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Archive for February 2016

More Non-Invasive Ventilation

Following the video on how to use non-invasive ventilation, I was asked to briefly again explain in graphical form how I see non-invasive ventilation as working. This is a very basic view. In terms of Non Invasive Ventilation, we can first start by thinking about CPAP (Continuous Positive Air Pressure) Ventilation. We can set this…

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Galeazzi Fracture

The forearm X-ray of a young man following a dirt bike accident are shown. Clinically he has a deformed distal radius. The X-ray shows a classic Galeazzi fracture. There is a fracture of the distal radius(usually distal third, with dorsal angulation) and a dislocation of the distal radioulnar joint. They can be split into Type I and type…

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Reflex Sympathetic Dystrophy

Introduction and a case Reflex Sympathetic Dystrophy,  also called regional pain syndrome,  is usually as a result of surgery or trauma and the diagnosis is made clinically. The presentation will include pain, swelling and vasomotor dysfunction. In the case shown here, a well-looking 45 year old woman, is triaged with a swollen, red and painful forearm.…

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Case: Leg Weakness and a Sensory Level

THE CASE A 35yo patient presents with multiple complaints which include: lower abdominal pain retrosternal chest pain lumber back pain and numbness and weakness in both legs This is a previously well patient with no significant medical history. This morning, the patient noticed some mild flu-like symptoms on waking. During the day the patient felt severe…

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Early Repolarisation or AMI

A 28 year old male presents with atypical chest pain, shortness of breath and a feeling of general muscular aches and pains. He has an ECG. Does it show early repolarisation or an infarction, or something else? In this ECG, there is ST elevation in the inferior and anterior leads. What do you think? What…

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How To Read The Paediatric ECG

Below is an ECG taken of a 0ne week old infant, who has some shortness of breath whilst feeding according to the parents. What does it show? Is it normal?ECG’s can already present a significant challenge, however there is a fear associated with the paediatric ECG. There should not be, as the same principles that…

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Wolff-Parkinson-White

Introduction Wolff-Parkinson-White Syndrome occurs in about 0.3% of the population (1), although this is an underestimate, as evidence of pre-excitation on the ECG my be transient.  The characteristic delta wave indicates that the accessory pathway conducts faster than the Atrioventricular (AV) node, thus resulting in pre-excitation. However, the refractory period of the accessory pathway may…

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Non-Invasive Ventilation

Introduction If find myself reaching more and more for the non-invasive ventilation, in the COPD patient. I’ve always loved it for acute pulmonary oedema. However, there is something about assisting the patient’s work of breathing, that allows me to ‘titrate’ what I give. A Case The ambulance bring a patient in on a rebreather. She…

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The Shock Index to predict hypotension

The Shock Index. Do you use it? Do you know what it is? The Shock Index was originally used to predict shock in medical patients in the Emergency Department. It has also been evaluated for use in trauma and myocardial infarction. Although it’s been around for over 50 years it’s doesn’t appear to be widely used…

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