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Seizure, Syncope and Sudden Collapse

Associate Professor Peter Kas presents Seizure, Syncope and Sudden Collapse. The patient with syncope or presyncope becomes a challenge in the emergency setting. Although this diagnosis is reported to comprise 5% of emergency presentations, it seems like so much more than this. This lecture looks at the definition of syncope, which comprises three elements: a sudden…

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Hypernatraemia

CASE A 76 yo woman is sent in from the nursing home with myoclonic jerks. She has a past medical history of slight dementia and seizures. Her GCS is 13-14/15. On arrival she has constant myoclonic jerks. Initial Blood tests reveal the following: Na 165 K 3.6 Cl 112 U 12 Cr 112 You make…

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A Man Walks Into a Hole.

We often start with a case and talk about a single topic. This case is a little different. It is a real-time case. What would you do with this patient every step along the way? In real life, things are not always clear-cut. Here’s the story of a man that walked into a hole and…

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Age-Adjusted D-dimer for ruling out pulmonary embolism

We use D-dimer in patients with a low probability of a pulmonary embolism, to rule out the condition and thus avoid imaging. The level of D-dimer rises with many conditions and also with age, thereby reducing it’s specificity for this condition. In a retrospective cohort study of D-dimer cut-offs, Ackerly et al(1)  compared three proposals for…

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Elbow Fractures

How good are you at reading elbow X-rays? Here are some tools and rules that will help you pick up those elbow fractures. Fractures of the elbow usually fall into the following groups: CHILDREN: Supracondylar fractures ADULTS: Radial Head Fractures ELDERLY: Multiple Fractures Fractures are a CLINICAL Diagnosis. The x-ray merely confirms that you have found it….

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Hypothermia

Hypothermia is defined as any core temperature < 35 degrees Celsius Today I wanted to look at a case and then discuss the controversies associated with the Management of Hypothermia. CASE: An 87 year old woman is brought to your emergency department. She has been found unconscious in the street by a passer by. She…

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Intraosseous Needle for Craniotomy

This week, I would like to present a case study by Bulstrode et al (Injury, Int. J. Care Injured 48 (2017) 1098–1100) on the use of the EZ-IO drill for drainage of an extradural haemorrhage.         The case is of a 43 yo pedestrian hit by a car at low speed. The…

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Maisonneuve Fracture

A Maisonneuve fracture is caused by pronation and external rotation. It can be difficult to find, even if we get fixated on the ankle. The patient may present with a complaint of rolling their ankle and ankle pain. Be vigilant for this type of injury. It is made of two main components: A spiral fracture of…

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Lateral Canthotomy

When and How to Perform a Lateral Canthotomy A 35 yo woman presents to your rural emergency department. She has recently had eye surgery at a large tertiary centre and has been allowed home. Her presentation to the emergency department is: Increasing Headache Left Eye Pain There is proptosis of the eye Restricted Extra-Occular Eye Movements…

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