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Diagnosing Ventricular Tachycardia in 5 easy steps

Here is a simple case of potential ventricular tachycardia(VT) How do you manage this? A patient has been brought into your resuscitation cubicle with the a complaint of palpitations. His ECG is as follows: The patient is obviously unstable, so the management decision is easy: ELECTRICITY. What if the patient is stable with a BP…

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Rapid IV Fluid Administration Does NOT Affect Neurological Outcome in Children with DKA

HOT OFF THE PRESS: A new clinical trial showing that rapid IV fluid administration does not affect neurological outcome in children with DKA, as has previously been thought. Clinical Trial of Fluid Infusion Rates for Pediatric Diabetic Ketoacidosis. N Engl J Med 2018; 378:2275-2287 The Numbers This was a randomised controlled trial in 13 centres….

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Pericardiocentesis

How to Perform Pericardiocentesis Pericardiocentesis is used to treat symptomatic pericardial effusions and cardiac tamponade. It was first described in the 1650’s and since the introduction of the subxiphoid approach in 1911, has been used very successfully, with significant reduction in morbidity and mortality. The use of echocardiography and other guidance techniques have reduced the…

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Neuro Exam Pearls: Upper limb

I don’t know about you, but I’ve always wanted to be able to perform a neurological exam and pick the lesion and look good doing it. Over the years I’ve tried to get better at it. What I have put together is a series of ‘PEARLS’ that sometimes help me decipher the cryptic world of…

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VAPOX and Ventilation During the Apnoeic Period

In Rapid Sequence Intubation(RSI), there is that period of apnoea that occurs following delivery of paralytics and prior to attempting laryngoscopy and intubation. It’s a period of 40 to 50 seconds, before we attempt to do anything. “Don’t bag!” we often scold. “It’ll fill the stomach and cause regurgitation and aspiration”…… In the background the patient’s saturations…

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The SIC KID

For years I’ve been speaking about the SIC KID Mnemonic. It’s time to see where we are at in 2017. When was it to be used? To be used as a memory aid in the crying child, where we weren’t sure of the diagnosis. Let me remind you of what the letters stand for: S –…

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Should we intubate in the ramped position?

I’ve spoken on awake intubationat the EMCORE Conferences, especially at the last Masterclass. I also spoke about the potential benefits of intubating patients in the ramped positionie., head of the bed up at 25-30 degrees. Mostly this is based Off studies, using operating theatre patients that have already been intubated, then disconnected from oxygen sources and observed to see how long…

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5 Things to Think About in a Wheezy Child

Minimal Handling Stop touching the patient.  Often enough in paediatrics, more is not better. This is of key importance in the younger age group. The more lights/monitors and hands on assessment – the more distressing to the child. The more distress – the greater the effort of breathing becomes.  Most children with wheeze are best…

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Zipper Injuries

This blog is often full of new evidence from high quality trials and literature reviews as well as clinical pearls to help enable us to choose wisely with our sickest patients, usually those in the resus bay. That being said, for most emergency physicians, perhaps up to a third of their clinical time, may be…

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Contrast Induced Nephropathy: Is it Real?

You are managing a trauma and request a CT abdomen to exclude an intra-abdominal injury. The radiology registrar asks about the patients’ renal function. Sound familiar? The good news is that the scan go ahead without knowing the renal function. This is supported by the current guidelines of the Royal Australasian and New Zealand College…

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Fixed Dilated Pupils

Head injury with fixed dilated pupils: Are we done? We have looked at the pupillary response before on this blog in terms of the Doll’s Eye Reflex in brainstem death and the oculocephalic reflex. However, what if the pupils are fixed and dilated? We seem to learn quite early in our medical careers that fixed…

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