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Double Sequential External Defibrillation

Double sequential external defibrillation

Double Sequential External Defibrillation(DSED) is a means of administering sequential shocks to terminate shock resistant ventricular fibrillation. It is a controversial topic, with no robust studies. Resistant ventricular arrhythmias are different to electrical storm(1). Electrical storm is a state characterised by recurrent occurrences of unstable ventricular arrhythmias, over a short period of time. This is…

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Complications of Bariatric Surgery

Complications of Bariatric Surgery

In this blog we discuss the various complications of Bariatric Surgery. Bariatric surgery is one of the fastest growing areas of surgery. As with all surgical procedures, there is the possibility of postoperative complications. Emergency physicians should be familiar with the common problems encountered, limitations of conventional investigations, and the management of these complications, which…

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Gilula’s Carpal Arcs

Third carpal arch

Gilula’s carpal arcs are used to determine carpal alignment. They can assist in identifying ligamentous injury, dislocations and fractures of the carpus on X-ray. They are of used in the sometimes difficult to interpret x-rays of the carpal bones. As we will see below, the carpal arcs act similarly to the raised fat pad sign(sail…

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Runaway Pacemaker and Lethal Arrhythmia

pacemaker

A potential complication of a failing pacemaker, is a condition known as ‘Runaway Pacemaker’. Below are two cases from the literature, that demonstrate a runaway pacemaker causing a potentially lethal ventricular arrhythmia. Whenever we look at an ECG, we always look for the pacing spikes. These may not be visible, especially if the patient’s rate is…

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Hypertensive Emergencies and how to treat them

hypertensive emergencies

Hypertensive emergencies are defined as sudden and prolonged increases in the arterial blood pressure, with associated organ damage. The degree of increase above that which the patient normally has, and the degree and duration of the rise are not usually taken into account. No single figure for blood pressure is usually defined, however if a…

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Phenytoin and Levetiracetam: EcLIPSE and ConSEPT trials

Phenytoin and Levetiracetam: EcLIPSE and ConSEPT

There has been a longstanding discussion over which is the best second-line agent to use in paediatric seizures and more specifically in convulsive status epilepticus. We now have two trials that have tried to answer this question by comparing Phenytoin and Levetiracetam: The EcLIPSE(1) and ConSEPT(2) trials. Phenytoin and Levetiracetam: EcLIPSE and ConSEPT-The Bottom Line…

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Honey for Button Battery Ingestion?

A 25-year-old patient presents with recurrent lithium button battery ingestion. She had been admitted with the same presentation 3 week before and had undergone urgent endoscopic removal of the button battery. It was noted on the operation note, that the oesophagus had “significant erosions” at approx. 23 cm and evidence of early stricture formation. On…

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The U wave and the ECG: Don’t miss this

The U wave is an often ignored deflection on the ECG. It is usually < 1mm, upright and has the same polarity(is in the same direction) as the preceding T wave(1). It is usually seen in the anterior leads V2-V3. It may be present in normal individuals and is sometimes ignored…… beware. Here is a quick look…

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Why are we still doing log roll, FAST and rectal exams?

In the blunt trauma patient, where we are considering a pan-scan, is there a role for the log roll, the FAST scan or the rectal examination any more? Case The ambulance phone rings: “ETA 15 minutes. We have a 25 year old male involved in a high speed motor vehicle accident. He has come off the…

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