’ve always wanted to be able to perform a neurological exam and pick the lesion and look good doing it. Over the years I’ve tried to get better at it. What I have put together is a series of ‘PEARLS’ that sometimes help me decipher the cryptic world of...
EMCORE FIJI
2-4 October
EMCORE Santorini
25-27 October
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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