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Archive for April 2012

Differentiating stroke from benign causes of vertigo; the HINTS study.

The patient with acute vestibular syndrome can present a major diagnostic challenge. The patient with dizziness can be a tricky case to diagnose. In my preparation for the ‘Vertigo’ talk I get to give at this year’s EMCORE I came across the HINTS study (Stroke 2009; 40 3504-3510). It’s one you have to read. I have…

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V/Q or CTPA in suspected PE in pregnancy

OK here it is. The final word in investigating the pregnant patient with suspected pulmonary embolism. Well, it’s my final word anyway. I’ve spent the last month or so reviewing the literature on this. What amazes me, is that two people can quote the same study and come up with a different conclusion. The confusion appears…

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Pericarditis vs Infarction vs Repolarisation

I’ve done blogs on early depolarisation and infarction in the past. The story isn’t complete unless we also discuss pericarditis. In acute pericarditis the ST elevation that occurs reflects abnormal repolarization that develops secondary to pericardial inflammation. PR depression is very specific for pericarditis. It is a result of subepicardial injury. PR depression occurs in all leads…

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ADRENALINE: SAVIOUR OR FAILURE?

Our obsession with adrenaline continues. We want to prove it works. It must! If it doesn’t what do we have? We’ve been running arrests in this way for the last 50 odd years. If they took adrenaline away, what’s left? I ran a resus two days ago on a patient with refractory pulseless VT. When…

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