Patients that present with syncope can be challenging purely because syncope is a symptom, not a diagnosis. We need to find the cause. The most important causes to look for are CARDIAC. Why? Because cardiac syncope is an independent predictor of overall mortality and cardiac mortality. The cardiac causes include: Arrhythmias: ventricular and supraventricular Low…
What does this ECG show? Try it before you go on. From ‘theecglibrary.com’ Let’s use the ‘ECG in 20 Seconds’ approach. Step one: this is most likely an ischaemia or a PE given the history. Rate = 25 (complexes across the whole ECG) x 6 = 150bpm Rhythm = P waves are seen (best in…
The cervical spine continues to cause problems. Once we understand the basics, clearance of the cervical spine is not a mystery. A Recent Case An 8 year old child was brought into the emergency department following being involved in a motor vehicle accident. There was a closed head injury of significance and the GCS was…
I was teaching ‘The ECG in 20 Seconds’ the other day and again thought about how important the lead avR is. Also, how many times had I ignored it and how many times have you? In the patient that presents with suspected cardiac ischaemia, we should look at the vascular territories on the ECG. Anterior…
Came across this interesting X-ray the other day. These are PLOMBAGE balls. From the latin ‘plumbum’, meaning lead. Great if you can make the diagnosis on the X-ray. They are a form of treatment prior to the 1960′s for TB. It was believed at that time, that if an inert substance was placed in the…
A 2 year old girl is brought into the Emergency Department by her parents. She has recently had some coryzal symptoms. Today when the child was picked up from kindergarten, the parents noticed a lump on the left side of the neck. It had not been there the morning before. The child is febrile at…
In this video, Dr Sam Bendall presents one of many cases at our ECG workshop. This is now in our CARDIAC COURSE. This case involves the patient with inferior infarction and what else to look for, including posterior infarction and right ventricular infarction with a reminder to think of dissection. The management of these patients is…
One of the unfortunate consequences of busier ED’s is we do more of everything. Every shift, most of us see over 20 ECG’s, sometimes more. To perform we have to be faster and smarter – thus the 20 second ECG. See more, miss less. See more patients with less staff etc. We need to make…
The new Australian Resuscitation Guidelines are out. We were waiting to see if they took on the form of the Americal Heart Association or the European version. We tend to follow the European version. Here they are. The new guidelines recognise the need for continuous chest compressions as well as the need to minimise time…
A 63 year old woman presents to the Emergency Department with the complaint of diplopia. She is keeping her right eye closed.She awoke this morning and was seeing double. Her health is otherwise normal and her only past history is of a melanoma excised many years ago. Her Neurological examination in general is normal. Her eye…
It is sometimes called Erythema Multiforme Major and is a severe skin involvement with bullous skin lesions, more than 2 mucous membrane involvement as well as multisystem involvement.(Picture from Wikipedia) The aetiology is as for erythema multiforme. Clinically the patient may have fevers, arthralgias, headache and diarrhoea. The lesions may begin as macules and progress to bullae,…
An 8 month girl is brought to the Emergency Department by her parents. She has not been eating as much as usual over the previous 24 hours and has now decreased her fluid intake. She has had a fever of 38 and they are very concerned about this rash she has over her legs. It…
