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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Continuous CPR vs 30:2

Getting CPR right is important. We talk about rate and depth and recoil and duty cycle. All those things need to be right to achieve even low flow. Remember that even with the best CPR we may only achieve about 50% of normal cardiac output. Delaying CPR, taking inappropriate breaks and poor technique affect the…

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Why is the CO2 so high?

A 29 yo female presents with tachycardia and shortness of breath and some pleuritic chest pain. She has driven from interstate for the last 8 hours. Examination reveals vitals of: Heart rate of 108bpm sinus BP 105/68 Saturations of 87% on room air The physical examination is normal. The working diagnosis is a pulmonary embolism.…

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ACE Inhibitor mediated Angioedema

A 71 year old male with a history of COPD and heavy ongoing smoking habit, presented to the emergency department with a 3 hour history of tongue, mouth and throat swelling. He had awoken from an afternoon nap with the symptoms and initially refused to come to hospital. By the time he arrived he was…

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A Pregnant Patient with Chest Pain

A 27 yo 34/40 gestation G1P0 patient presented to the Emergency Department with central chest pain, with some radiation to between the scapulae. There was no shortness of breath or diaphoresis, nausea or vomiting or palpitations. The patient did not complain of leg pain. The registrar presented the case to me with the following findings.…

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The Davos Technique for Shoulder relocation

Patients with shoulder dislocations are not an uncommon presentations to the Emergency Department. The ability to reduce the shoulder depends on many factors which include whether the patient can Adduct or Abduct, how painful the dislocation is. We know that in some patients, small movements, even with analgesia, can be very painful, and others will…

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