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…
Here is a case, you are probably all familiar with: The police arrive with a patient that was “out of control”. He is known to take illicit substances. He went home earlier today, where he lives with his mother and ‘punched her in the face’, before running off. Police were called and he was later found naked,…
Perimortem cesarian section is a rare and stressful procedure that must be performed in a timely fashion to give both the mother and foetus, the best chance for survival. Its rarity makes it something we must talk about, so that if any of us are faced with it, we know what to do. The fact that…
Hyponatremia is a common electrolyte abnormality. It can be acute or chronic. It can occur in isolation or as part of other disease processes. Diagnosing its cause can be challenging in the Emergency Department and there may be some confusion over how to initially manage these patients. Let’s clear up that confusion, with a simple…
Convulsive Status Epilepticus accounts for up to 75% of all status epilepticus(1). We recognise it in patients where they have a depressed conscious state accompanied by tonic clonic movements of the extremities. The length of status epilepticus is important in terms of patient survival. About 5% of adults and up to 25% of children with epilepsy…
I go on about how important it is to be able to interpret blood gases, with our junior doctors and Fellowship Candidates. It can really change your diagnostic capabilities in the emergency department. Here is an interesting case, where gases solve the problem. A 30 yo woman is transferred to your emergency department. She has…
It is the festive season and with it, comes the patient that has more than their usual few drinks. They present to the emergency department soon after, with abdominal pain and nausea and when their lipase comes back; a diagnosis of pancreatitis. This disease carries an overall risk of mortality of 2%, but it may…
A Case of Severe Metformin Toxicity The call comes in just after midnight. A 67 year old male has been brought to the Emergency Department. He had complained of lower back pain, feeling unwell, with two episodes of vomiting. He arrived in the Emergency Department, aggitated, complaining of severe pain and having already been given,…
Introduction If find myself reaching more and more for the non-invasive ventilation, in the COPD patient. I’ve always loved it for acute pulmonary oedema. However, there is something about assisting the patient’s work of breathing, that allows me to ‘titrate’ what I give. A Case The ambulance bring a patient in on a rebreather. She…
The Shock Index. Do you use it? Do you know what it is? The Shock Index was originally used to predict shock in medical patients in the Emergency Department. It has also been evaluated for use in trauma and myocardial infarction. Although it’s been around for over 50 years it’s doesn’t appear to be widely used…
A new paper by the Resuscitation Outcomes Consortium (ROC) was published in the NEJM(November 9th 2015). Nichol et al looked at Trial of Continuous or Interrupted Chest Compressions during CPR and their effect on survival. This was a prospective randomised crossover trial of 26148 patients in the pre-hospital environment. In the test group, CPR was performed…
Last month, August 25th, the REVERT Trial was published in the LANCET. This study used a slight modification on the classic Valsalva manoeuvre, to more than DOUBLE the reversion rate from SVT. I’m excited about this. I don’t like giving drugs to patients if I don’t have to. Until Now… The normal cardioversion rates in…
