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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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Brugada Syndrome

A 25 year old male presents to the emergency department following a near syncopal episode. His ECG shows a supraventricular tachycardia(SVT). Vagal manoeuvres are attempted, unsuccessfully. Adenosine is then given for reversion. He reverts and his post-reversion ECG is shown below. One of the registrars is concerned that the ECG is showing a Brugada pattern.…

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11 Things to Maximise Adult Cardiac Resuscitation

INTRODUCTION I was recently speaking with a colleague, about a recently published paper on ‘ideal’ compressions and depth combinations in cardiac resuscitation and I was ranting away.  She asked if I would write down the things I was ranting about, as she had found them helpful. So here goes, a short list of my 11…

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Double Sequential External Defibrillation

Double sequential external defibrillation

Double Sequential External Defibrillation(DSED) is a means of administering sequential shocks to terminate shock resistant ventricular fibrillation. It is a controversial topic, with no robust studies. Resistant ventricular arrhythmias are different to electrical storm(1). Electrical storm is a state characterised by recurrent occurrences of unstable ventricular arrhythmias, over a short period of time. This is…

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Complications of Bariatric Surgery

Complications of Bariatric Surgery

In this blog we discuss the various complications of Bariatric Surgery. Bariatric surgery is one of the fastest growing areas of surgery. As with all surgical procedures, there is the possibility of postoperative complications. Emergency physicians should be familiar with the common problems encountered, limitations of conventional investigations, and the management of these complications, which…

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Gilula’s Carpal Arcs

Third carpal arch

Gilula’s carpal arcs are used to determine carpal alignment. They can assist in identifying ligamentous injury, dislocations and fractures of the carpus on X-ray. They are of used in the sometimes difficult to interpret x-rays of the carpal bones. As we will see below, the carpal arcs act similarly to the raised fat pad sign(sail…

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Runaway Pacemaker and Lethal Arrhythmia

pacemaker

A potential complication of a failing pacemaker, is a condition known as ‘Runaway Pacemaker’. Below are two cases from the literature, that demonstrate a runaway pacemaker causing a potentially lethal ventricular arrhythmia. Whenever we look at an ECG, we always look for the pacing spikes. These may not be visible, especially if the patient’s rate is…

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Hypertensive Emergencies and how to treat them

hypertensive emergencies

Hypertensive emergencies are defined as sudden and prolonged increases in the arterial blood pressure, with associated organ damage. The degree of increase above that which the patient normally has, and the degree and duration of the rise are not usually taken into account. No single figure for blood pressure is usually defined, however if a…

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