Hip Dislocation

Introduction This review is based on a great journal article just published (1) The most common hip dislocation is a Posterior DislocationThe most common Cause of a posterior hip dislocation is: In Native Hips: Motor vehicle accidents In Prosthetic Hips: Bending over, although they are much easier to dislocate from any movement The most common complication…

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NOACs and a Patient with Palpitations

Below is a case of a 60 yo patient with palpitations, who is commenced on a NOAC, with 8 MCQ questions that address the anticoagulation management of atrial fibrillation/flutter. Try them. CASE A 60 yo male presents to the Emergency Department with palpitations. He has had palpitations in the past. On a recent presentation to…

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Emergency vs Delayed Coronary Angiography for Patients with Out of Hospital Cardiac Arrest

This is a review of a recent paper in JAMA Cardiology:Hauw-Berlemont C et al. Emergency vs Delayed Coronary Angiography in Survivors of Out of Hospital Cardiac Arrest. Results of the Randomised, Multicentric EMERGE Trial. JAMA Cardiol. 2022;7(7):700-707. (1) Our assumption would be that most patients would benefit from coronary angio post survival from cardiac arrest.…

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Guidelines for the Management of Spontaneous Intracerebral Haemorrhage.

The 2022 Guidelines for the Management of Spontaneous Intracerebral Haemorrhage have just been released by the American Heart Association and the American Stroke Association.​This is a brief summary.  Read the journal article here: Stroke 2022 Jul;53(7):e282-e361. ​I will be covering all the management aspects associated with Intracerebral Haemorrhage at the next two EMCORE Conferences(Fiji, Queensland). Once you’ve read the summary below, come…

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Does Fluid Restriction in Septic Shock result in Better Outcomes?

Literature Review: Restriction of Intravenous Fluids in ICU Patients with Septic Shock. NEJM 386;26. June 30,2022 pp2459-2470. In patients with septic shock, higher volumes of intravenous fluids have been associated with worst outcomes. These included kidney injury, respiratory failure and an increased risk of death. Most of these conclusions came from randomised trials and observational…

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Epicardial Fat Necrosis

Epicardial fat necrosis is a rare, benign, self limiting condition that can mimic more serious causes of chest pain. Case A 30 yo patient present via ambulance with a complaint of chest pain. The chest pain started at 2am in the morning and lasted all night. It was relieved with Aspirin and GTN given by…

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Atrial Fibrillation in the Emergency Department

Here are two cases of patients with Atrial Fibrillation. Would you treat them in the same way? Patient 1 is a 68 yo male presents with palpitations and vague chest tightness. He has noticed his heart racing for the last 2 hours. He has a past medical history of hypertension and smoking.His vitals are Heart…

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The Right Ventricular Spiral of Death

The right ventricular spiral of death in PE is very real and very scary. We sometimes miss it, because we treat all resuscitations the same way and we shouldn’t. Here are two cases:CASE 1: A 35 yo woman presents to the ED with SOB, tachycardia, BP of 105/60, a high respiratory rate and sats of…

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