Archives for March 2011

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Obstetric Evidence: What difference does a week make?

What difference does a week make?  Those of us who work in rural Obstetric services know the difficulties of planning for timely intervention and delivery of healthy babies.  The trend in recent years has been to “deliver if in doubt” after 37 weeks.  The thinking being that we have found  neonatal outcomes are pretty much […]

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Case 0003 – Beyond opiates in Chronic pain

63 yo man with advanced oesophageal cancer, diagnosed 18 months ago.  Now has extensive liver mets, retroperitoneal tumour and fungating open tumour in lower abdomen. Presents to ED Saturday morning with intractable visceral-sounding pain – “not responding to his usual pain tablets”.  So what is he taking for this pain : 2 x 80 mg OxyContin […]

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Case 0002 – Speeding on speed….

30 yo man with a past history of IVDU, infective endocarditis with mitral vegetations / scarring and “adult-onset ADHD”. Several recent admissions for SVT.  Presents to ED after consuming a handful of “LSD” in combination with his prescribed dexamphetamines.  Looking unwell, a bit angry, sweaty, pale, dilated pupils and a ventricular rate of 249!!  Normotensive, […]

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Raised Intracranial pressure – can we pick it with the US?

Working in small hospitals where CT is either not available or hard to get after 16:00 one of the big questions that I find myself asking with a lot of patients is this – “does this guy have raised ICP?” Common presentations where I find myself wondering:  the drunk, head-injured patient; the bad ‘migraine’ headache; […]

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Special K – ketamine is making a comeback – new, safer and smoother!

Ketamine for ED sedation – seems to be making a big comeback for pretty much anything you want it for. Check out the link below to a great review of recent study and the ED Updates guide to its use.  It has also been championed by Dr Weingart at EmCrit for use in “delayed sequence […]