The case A 51 year old male is brought into ED after collapsing at work. He had been lifting a box of shopping from the floor to a table when he collapsed. A colleague had heard a thud and entered the room to find the patient unresponsive on the floor with what sounds like agonal…
This week, I would like to present a case study by Bulstrode et al (Injury, Int. J. Care Injured 48 (2017) 1098–1100) on the use of the EZ-IO drill for drainage of an extradural haemorrhage. The case is of a 43 yo pedestrian hit by a car at low speed. The…
In the patient who presents with cariogenic shock, the cath lab and a stent or a CABG is probably the treatment of choice, however we don’t always have those luxuries. What inotrope(s) do we use in cariogenic shock? How do we approach those patients for the best outcome? Here is a recent case. It is…
A new study is about to be published which questions the use of current cervical spine clearance criteria in the elderly(1). It goes further, recommending “liberal c-spine imaging for older trauma patients with significant mechanism of trauma”. Here is a typical case: 74 year old patient from home, has had a mechanical fall from a…
HOT OFF THE PRESS Prandoni P et al. Prevalence of Pulmonary Embolism among Patients Hospitalised for Syncope. NEJM 375:16 Oct 20 2016. This is a big study in the NEJM, that a lot of people will pay attention to. The finding in a nutshell, was that Pulmonary Embolism(PE) occurs in 1 in 6 patients hospitalised…
Introduction Most of our treatment strategy in young children is based on our clinical judgement. The evidence on clearing cervical spines, in those older than 18 years, is clear, validated, accepted and is duty of care. The evidence for clearing the cervical spine is not as clear. It is even more obscure for less than 8 year…
Introduction Wolff-Parkinson-White Syndrome occurs in about 0.3% of the population (1), although this is an underestimate, as evidence of pre-excitation on the ECG my be transient. The characteristic delta wave indicates that the accessory pathway conducts faster than the Atrioventricular (AV) node, thus resulting in pre-excitation. However, the refractory period of the accessory pathway may…
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…
We have an update on the Management of Paracetamol Poisonings (MJA 203(5). 7 September 2015) (last update was in 2008) and it covers six main areas: Risk Assessment Charcoal Use Modified Release Paracetamol Large/Massive Ingestions Liquid paracetamol in children less than 6 years old. Consulting a Liver Transplant Unit Some Notes: In children less than 6…
We recently had a face to face day for our 6 Month Fellowship Course and the emotions and the feelings and even some of the stress of those days resurfaced in me, as we all sat around the table learning and reviewing key topics like ‘every ECG ever asked’, ‘every X-ray you could ever see’…
Differentiating between Pericarditis, Benign Early Depolarisation and ST Elevation Myocardial Infarction can sometimes be difficult. CASE A 35 yo male presents with palpitations and pleuritic chest pain. He’s recently had a viral illness but has no other medical history. At 1am in the morning, the patient was woken by palpitations. He now complains of left…
What differentiates Peri-orbital from Orbital Cellulitis is which side of the orbital septum the infection is on. The orbital septum is a layer of fascia that extends vertically from the periosteum of the orbital rim down to the elevator aponeurosis and the inferior border of the tarsal plate. Anatomically that’s great, but clinically it doesn’t…
