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The SIC KID

For years I’ve been speaking about the SIC KID Mnemonic. It’s time to see where we are at in 2017. When was it to be used? To be used as a memory aid in the crying child, where we weren’t sure of the diagnosis. Let me remind you of what the letters stand for: S –…

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Should we intubate in the ramped position?

I’ve spoken on awake intubationat the EMCORE Conferences, especially at the last Masterclass. I also spoke about the potential benefits of intubating patients in the ramped positionie., head of the bed up at 25-30 degrees. Mostly this is based Off studies, using operating theatre patients that have already been intubated, then disconnected from oxygen sources and observed to see how long…

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5 Things to Think About in a Wheezy Child

Minimal Handling Stop touching the patient.  Often enough in paediatrics, more is not better. This is of key importance in the younger age group. The more lights/monitors and hands on assessment – the more distressing to the child. The more distress – the greater the effort of breathing becomes.  Most children with wheeze are best…

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Zipper Injuries

This blog is often full of new evidence from high quality trials and literature reviews as well as clinical pearls to help enable us to choose wisely with our sickest patients, usually those in the resus bay. That being said, for most emergency physicians, perhaps up to a third of their clinical time, may be…

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Contrast Induced Nephropathy: Is it Real?

You are managing a trauma and request a CT abdomen to exclude an intra-abdominal injury. The radiology registrar asks about the patients’ renal function. Sound familiar? The good news is that the scan go ahead without knowing the renal function. This is supported by the current guidelines of the Royal Australasian and New Zealand College…

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Fixed Dilated Pupils

Head injury with fixed dilated pupils: Are we done? We have looked at the pupillary response before on this blog in terms of the Doll’s Eye Reflex in brainstem death and the oculocephalic reflex. However, what if the pupils are fixed and dilated? We seem to learn quite early in our medical careers that fixed…

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The Unstable Atrial Fibrillation Patient

THE CASE A 75 yo man is brought into your small rural ED after 3 hours of ischemic chest discomfort.  His background is significant for hypertension, a CVA 5 years ago for which he is on aspirin/dipyrimidole, and 2 coronary artery stents in 1995.  The ambulance officers found the patient to be in AF, with…

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Are You Still Feeling For A Pulse? Stop It!

I remember years ago when we used to manage cardiac arrests and everyone was asked to stop compressions while someone felt for a pulse. Do you remember that? “I think I feel one. I wonder if that’s mine? Can someone else feel please?” Meanwhile time with no CPR passed. Today with the push for cardiocerebral resuscitation…

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Pulseless Electrical Activity

Pulseless Electrical Activity(PEA) occurs in about 30% of cardiac arrest cases. Given that it’s not a shockable rhythm, it has a very poor prognosis, especially when associated with acute myocardial Infarction(MI)(1). More recently, the term pseudo-PEA, is used for those patients where we can’t find an output by feeling for a pulse, but there may in fact be…

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The Cervical Spine: The Iconoclasm Continues

In recent blogs I suggested that clinically significant C spine injuries can be excluded by CT scan in the intoxicated patient and Luke Lawton raised the suggestion that the hard collar may not be as efficacious as we were led to believe in our youth. One of the questions that the C spine blog attracted…

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How Important is a C-Spine Collar….really?

In preparation for EMCORE Hong Kong 2018, I took some time to sit down and revisit how and why we do one of the oldest rituals in trauma medicine – applying a rigid c-collar. I still remember as a junior doctor being taken through the rigorous method of application….measure up properly, hold the head steady,…

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Cervical spine clearance in the intoxicated patient

The most commonly used c spine clearance rules exclude or mandate imaging in the case of the “intoxicated” patient, and there is debate as to whether a normal CT C spine is adequate to clear the neck of the intoxicated patient in blunt trauma.(1,2) Many clinicians advocate either waiting for intoxicants to clear before clinically…

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