What is Bell’s Palsy? It is an ipsilateral Cranial Nerve VII (lower motor neurone) palsy. There is usually a sudden onset of facial weakness, that progressively worsens over 48 hours. The diagnosis itself, is one of exclusion. CASE A 60 yo male presents to the emergency department, with a 2 day history of progressive right facial…

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When examining a patient with a facial nerve palsy and we wish to determine if the lesion is central or peripheral, we are often told do not ask the patient to smile. It always seemed strange to me. Here’s the reason…. When examining a patient with facial weakness, with a potential central cause, we need to…

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An excellent review article on Trigeminal Neuralgia, has just come out in the NEJM(1). Here is a quick summary. FACTS Usually affects the mandibular or maxillary division of the Trigeminal Nerve F>M Right face > left. Bilateral is rare – look for other causes CLINICAL PICTURE Trigeminal Neuralgia is diagnosed clinically and must have 3…

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A 50 male patient is brought to your emergency department by ambulance post cardiac arrest. He has an adrenaline infusion running at 100mcg/min, has been intubated in the field by paramedics and has had a protracted resuscitation period with 10mg of adrenaline given in the field, for repetitive loss of ROSC. The patient is very…

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You’ve had a horrible, horrible shift. The resus went wrong, you couldn’t intubate, the ortho reg was a schmuck. You were glad to finish your shift. You head for the carpark and you can’t wait to get home… You get to your car and you’ve got a flat. You fu%7*g piece of s!$t. You get everything out of…

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You’ve had a horrible, horrible shift. The resus went wrong, you couldn’t intubate, the ortho reg was a schmuck. You were glad to finish your shift. You head for the carpark and you can’t wait to get home…you’ve got to study for this exam. You get to your car and you’ve got a flat. You fu%7*g piece of…

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We often see patients presenting with SVT. They often have ST changes, so we have to ask; Is SVT an ischaemic arrhythmia? The answer is no, but beware as it can trigger ischaemia. Let’s look at some cases. ST segment depression occurs during supraventricular tachycardias but is transient and usually resolves following conversion to sinus…

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Compartment Syndrome, is usually straightforward to pick up. How do we measure Compartment pressures? Below is a MacGyver setup. CASE A 21 yo male presents to the emergency department with a very painful leg. He was tackled to the right lower leg the day before, in a game of football. He continued to play at…

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‘Nanging’ is the recreational use of nitrous oxide. That cylinder you have in your emergency department and use for some uncomfortable procedures, especially on children…..that nitrous is now being abused on the street, with some disastrous consequences. It’s nothing new. It’s been going on for some time. However recently, there has been a startling growth…

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