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Archive for March 2012

It’s Quiz time again

Question 1     A mother brings her 2 year old child into the emergency department. She is distressed at the lesions that have appeared on her childs arms and are now spreading to his torso. They appeared 24 hours ago and are still there. The child is well looking, feeding well with normal vitals. The…

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Early Repolarization, not benign in the inferior leads!

Early repolarization in the right precordial leads(V1-3) occurs in up to 5% of the population (AMJ Med 2003) and is considered as benign. The same repolarization pattern in the inferior leads is not and has been associated with increased arrhythmogenicity ie., ventricular fibrillation. Studies now show that elevation of the J-point in the inferior + lateral…

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Can new CT scanners rule out subarachnoid?

Patients presenting with sudden onset of headache, must have a subarachnoid haemorrhage(SAH) ruled out. If missed, the potential consequences of a rebleed can be devastating. The warning leak or sentinel headache is a window of opportunity to make the diagnosis. The approach so far, is to perform a non-contrast CT head. If this is normal, then…

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Let’s use exercise stress testing in the ED cleverly.

Exercise stress testing has been around for some time now. We use it for those low risk patients after exclusion of an AMI. We know the results aren’t great and that the pickup for single vessel disease is very low. In fact the overall sensitivity is about 68% and specificity of 77% (Lee NEJM 2001).…

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Its quiz time- here’s a visual quiz

OK THRILL-SEEKERS, IT’S QUIZ TIME AGAIN! Here are 3 visual questions for you. The answers are below each question. QUESTION 1 A 19 yo man is brought to the emergency department following a syncopal episode whilst playing basketball. His only history is of two previous episodes of syncope. The was no chest pain, no shortness…

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The scalpel,finger,tube method for Surgical Airway

THE ‘SCALPEL-FINGER-TUBE’ METHOD  HOT OFF THE PRESS! The February edition of Emergency Medicine Australasia (2012) 24, 23-30 has a case series of surgical cricothyrotomies. 24 cases are described by two operators(anaesthetists) over 19 years. In the Advanced Airway workshop, I teach a different approach, but lets see what was written and then discuss. In this…

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Hyphaema

It’s 2pm on a Saturday and the regular crowd shuffles in. Sorry that’s a Billy Joel song. It’s 2pm on a Saturday and a 23 year old male presents after being struck in the eye by a squash ball. You quickly look and it’s a ……….HYPHAEMA. A hyperaemia is defined as blood in the anterior…

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75 Year Old Male Who Feels Faint

A 75 year old male is brought to the emergency department because he was feeling faint this morning. They report that he is bradycardic with a blood pressure of 95/60. He is afebrile, and has a GCS of 15. You are shown his ECG. Please diagnose. Using ECG in 20 seconds approach, we assume an…

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Cauda Equina Syndrome

The local GP calls you as the admitting officer of a rural emergency department and tells you he has a patient who has: Lower back pain, Numbness in both feet  and Impotence The GP has performed a CT this morning from L1 down, which was normal.  You advise the GP that you think the diagnosis is cauda equina…

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