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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Cannabis Hyperemesis

We’ve all seen Cannabis hyperemesis and it’s not pretty. The patient showers and feels much better….. and keeps wanting to shower in the ED. We give some Ondansetron and feel better…. although the patient keeps vomiting. A year ago we presented Cannabis Hyperemesis Syndrome at EMCORE Gold Coast(Watch the Video below and watch to the end for…

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The Reverse Vagal Manoeuvre for SVT

A NEW technique for reverting SVT was published in AJEM(1) this week. The Reverse Vagal manoeuvre for SVT, is simple and safe and in a limited case series, VERY effective. SVT is not an uncommon patient presentation in the emergency department. In many cases the patient has had SVT before and knows what is happening.…

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Canadian Syncope Risk Score

Those Canadians are clever. They’ve given us ankle rules and knee rules and subarachnoid rules. Now a Syncope Risk Score. In 2016 the first Canadian Syncope Risk Rule was published. The aim was to predict 30 day serious outcomes. In 2020 they validated the score. Sort of…. It was really an internal validation, conducted in…

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A Patient with Wide Complex Tachycardia

Beware the Impersonators This week we see one of my favourite ECGs of the year. In fact I will call it that! It was sent in to me by a good friend, who goes by the alias of Dr Einthoven. Here is the story…..An elderly patient is brought into the ED with recurrent falls. There…

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Don’t Miss the Occult Fracture

A normal X-ray does not necessarily exclude a fracture. It is simply a test used, with our pre-test probability to help us make a decision, in regards to a fracture being present or not. This is the way to not miss an occult fracture. In the last few weeks we are seeing a lot of…

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Pronator Quadratus Sign

The pronator Quadratus sign is a sign seen on the lateral X-ray of the wrist/forearm and can assist in diagnosing an occult radial fracture. The line represents a fat pad that lies parallel to the distal radius, over the fascial covering between pronator quadratus and flexor digitorum profundus muscle. The line runs from the palmar…

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Retinal Detachment

An elderly patient presents with worsening vision in one eye over the last 2 days. There is no pain and there has been no trauma. The patient’s visual acuity is significantly reduced in the affected eye and you question if there is an afferent pupillary defect. Your differentials here include retinal detachment, so you decide…

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