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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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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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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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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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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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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A 64 year old male is sent into the Emergency Department by an audiologist with a sudden, greater than 50dB hearing loss in the right ear. The patient was previously being tested for a hearing aid in the left ear, however he woke up 2 days previously with marked hearing loss in the right ear.…

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This week we try something different. I interview the lead author of a recent paper on a proposed risk stratification approach to the investigation of Sudden headache. We risk stratify heart disease, we stratify pulmonary embolism and so many other things in the emergency department….why not sudden onset of headache. We know that at most,…

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A 28 year old woman presents to the emergency department with one week of headaches. The headache is worst on waking and improves during the day. It’s worst if she coughs and bends. Today she has awoken with a headache and right eye pain. The patient has a past medical history of migraines, however these…

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