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Archive for January 2014

The Crashing Atrial Fibrillation Patient: Part 1

You know this patient. You’ve probably seen a patient, just like this. They are old, they have rapid atrial fibrillation(AF) and their blood pressure is sinking to their boots. What do you do? Let’s look at a case we had recently. Case An 82 year old male with a past medical history of hypertension and…

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Diagnosis of Scaphoid Fractures

Here is the case You have a 24 year old, right-handed tradesman, with who fell over playing football on the weekend. He has injured his right wrist, he has tenderness over distal radius and snuff box and his initial x-ray series is normal. What next? This blog contains the short answers, and the longer answers…

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Pseudo-Wellens' Syndrome

I recently saw post-op patient sent down to the ED (no ICU at this hospital), who had biphasic T wave changes in her anterior leads and had complained of chest pain, which was relieved with anginine. The patient was discussed with cardiology and transferred to coronary care. In this patient there was no doubt that this…

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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 is well recognised in the fields of ophthalmic surgery and anaesthesia, but few cases exist…

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Takotsubo Cardiomyopathy

Takotsubo Cardiomyopathy is a transient syndrome that mimics an acute myocardial infarction(MI) and patients present with left ventricular apical akinesia. It has been called ‘The Broken Heart Syndrome’ and was first described in Japan in 1990. Takotsubo translates to ‘Octopus Pot’, an example of which you see here, used for octopus fishing. It also resembles the left…

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