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Head-Up CPR

You may have heard of Head-Up CPR as a new approach to patient positioning during CPR. It may not be totally prime-time yet(although it is being used right now), but it is, thinking outside the box and concentrating on the most important part of what cardiac resuscitation is about…. saving the brain. If we go…

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Phlegmasia Cerulean Dolens

CASE A 35 yo woman presents with a painful blue swollen leg, that occurred rapidly, the evening before. There is little relevant past history and the patient is on the oral contraceptive pill. Examination reveals a dusky, blue left leg, that is swollen in comparison to the other side. Pulses are present and the patient in neurologically…

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Resuscitation:The Outer limits

Resuscitation is reaching new limits, with new techniques and technologies giving results that we never thought possible. In Lazarus-like fashion, patients that a few years ago, would have been pronounced deceased, are now leaving hospital to resume their lives, with their families and their work and with very little, if any, deficit. About 8 years ago I…

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The ‘Lightbulb Sign’ doesn’t always mean a posterior dislocation

A 35 yo woman presents to the emergency department with a complaint of shoulder dislocation. There is a previous history of multiple dislocations, including two posterior dislocations. There has been no trauma, or seizure or other major force, as might be expected to cause a posterior dislocation, although posterior dislocation can occur in the absence…

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Will Paramedic-2 change my practice?

If you haven’t caught the newly published Paramedic-2  trial, here’s a brief rant that tells you everything you need to know. The ostensible reason for the publication has been the ongoing debate about the role of adrenaline in cardiac arrest. In fact the very first line of the paper reads “concerns about the use of…

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The Patient with Diplopia

A 58 yo male presents to the emergency department with an 8 hour history of diplopia. He has no past medical history, has no allergies and is on no medications. He denies any recent illness or trauma. Recently a great journal article was brought to my attention and I thought everyone should hear about it….

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A 51 year old with collapse

The case A 51 year old male is brought into ED after collapsing at work. He had been lifting a box of shopping from the floor to a table when he collapsed. A colleague had heard a thud and entered the room to find the patient unresponsive on the floor with what sounds like agonal…

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A 29 yo male with sudden onset of flaccid paralysis

The Case A Previously well 29 year old male awoke at 0630hrs unable to move his torso or limbs. His initial complete paralysis had lessened somewhat after 2 hrs and he had managed to reach the phone and call for help. When the ambulance service arrived and forced entry he was found on his bed…

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A new DAWN for stroke treatment

Last week we looked at a case study involving a patient who awoke with stroke symptoms. In these cases there has been little to offer patients. Thrombolysis has no application here, given its 3-4 hour window. Endovascular mechanical thrombectomy has been hailed as the new treatment. Until January of 2018, trials in this area demonstrated…

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