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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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The Crashing Asthmatic Patient

The Crashing Asthmatic Patient is perhaps one of the most frightening of patients to treat. I’m not talking about the patient that has wheeze and gets five or six nebs and gets better in an hour. I’m talking about the sweaty, drowsy, tiring, non-responsive patient that you know has a good chance of dying. Here…

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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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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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More Non-Invasive Ventilation

Following the video on how to use non-invasive ventilation, I was asked to briefly again explain in graphical form how I see non-invasive ventilation as working. This is a very basic view. In terms of Non Invasive Ventilation, we can first start by thinking about CPAP (Continuous Positive Air Pressure) Ventilation. We can set this…

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How Big is that Pneumothorax?

Can you easily calculate the size of a pneumothorax? Does the size matter? Calculating the size has been difficult, as it requires formulas we don’t necessarily carry around in our heads; like the figure on the left. In most cases we approximate and say it’s about such and such a percent. I know in many…

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The Deep Sulcus Sign and more.

Have you ever had a chest X-ray in someone that might have a pneumothorax, but you couldn’t see it? I know I have. Today I wanted to mention three signs that might help: The first is the Deep Sulcus Sign. This is the more widely known. The other two signs are the Etched Diaphragm and…

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PE or NOT PE? That is the Question

Prasad. V., Rho J., Cifu A., A Metaphor for Medicine in the Evidence Based Medicine Era Achives Internal Med  Vol 172 (no 12) June 25, 2012TG 9† In this article the Authors from Chicago discuss how the concept of PE has changed over the last 100 years. Originally PE was diagnosed clinically with minimal or…

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TB in the ED

Case Presentation: During a recent shift as a VMO in an Eastern State Regional ED I was faced with a rarely encountered, clinically important and emerging clinical challenge. Many of you would have noted the increase in media attention to the problem of tuberculosis, and particularly multi-drug resistant TB (MDR TB). 4 recent cases of…

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V/Q or CTPA in suspected PE in pregnancy

OK here it is. The final word in investigating the pregnant patient with suspected pulmonary embolism. Well, it’s my final word anyway. I’ve spent the last month or so reviewing the literature on this. What amazes me, is that two people can quote the same study and come up with a different conclusion. The confusion appears…

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