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Intraosseous Access Results In Decreased Survival In Cardiac Arrest

A new study shows a decreased survival in out of hospital cardiac arrest(OHCA) when intraosseous(I/O) access is used instead if intravenous(IV) access as a means of delivering fluids and medications. I/O lines provide rapid access where IV is not available and are progressively being used as the first line of access, primarily because they are quick, easy, don’t interfere…

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Paediatric Heart Conditions You MUST KNOW

Congenital heart conditions present at birth, but can also present within the first month of life. We look at a simplified approach to the assessment and management of patients presenting with symptoms of congenital heart disease. In this video Dr Claire Wilkins, talks about these conditions and spits them into three categories: Patients presenting with SHOCK…

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Myocarditis

Myocarditis is simply an inflammation of the heart muscle, that can lead to myocardial cell damage, myocardial dysfunction and heart failure. A Recent Case A 15 yo male presents to the emergency department with sharp central chest pain that is worst on inspiration. The pain has woken him from sleep. There is no radiation although…

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Should We Shock Patients in Asystole?

Should cardiac arrest patients in asystole be shocked? Is there any advantage to this? What do we know about asystole in cardiac arrest? Patients in asystole are known to have a very poor prognosis, with 0% to 2% surviving to hospital discharge. There is a slightly better prognosis if the rhythm converts spontaneously to a shockable rhythm…

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Fever in the ED

Fever In The Emergency Department We like to see things as binary in the ED, troponins, d-dimers, CTPA they all give yes no answers. We often treat fever in a similar way, fever = infection just like our mothers taught us. But are we any better than a hand on the forehead, can we use temperature…

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Syncope Rules

Patients presenting with syncope to the Emergency Department can pose a significant diagnostic challenge. The two main reasons for this are: Syncope is a symptom, not a diagnosis. We need to search for the underlying cause. Adverse events can occur, when none are obvious or predictable during our Emergency Department evaluation. We know that the rate…

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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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