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Seizure, Syncope and Sudden Collapse

Associate Professor Peter Kas presents Seizure, Syncope and Sudden Collapse. The patient with syncope or presyncope becomes a challenge in the emergency setting. Although this diagnosis is reported to comprise 5% of emergency presentations, it seems like so much more than this. This lecture looks at the definition of syncope, which comprises three elements: a sudden…

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Age-Adjusted D-dimer for ruling out pulmonary embolism

We use D-dimer in patients with a low probability of a pulmonary embolism, to rule out the condition and thus avoid imaging. The level of D-dimer rises with many conditions and also with age, thereby reducing it’s specificity for this condition. In a retrospective cohort study of D-dimer cut-offs, Ackerly et al(1)  compared three proposals for…

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VT vs SVT with Aberrancy

The following ECG was sent to me recently. It’s a great case and a situation that we can all be faced with. The question is: Is this VT or SVT with Aberrancy? The further question is; What do you do when your treatment isn’t working? An 80 year old male presents feeling unwell with palpitations….

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The ECG of Athletes: Normal variations you must know.

The ECG of the athletes can pose a challenge in distinguishing pathological changes from those physiological changes, that are associated with physical training and cardiac remodelling. We don’t want to erroneously attribute heart disease to those with normal variants and more importantly, we don’t want potentially life threatening cardiac conditions being erroneously dismissed as normal…

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Cardiogenic Shock: Which Vasopressor to use

In the patient who presents with cariogenic shock, the cath lab and a stent or a CABG is probably the treatment of choice, however we don’t always have those luxuries. What inotrope(s) do we use in cariogenic shock? How do we approach those patients for the best outcome? Here is a recent case. It is…

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Syncope

Syncope is one of those conditions you either love or hate. I certainly have at least five presentations of patients with syncope per shift. Having an approach to those patients certainly helps minimise missing the big stuff. Remember that syncope is a symptom and we need to find the diagnosis. The detective work is about…

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Wellen’s Syndrome

Wellen’s Syndrome is one of those syndromes that all emergency physicians know about. It’s probably also one of those syndromes that the emergency community introduced to clinicians everywhere. It was first described as an inverted U wave as early as 1980 and then introduced by Wellen in 1982 as Wellen’s syndrome, the name by which…

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Spodick’s Sign and Pericarditis

Spodick’s Sign appears in Stage I of Pericarditis and is a downsloping of the TP line ie., the baseline. It is said to be present in some 80% of cases of acute pericarditis and is best visualised in lead II and the lateral precordial leads(1).       The ECG findings of pericarditis are important…

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Which Patients with Pulmonary Embolism should get Thrombolysis?

The diagnosis of pulmonary embolism(PE) is an almost common occurrence in the emergency department. The question of which patients to thrombolyse can be a difficult one to answer. Certainly there is consensus over patients with massive PEs needing thrombolysis. The same cannot be said for those patients with a submissive PE, because our greatest fear is…

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How Dangerous is Pulmonary Embolism?

How Dangerous is Pulmonary Embolism? The diagnosis and management of pulmonary embolism(PE), like most things in emergency medicine; it’s about risk stratification. In chest pain, the low risk patient is approached very differently to the high risk, ST elevation chest pain patient. It is exactly the same in PE. There is that group of patients…

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