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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 Cervical Spine: The Iconoclasm Continues

In recent blogs I suggested that clinically significant C spine injuries can be excluded by CT scan in the intoxicated patient and Luke Lawton raised the suggestion that the hard collar may not be as efficacious as we were led to believe in our youth. One of the questions that the C spine blog attracted…

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How Important is a C-Spine Collar….really?

In preparation for EMCORE Hong Kong 2018, I took some time to sit down and revisit how and why we do one of the oldest rituals in trauma medicine – applying a rigid c-collar. I still remember as a junior doctor being taken through the rigorous method of application….measure up properly, hold the head steady,…

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Cervical spine clearance in the intoxicated patient

The most commonly used c spine clearance rules exclude or mandate imaging in the case of the “intoxicated” patient, and there is debate as to whether a normal CT C spine is adequate to clear the neck of the intoxicated patient in blunt trauma.(1,2) Many clinicians advocate either waiting for intoxicants to clear before clinically…

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Maisonneuve Fracture

A Maisonneuve fracture is caused by pronation and external rotation. It can be difficult to find, even if we get fixated on the ankle. The patient may present with a complaint of rolling their ankle and ankle pain. Be vigilant for this type of injury. It is made of two main components: A spiral fracture of…

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Unstable Trauma Patient: The Surgeon wants a CT

Introduction What if we had a tool that allowed identification of haemorrhage source, in trauma patients with no obvious primary source or with potentially multiple sources of bleeding? Who would gain the most from this?…..The sickest and most unstable patients obviously. Well we do have such a tool!…….It’s the CT Scanner. Who are the sickest…

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Airbag Injuries: Think Carotid Artery Dissection

Introduction Airbags have had a significant effect on decreasing fatalities in high speed motor vehicle collisions. However they are also responsible for injuries, in most cases minor, in approximately half the cases where they are deployed. Not wearing a seat belt and sitting less than 25cm from the bag, predicts a subgroup of patients that…

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Unstable Pelvic Fractures

Pelvic fractures are most often associated with massive trauma. In terms of skeletal injuries they account for about 3% of all injuries. However they have the potential to result in haemodynamic instability, leading to significant mortality. Approximately 10 years ago the mortality from multi trauma with pelvic ring disruptions and haemorrhagic shock approached 60% (J…

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Hip Relocation Made Easy

Here is a 3 minute video on the Whistler technique for putting in hips. Its quick and easy and really doesn’t allow you to hurt yourself. You use your legs to give you the traction. Just watch and see. Try it for yourself. I call it the under-over technique: I put my arm UNDER the…

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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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Carotid Dissection-When to Suspect, When to Scan.

Have you ever wanted to order a test, especially a radiological one and after hours at that and were made to feel inept, for asking? It’s after 11pm, here’s the how the conversation goes: PK: “Hello Dr (fill in space) PK here, one of the ED consultants. Sorry to bother you, but I wanted to…

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Cement Burns: “She’ll be right mate”. Maybe not.

Here is the case. A 48 year old man presents with some redness and burns on his lower limbs. He was using cement one day previously, laying a concrete slab and standing in it, his denim pants soaked. He felt some mild discomfort at the time, but now that he has seen his legs, he…

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