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Archive for October 2011

The JOLT TEST for Meningitis

Neck stiffness in suspected meningitis is a difficult thing to elicit and its definition varies. One doctor may call a slight difficulty or pain in neck bending, stiffness, whilst another will want a totally stiff neck. The problem arises when there is no real neck stiffness in a patient that presents with headache and fever.…

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The patient with SOB and chest pain

What does this ECG show? Try it before you go on. From ‘’ Let’s use the ‘ECG in 20 Seconds’ approach. Step one: this is most likely an ischaemia or a PE given the history. Rate = 25 (complexes across the whole ECG) x 6 = 150bpm Rhythm = P waves are seen (best in…

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Clearing the cervical spine

The cervical spine continues to cause problems. Once we understand the basics, clearance of the cervical spine is not a mystery. A Recent Case An 8 year old child was brought into the emergency department following being involved in a motor vehicle accident. There was a closed head injury of significance and the GCS was…

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avR – 'the little lead that could'

I was teaching ‘The ECG in 20 Seconds’ the other day and again thought about how important the lead avR is. Also, how many times had I ignored it and how many times have you? In the patient that presents with suspected cardiac ischaemia, we should look at the vascular territories on the ECG. Anterior…

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