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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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Treating Patients on Stimulants

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,…

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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…

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Status Epilepticus

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…

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Lactation Ketoacidosis

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…

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Fluid Resuscitation in Pancreatitis

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…

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Non-Invasive Ventilation

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…

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The Shock Index to predict hypotension

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…

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Continuous vs Interrupted CPR for Survival

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…

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