‘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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This is a great case that highlights how important it is, to know how to check if your ECG lead placement is correct. It also includes a rare case of dextrocardia. CASE A 39 yo male presented to the Emergency Department with crushing chest pain, that was associated with diaphoresis and shortness of breath. There…

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This is a fantastic case to learn from for a recent Circulation article(1) titled ‘An Ominous ECG Sign in Critical Care’. THE CASE A 35 year old woman, who is a known intravenous drug user, is admitted with septic shock secondary to bacterial endocarditis. She is acidotic and hypotensive. Her ECG is shown. Here are…

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We know that Double Sequential(DSED) External Defibrillation has been used primarily for the treatment of resistant ventricular arrhythmias. Here is a case study proposing its use in refractory atrial fibrillation(1) The case discussed is of a 56 year old patient with a history of paroxysmal atrial fibrillation on the background of ischaemic cardiomyopathy. The patient…

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Can Ketamine be used for the control of the agitated patient? CASE A patient is brought into the emergency department in an agitated state. There is a history of recent drug use, potentially amphetamines. The patient has been treated with Midazolam and doses of Droperidol are added. However there is a significant delay in the…

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Here are my top 8 tips for succeeding at intubation. 1. Use a Video Laryngoscope(VL), or at least have one nearby Okay, maybe a little controversial still.  But if there is some way that you can get your hands on one, have it on standby. In a  statement several years ago, Ron Walls said that VL…

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A recent clinical practice article in the NEJM(1) on Transient Ischaemic Attack (TIA) gave a nice summary of this topic. Current guidelines that are good reference sources on stroke and TIA management include: American Heart Association and the American Stroke Association (AHA–ASA),(2) NICE,(3) and the European Stroke Organization(4) Definition of TIA The new definition of…

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Hanging is one of the topics that comes up every now and then on an exam and infrequently into the emergency department. What are the key points? 2 Types of Hangings Suspension: rope tied around the neck and the person suspended so that the ligatures tighten. These are the most common forms of hanging presentation…

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This is a review of the updated guidelines on Diagnosis and Management of DVT and PE, which were released in March 2020 by the National Institute for Health and Care Excellence(NICE). They now incorporate the use of age adjusted D-dimers and the PERC(Pulmonary Embolism Rule-Out Criteria). They cover the management of different causes of thromboembolism…

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