Patients who present to the emergency department following a syncopal episode can be a diagnostic challenge to us. There are 5 things we should always do, to help us make the diagnosis. Before we start with the big 5, I need to make 3 general comments: Syncope is a symptom, not a condition. We need…

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Is cardioversion safe in the pregnant patient? A CASE A 24 yo female patient presents with palpitations and some dizziness. She is  G1P0 and is 28 weeks gestation. Her rhythm strip is shown below. You make the diagnosis of SVT. You try the ‘REVERT‘ approach and other vagal techniques, with no success. What medications are…

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Paediatric Resuscitation is stressful. However if we remember a few small points, it makes it so much easier. Here we specifically look at resuscitating children, not neonates. The Paediatric Resuscitation Guideline flowcharts have been purposefully made to look similar to the Adult guidelines, because the principles are the same. There are 3 main differences, discussed…

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Cardiac arrest in children is certainly less frequent than in adults. However most paediatric in-hospital cardiac arrests do not survive to discharge. Shockable rhythms are associated with a higher rate of survival. However there is some disagreement as to the first shock dose delivered and if it makes a difference: The Australian Resuscitation guidelines recommend 4…

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This is for those Emergency Medicine registrars about to sit the ACEM Written Fellowship Exam. It’s 4 weeks to go until the Exam…. That’s right it’s 4 weeks and bit to go until the Fellowship Written. It’s about now, that the doubts and fears set in. “I’m not ready”. “I’ll never get it” ” I…

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What is Bell’s Palsy? It is an ipsilateral Cranial Nerve VII (lower motor neurone) palsy. There is usually a sudden onset of facial weakness, that progressively worsens over 48 hours. The diagnosis itself, is one of exclusion. CASE A 60 yo male presents to the emergency department, with a 2 day history of progressive right facial…

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When examining a patient with a facial nerve palsy and we wish to determine if the lesion is central or peripheral, we are often told do not ask the patient to smile. It always seemed strange to me. Here’s the reason…. When examining a patient with facial weakness, with a potential central cause, we need to…

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An excellent review article on Trigeminal Neuralgia, has just come out in the NEJM(1). Here is a quick summary. FACTS Usually affects the mandibular or maxillary division of the Trigeminal Nerve F>M Right face > left. Bilateral is rare – look for other causes CLINICAL PICTURE Trigeminal Neuralgia is diagnosed clinically and must have 3…

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