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Archive for October 2016

External Pacing

A 65 year old male is brought to the emergency department. He has had a collapse at home. When the ambulance arrive, he has altered mental status, and they are having difficulty registering a pulse or getting a blood pressure above 60mmHg systolic. Here is his ECG: Using the ECG in 20 seconds method: Ventricular…

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How Dangerous is Pulmonary Embolism?

How Dangerous is Pulmonary Embolism? The diagnosis and management of pulmonary embolism(PE), like most things in emergency medicine; it’s about risk stratification. In chest pain, the low risk patient is approached very differently to the high risk, ST elevation chest pain patient. It is exactly the same in PE. There is that group of patients…

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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 paeds ECG. There should not be, as the same principles…

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Amiodarone vs Procainamide for Ventricular Tachycardia

The PROCAMIO Study(1) This was a randomised (non-blinded) open labelled study. 62 haemodynamically stable patients with sustained, monomorphic, Ventricular Tachycardia(VT), were assigned to receive either: (i) intravenous procainamide (single dose 10 mg/kg over 20 min) or (ii) intravenous amiodarone (single dose 5 mg/kg over 20 min). The study period was 40 min from infusion initiation…

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Clearing the Cervical Spine in Children

Introduction Most of our treatment strategy  in young children is based on our clinical judgement. The evidence on clearing cervical spines, in those older than 18 years, is clear, validated, accepted and is duty of care. The evidence for clearing the cervical spine is not as clear.  It is even more obscure for less than 8 year…

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