ACE Inhibitor mediated Angioedema

A 71 year old male with a history of COPD and heavy ongoing smoking habit, presented to the emergency department with a 3 hour history of tongue, mouth and throat swelling. He had awoken from an afternoon nap with the symptoms and initially refused to come to hospital. By the time he arrived he was…

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A Pregnant Patient with Chest Pain

A 27 yo 34/40 gestation G1P0 patient presented to the Emergency Department with central chest pain, with some radiation to between the scapulae. There was no shortness of breath or diaphoresis, nausea or vomiting or palpitations. The patient did not complain of leg pain. The registrar presented the case to me with the following findings.…

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The Davos Technique for Shoulder relocation

Patients with shoulder dislocations are not an uncommon presentations to the Emergency Department. The ability to reduce the shoulder depends on many factors which include whether the patient can Adduct or Abduct, how painful the dislocation is. We know that in some patients, small movements, even with analgesia, can be very painful, and others will…

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Reading the ABG

The ABG is one of the most basic tests we run in the Emergency Department. It may be an ABG or a VBG. Regardless, it is an opportunity to gain information quickly. ​This module will assist you in learning to read the ABG. Look for my overall approach to the ABG at the end of…

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Paediatric Pearls

I’ve given a talk on Paediatric Pearls in the past. I recently revived the talk for my residents, so thought I’d put it up here. 15 paediatric pearls. Now some of you may not agree with them, some may think they are too conservative, some may think they are not conservative enough. I make no…

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Inotropes and Vasopressors: Which one would you use?

Below are 2 cases we have all been confronted with, in the Emergency Department. Which medication is best to support the blood pressure in each case? Case 1 A 68 yo male is brought to your emergency department in what appears to be septic shock. He has had a recent urine infection. Over the last…

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Is it Thoracic Aortic Dissection?

The Case A 58 yo patient presents to the emergency department with central crushing chest pain that came on abruptly and moved through to his back. The pain was rated as being 8/10. There was no shortness of breath, no diaphoresis and no vomiting. The patient has not had chest pain previously, but does take…

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Ketamine-only breathing intubation

Ketamine-only breathing intubation(KOBI), is a technique where Ketamine(+/- topical local anaesthetic) is used to facilitate intubation in patients that may not be able to tolerate traditional Rapid Sequence Intubation(RSI) 3 Approaches to Ketamine use in intubation Ketamine as the induction agent in normal RSI: It shows haemodynamic stability and a long duration of action Ketamine…

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Ketamine Only Intubation

In a recent paper by Driver et al (1) there was a comparison of Ketamine-Only intubation with topical anaesthetic and traditional RSI. The primary outcome was 1st attempt intubation success and it was found that Ketamine only intubation had the worst success rate of all the techniques and it also had the greatest incidence of…

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