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Posts by Dr Peter Kas

CRASH-3 Trial

The CRASH-3 Trial has been published. CRASH-2 demonstrated that early administration of tranexamic acid(within 3 hours of injury) reduced bleeding deaths by one third(1). In CRASH-3, the investigators looked at the effects of tranexamic acid in patients with potential traumatic brain injury. The Trial International, multi-centre, randomised, placebo-controlled trial Big Trial Eligibility criteria: Within 3…

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ECG predictors of Cardiac Arrhythmias in Elderly with Syncope

CASE A 72 yo woman presents to your emergency department following an episode of syncope. There was a brief 2-3 seconds of dizziness followed by a loss of consciousness. The patient did not complain of chest pain or palpitations, nor headache, nor abdominal pain and there was no weakness, or loss of function. There was…

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Diplopia

A patient presenting to the Emergency Department with diplopia can be a diagnostic challenge. Which patients need urgent imaging and which patients can be referred to outpatients? What is the imaging of choice? A recommended approach is shown below(1): As a summary: If it’s Binocular PLUS any of the abnormalities below, perform a CT brain…

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Brachial Plexus Block and its Complications

A 40 yo patient presents with a complaint of total arm paraesthesia and global loss of power. Over 16 hours previously she had a surgical procedure on her hand. A Brachial Plexus block (axillary approach), was used to provide anaesthesia. There has not been any return of function. On examination there is a total loss…

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Resuscitation Literature Review October 2019

This week, I wanted to quickly review some of the latest resuscitation literature. Let’s look at 3 studies. STUDY 1 Yamamoto M et al. Diagnostic value of lead aVR in electrocardiography for identifying acute coronary lesions in patients with out of hospital cardiac arrest. Resuscitation 2019 142:97-103 Background Emergency coronary angiography is currently recommended in…

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The Lewis Lead

The Lewis lead(1), is a means of detecting atrial activity and can be used where p waves are not readily evident. It is particularly helpful in wide complex tachycardias, where the presence of atrial activity can be used to exclude a diagnosis of ventricular tachycardia. It is meant to be seen on the cardiac monitor…

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Benediction Sign

The Benediction Sign is mistakenly called an Ulnar nerve injury. It is in fact a MEDIAN nerve injury at the level of the Elbow. It occurs as the median nerve supplies the lumbricals 1 and 2, which flex the the first 2 digits at the metacarpophalangeal joints. Another way to test this is to ask…

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ST Elevation in aVR

A 70 year old woman presents with severe shortness of breath and chest pain. She loses output briefly. Her ECG is shown below She has ST elevation in aVR. What is the diagnosis? Read below and then view the angiogram. We diagnosed critical Left Main Coronary Artery(LMCA) obstruction and urgently transferred the patient for angiography and…

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