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Phenytoin and Levetiracetam: EcLIPSE and ConSEPT trials

Phenytoin and Levetiracetam: EcLIPSE and ConSEPT

There has been a longstanding discussion over which is the best second-line agent to use in paediatric seizures and more specifically in convulsive status epilepticus. We now have two trials that have tried to answer this question by comparing Phenytoin and Levetiracetam: The EcLIPSE(1) and ConSEPT(2) trials. Phenytoin and Levetiracetam: EcLIPSE and ConSEPT-The Bottom Line…

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Honey for Button Battery Ingestion?

A 25-year-old patient presents with recurrent lithium button battery ingestion. She had been admitted with the same presentation 3 week before and had undergone urgent endoscopic removal of the button battery. It was noted on the operation note, that the oesophagus had “significant erosions” at approx. 23 cm and evidence of early stricture formation. On…

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The U wave and the ECG: Don’t miss this

The U wave is an often ignored deflection on the ECG. It is usually < 1mm, upright and has the same polarity(is in the same direction) as the preceding T wave(1). It is usually seen in the anterior leads V2-V3. It may be present in normal individuals and is sometimes ignored…… beware. Here is a quick look…

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Why are we still doing log roll, FAST and rectal exams?

In the blunt trauma patient, where we are considering a pan-scan, is there a role for the log roll, the FAST scan or the rectal examination any more? Case The ambulance phone rings: “ETA 15 minutes. We have a 25 year old male involved in a high speed motor vehicle accident. He has come off the…

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Pregnancy and Trauma

Trauma in pregnancy is a much more complex topic than simply, ’tilt them on their side’. Trauma in the obstetric patient is a leading cause of non-obstetric mortality. The complexity of the obstetric trauma scenario relates to: Alterations in maternal anatomy and physiology The sensitivity of the foetus to hypotension and hypoxia. Issues of radiation…

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Capnography

Understanding capnography and being able to decipher the waveforms, can give us critical information on a patient’s condition, early. Below are 3 cases, where we look at some of the potential waveforms we might encounter in the intubated patient in the emergency department. What does it tells us? Capnography gives information on: Metabolism: Responsible for the…

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Is there anything New in Cardiac Failure?

In this video, A/Prof Kas looks at the new guidelines on heart failure and really shows that not much is new. The approach should still be: A decrease in preload /afterload- GTN A recruitment of alveoli by CPAP or BiPAP Frusemide but only recognised as a delayed working agent.

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The 6 Human Needs

As part of a talk on ‘Dealing with Difficult People’, I gave at EMCORE Hong Kong this year, I spoke about the 6 Human Needs and how they determine behaviour. This was all in the context of dealing with difficult colleagues and the potential psychopathic behaviour we sometimes see. The key here was that, although…

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Should we bring Bretylium back in cardiac arrest?

Following a brief presentation at EMCore Hong Kong in April of this year, that challenged our thinking, I have asked our expert colleague, Dr Will Davies, to expand on an argument he put forward, (in our clinical topics series), that we should revisit the use of bretylium tosylate in cardiopulmonary resuscitation, especially in the treatment…

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