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Intraosseous Needle for Craniotomy

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…

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Cardiogenic Shock: Which Vasopressor to use

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…

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Asymptomatic Cervical Fractures in The Elderly

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…

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Wolff-Parkinson-White

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…

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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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The New Paracetamol Guidelines

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…

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Memories of the Fellowship Exam

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’…

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Pericarditis, Benign Early Depolarisation or STEMI

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…

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Peri-Orbital vs Orbital Cellulitis

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…

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MCQ EMQ SAQ

Let’s face it, everyone’s nervous about the new exam. What’s different, what isn’t? Everything is different, yet nothing is. The syllabus is still the same. The knowledge you need to have to practice as an Emergency Physician is still the same! But this is an exam that relies less on technique….sure there’s still some technique…

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