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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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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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The Unstable Atrial Fibrillation Patient

THE CASE A 75 yo man is brought into your small rural ED after 3 hours of ischemic chest discomfort.  His background is significant for hypertension, a CVA 5 years ago for which he is on aspirin/dipyrimidole, and 2 coronary artery stents in 1995.  The ambulance officers found the patient to be in AF, with…

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Are You Still Feeling For A Pulse? Stop It!

I remember years ago when we used to manage cardiac arrests and everyone was asked to stop compressions while someone felt for a pulse. Do you remember that? “I think I feel one. I wonder if that’s mine? Can someone else feel please?” Meanwhile time with no CPR passed. Today with the push for cardiocerebral resuscitation…

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Pulseless Electrical Activity

Pulseless Electrical Activity(PEA) occurs in about 30% of cardiac arrest cases. Given that it’s not a shockable rhythm, it has a very poor prognosis, especially when associated with acute myocardial Infarction(MI)(1). More recently, the term pseudo-PEA, is used for those patients where we can’t find an output by feeling for a pulse, but there may in fact be…

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Massive Propranolol Overdose

Massive propranolol overdose is perhaps one of the most challenging overdoses to manage. In 2009 we posted a case we had. We have progressed in our management since then. CASE A 26 yo woman is brought to the ED by ambulance. She has been found by her mother in her bedroom in a confused state….

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Hypernatraemia

CASE A 76 yo woman is sent in from the nursing home with myoclonic jerks. She has a past medical history of slight dementia and seizures. Her GCS is 13-14/15. On arrival she has constant myoclonic jerks. Initial Blood tests reveal the following: Na 165 K 3.6 Cl 112 U 12 Cr 112 You make…

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Hypothermia

Hypothermia is defined as any core temperature < 35 degrees Celsius Today I wanted to look at a case and then discuss the controversies associated with the Management of Hypothermia. CASE: An 87 year old woman is brought to your emergency department. She has been found unconscious in the street by a passer by. She…

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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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