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Epicardial Fat Necrosis
Epicardial fat necrosis is a rare, benign, self limiting condition that can mimic more serious causes of chest pain. Case…
Epicardial Fat Necrosis
Epicardial fat necrosis is a rare, benign, self limiting condition that can mimic more serious causes of chest pain. Case...
Atrial Fibrillation in the Emergency Department
Here are two cases of patients with Atrial Fibrillation. Would you treat them in the same way? Patient 1 is a 68 yo male presents with palpitations and vague chest tightness. He has noticed his heart racing for the last...
Is it Thoracic Aortic Dissection?
The Case A 58 yo patient presents to the emergency department with central crushing chest pain that came on abruptly and moved through to his back. The pain was rated as being 8/10. There was no shortness of breath, no...
The Reverse Vagal Manoeuvre for SVT
A NEW technique for reverting SVT was published in AJEM(1) this week. The Reverse Vagal manoeuvre for SVT, is simple and safe and in a limited case series, VERY effective. SVT is not an uncommon patient presentation in the emergency...
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Epicardial Fat Necrosis
Epicardial fat necrosis is a rare, benign, self limiting condition that can mimic more serious causes of chest pain. Case...
Atrial Fibrillation in the Emergency Department
Here are two cases of patients with Atrial Fibrillation. Would you treat them in the same way? Patient 1 is...
Is it Thoracic Aortic Dissection?
The Case A 58 yo patient presents to the emergency department with central crushing chest pain that came on abruptly...
The Reverse Vagal Manoeuvre for SVT
A NEW technique for reverting SVT was published in AJEM(1) this week. The Reverse Vagal manoeuvre for SVT, is simple...
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Get notified on all upcoming Conferences PLUS our Webcasts, Education Newsletters, and more!
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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Sudden Hearing Loss
A 64 year old male is sent into the Emergency Department by an audiologist with a sudden, greater than 50dB...
Risk Stratification of Sudden Headache
This week we try something different. I interview the lead author of a recent paper on a proposed risk stratification approach to the investigation of Sudden headache. We risk stratify heart disease, we stratify pulmonary embolism and so many other...
Idiopathic Intracranial Hypertension
A 28 year old woman presents to the emergency department with one week of headaches. The headache is worst on waking and improves during the day. It's worst if she coughs and bends. Today she has awoken with a headache...
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Bell’s Palsy
...
Sudden Hearing Loss
A 64 year old male is sent into the Emergency Department by an audiologist with a sudden, greater than 50dB...
Risk Stratification of Sudden Headache
This week we try something different. I interview the lead author of a recent paper on a proposed risk stratification...
Idiopathic Intracranial Hypertension
A 28 year old woman presents to the emergency department with one week of headaches. The headache is worst on...
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Get notified on all upcoming Conferences PLUS our Webcasts, Education Newsletters, and more!
Bell’s Palsy
...
Risk Stratification of Sudden Headache
This week we try something different. I interview the lead author of a recent paper on a proposed risk stratification...
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...
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...
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Risk Stratification of Sudden Headache
This week we try something different. I interview the lead author of a recent paper on a proposed risk stratification...
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...
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Get notified on all upcoming Conferences PLUS our Webcasts, Education Newsletters, and more!
Why is the CO2 so high?
A 29 yo female presents with tachycardia and shortness of breath and some pleuritic chest pain. She has driven from...
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 March 2020 by the National Institute for Health and Care Excellence(NICE). They now incorporate the use of age adjusted D-dimers...
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
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Why is the CO2 so high?
A 29 yo female presents with tachycardia and shortness of breath and some pleuritic chest pain. She has driven from...
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....
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Get notified on all upcoming Conferences PLUS our Webcasts, Education Newsletters, and more!
Thyrotoxicosis Quiz
A 50 year old female presented to the emergency department with anxiety, palpitations and feeling generally unwell. She had no...
Thyrotoxicosis
A 50 year old female presented to the emergency department with anxiety, palpitations and feeling generally unwell. She had no past medical history and was on no medications. She had, however, seen her GP the week before complaining of 2...
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...
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Thyrotoxicosis Quiz
A 50 year old female presented to the emergency department with anxiety, palpitations and feeling generally unwell. She had no...
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...
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Cannabis Hyperemesis
We've all seen Cannabis hyperemesis and it's not pretty. The patient showers and feels much better..... and keeps wanting to shower...
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 uncomfortable procedures, especially on children.....that nitrous is now being abused on the street, with some disastrous consequences. It's nothing new....
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...
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Cannabis Hyperemesis
We've all seen Cannabis hyperemesis and it's not pretty. The patient showers and feels much better..... and keeps wanting to shower...
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...
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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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Get notified on all upcoming Conferences PLUS our Webcasts, Education Newsletters, and more!
Idiopathic Intracranial Hypertension
A 28 year old woman presents to the emergency department with one week of headaches. The headache is worst on...
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 to see him because he has a croaky voice? Hmmmm...I’m...
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Get notified on all upcoming Conferences PLUS our Webcasts, Education Newsletters, and more!
Idiopathic Intracranial Hypertension
A 28 year old woman presents to the emergency department with one week of headaches. The headache is worst on...
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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Get notified on all upcoming Conferences PLUS our Webcasts, Education Newsletters, and more!
Idiopathic Intracranial Hypertension
A 28 year old woman presents to the emergency department with one week of headaches. The headache is worst on...
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 to see him because he has a croaky voice? Hmmmm...I’m...
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Get notified on all upcoming Conferences PLUS our Webcasts, Education Newsletters, and more!
Idiopathic Intracranial Hypertension
A 28 year old woman presents to the emergency department with one week of headaches. The headache is worst on...
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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Get notified on all upcoming Conferences PLUS our Webcasts, Education Newsletters, and more!
Retinal Detachment
An elderly patient presents with worsening vision in one eye over the last 2 days. There is no pain and...
Idiopathic Intracranial Hypertension
A 28 year old woman presents to the emergency department with one week of headaches. The headache is worst on waking and improves during the day. It's worst if she coughs and bends. Today she has awoken with a headache...
Lateral Canthotomy
When and How to Perform a Lateral Canthotomy A 35 yo woman presents to your rural emergency department. She has recently had eye surgery at a large tertiary centre and has been allowed home. Her presentation to the emergency department is:...
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...
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Retinal Detachment
An elderly patient presents with worsening vision in one eye over the last 2 days. There is no pain and...
Idiopathic Intracranial Hypertension
A 28 year old woman presents to the emergency department with one week of headaches. The headache is worst on...
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...
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Get notified on all upcoming Conferences PLUS our Webcasts, Education Newsletters, and more!
The Davos Technique for Shoulder relocation
Patients with shoulder dislocations are not an uncommon presentations to the Emergency Department. The ability to reduce the shoulder depends...
Don’t Miss the Occult Fracture
A normal X-ray does not necessarily exclude a fracture. It is simply a test used, with our pre-test probability to help us make a decision, in regards to a fracture being present or not. This is the way to not...
Pronator Quadratus Sign
The pronator Quadratus sign is a sign seen on the lateral X-ray of the wrist/forearm and can assist in diagnosing an occult radial fracture. The line represents a fat pad that lies parallel to the distal radius, over the fascial...
Compartment Syndrome
Compartment Syndrome, is usually straightforward to pick up. How do we measure Compartment pressures? Below is a MacGyver setup. CASE A 21 yo male presents to the emergency department with a very painful leg. He was tackled to the right...
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The Davos Technique for Shoulder relocation
Patients with shoulder dislocations are not an uncommon presentations to the Emergency Department. The ability to reduce the shoulder depends...
Don’t Miss the Occult Fracture
A normal X-ray does not necessarily exclude a fracture. It is simply a test used, with our pre-test probability to...
Pronator Quadratus Sign
The pronator Quadratus sign is a sign seen on the lateral X-ray of the wrist/forearm and can assist in diagnosing...
Compartment Syndrome
Compartment Syndrome, is usually straightforward to pick up. How do we measure Compartment pressures? Below is a MacGyver setup. CASE...
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Paediatric Pearls
I've given a talk on Paediatric Pearls in the past. I recently revived the talk for my residents, so thought...
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...
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...
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Paediatric Pearls
I've given a talk on Paediatric Pearls in the past. I recently revived the talk for my residents, so thought...
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...
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Get notified on all upcoming Conferences PLUS our Webcasts, Education Newsletters, and more!
Exam Resources
ECG Topics
Is it Thoracic Aortic Dissection?
The Case A 58 yo patient presents to the emergency department with central crushing chest pain that came on abruptly and moved through to his back. The pain was rated as being 8/10. There was no shortness of breath, no...
A Patient with Wide Complex Tachycardia
Beware the Impersonators This week we see one of my favourite ECGs of the year. In fact I will call...
5 Things you Must do when Patients Present with Syncope
Patients who present to the emergency department following a syncopal episode can be a diagnostic challenge to us. There are...
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...
ECG Topics
Is it Thoracic Aortic Dissection?
The Case A 58 yo patient presents to the emergency department with central crushing chest pain that came on abruptly and moved through to his back. The pain was rated as being 8/10. There was no shortness of breath, no...
A Patient with Wide Complex Tachycardia
Beware the Impersonators This week we see one of my favourite ECGs of the year. In fact I will call it that! It was sent in to me by a good friend, who goes by the alias of Dr Einthoven....
5 Things you Must do when Patients Present with Syncope
Patients who present to the emergency department following a syncopal episode can be a diagnostic challenge to us. There are 5 things we should always do, to help us make the diagnosis. Before we start with the big 5, I...
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 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...
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...
ACE Inhibitor mediated Angioedema
A 71 year old male with a history of COPD and heavy ongoing smoking habit, presented to the emergency department...
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 to share some of it with you. Today I wanted...
ACE Inhibitor mediated Angioedema
A 71 year old male with a history of COPD and heavy ongoing smoking habit, presented to the emergency department with a 3 hour history of tongue, mouth and throat...
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...
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...