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Zipper Injuries

This blog is often full of new evidence from high quality trials and literature reviews as well as clinical pearls to help enable us to choose wisely with our sickest patients, usually those in the resus bay. That being said, for most emergency physicians, perhaps up to a third of their clinical time, may be…

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Postobstructive Diuresis

Postobstructive diuresis can occur following relief of urinary obstruction. It isn’t rare and can be potentially lethal. CASE A 65 year old male presents to the emergency department with a one day history of dysuria. He is diagnosed with a urine infection,  commenced on oral antibiotics and has an appointment made the next day for…

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Priapism: How To Treat It.

CASEA 46 year old man presented to our ED mid morning complaining of a persistent erection since 10pm the night before, when he had injected 20ml of alprostadil (“Caverject”) into his penis. He had not experienced any detumescence, and was quite distressed. We all know the solution to the problem – just drain the corpus…

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Bedside Ultrasound and Renal Colic

Can Bedside Ultrasound be a Tool in the Assessment and Management of Renal Colic? Bedside ultrasonography (BUS) has become a significant tool in the diagnostic repertoire of the emergency physician in recent years. Over the same period the use of, and potential risks of, CT imaging have come to the fore. Since the mid-1990s CT…

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The suprapubic just won’t go in!

Here’s the typical case: “Doctor, I’ve had a suprapubic in for some time and have been having it changed at home. I usually have a size 16, but last time they put in a 14. Today, they couldn’t change it and it’s been out all day. Can you please put a new one in?” The…

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Beware of making the diagnosis of renal colic!

Sometimes a little knowledge can be dangerous. Beware of just knowing the percentages, know to apply them in the clinical context.

I was recently handed over a patient who had presented with abdominal pain. The patient was reported as having some left sided abdominal pain and pain on left kidney ballottement. The diagnosis of renal colic colic had been made. The patient was being treated with oral analgesia with a view to going home when pain was under control.

The past history the patient gave was a hysterectomy a few years prior, with a complication of hernia, and a further complication of infection, post hernia repair. She had also had a secondary in the lung for which she had had a lobectomy. She did give a history of left renal colic some 19 years previously […]

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