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Archive for January 2018

Postobstructive Diuresis

Postobstructive diuresis can occur following relief of urinary obstruction. It isn’t rare and can be potentially lethal. CASE A 65 year old male presents to the emergency department with a one day history of dysuria. He is diagnosed with a urine infection,  commenced on oral antibiotics and has an appointment made the next day for…

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A patient with nausea, vomiting and lethargy

(Please note this is a free view of this week’s ‘own the ecg‘ blog. Enjoy). A 79 year old man presented to the emergency department with a 2 day history of nausea, vomiting, lethargy and left abdominal pain. He appeared pale, clammy and unwell. His initial observations revealed a pulse of 50/min, BP 170/87, sats of…

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Cyanosis or Something Else?

A 75 year old gentleman presented with acute on chronic abdominal pain. His triage noted that he was “centrally cyanosed, but comfortable” and that his daughter had reassured the concerned triage nurse that his skin was usually that colour and there was nothing to be concerned about. When I called the patient from the waiting…

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Massive Propranolol Overdose

Massive propranolol overdose is perhaps one of the most challenging overdoses to manage. In 2009 we posted a case we had. We have progressed in our management since then. CASE A 26 yo woman is brought to the ED by ambulance. She has been found by her mother in her bedroom in a confused state.…

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Seizure, Syncope and Sudden Collapse

Associate Professor Peter Kas presents Seizure, Syncope and Sudden Collapse. The patient with syncope or presyncope becomes a challenge in the emergency setting. Although this diagnosis is reported to comprise 5% of emergency presentations, it seems like so much more than this. This lecture looks at the definition of syncope, which comprises three elements: a sudden…

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Treating the Hyperglycaemic, Hyperosmolar, Hypernatraemic Patient

hyperglycaemia hypernatraemia hyperosmolar

An 84 year old male has been brought into the emergency department. He has been found at home, confused, by a visiting neighbour. On arrival to the emergency department, the patient’s observations are: GCS 14/15, T 38.6 C, Pulse 143bpm and saturations of 94%. His clinical examination is normal apart from right basal crepitations. His…

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Hypernatraemia

CASE A 76 yo woman is sent in from the nursing home with myoclonic jerks. She has a past medical history of slight dementia and seizures. Her GCS is 13-14/15. On arrival she has constant myoclonic jerks. Initial Blood tests reveal the following: Na 165 K 3.6 Cl 112 U 12 Cr 112 You make…

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A Man Walks Into a Hole.

We often start with a case and talk about a single topic. This case is a little different. It is a real-time case. What would you do with this patient every step along the way? In real life, things are not always clear-cut. Here’s the story of a man that walked into a hole and…

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