20 posts · 16,267 views
Medical Blog was born out of passionate (and usually unresolved) debate pertaining to the elements of eLearning; clinical cases; ECG interpretation; medical education; toxicology; medical history and information sharing strategies in the open source era.
sandnsurf
20 posts
Chris Nickson
0 posts
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- May 7, 2010
- 08:59 PM
- 1,127 views
Emergency marketing in just 4 hours!
by sandnsurf in Life in the Fast Lane
Selling patients is sad reality of life as an emergency doctor, will things be worse when the four hour rule is adopted Australia wide?... Read more »
Innes G. (2000) Successful hospitalization of patients with no discernible pathology. CJEM : Canadian journal of emergency medical care , 2(1), 47-51. PMID: 17637127
Nugus P, Bridges J, & Braithwaite J. (2009) Selling patients. BMJ (Clinical research ed.). PMID: 20008442
- January 13, 2010
- 08:48 PM
- 1,110 views
Are Redheads Bleeders?
by sandnsurf in Life in the Fast Lane
I first became aware that redheads were treated differently in medicine when I started hanging around anaesthetists. Most anaesthetists i know tend to get slightly more uptight when they see the phaeomelanin-laden locks of a freckled UV-sensitive patient. Especially in obstetrics. Why is this you ask?... Read more »
Liem EB, Lin CM, Suleman MI, Doufas AG, Gregg RG, Veauthier JM, Loyd G, & Sessler DI. (2004) Anesthetic requirement is increased in redheads. Anesthesiology, 101(2), 279-83. PMID: 15277908
- January 31, 2010
- 01:03 PM
- 1,023 views
Gastrointestinal Gutwrencher #001
by sandnsurf in Life in the Fast Lane
A 50 year-old man presented to the ED with sharp abdominal pain localised to his left lower quadrant.
Related posts:Pulmonary Puzzle #003
Trauma Tribulation #004
To Err is Human #001
... Read more »
Sand, M., Gelos, M., Bechara, F., Sand, D., Wiese, T., Steinstraesser, L., & Mann, B. (2007) Epiploic appendagitis – clinical characteristics of an uncommon surgical diagnosis. BMC Surgery, 7(1), 11. DOI: 10.1186/1471-2482-7-11
- January 7, 2010
- 03:13 AM
- 1,008 views
Don’t put your Patient in a Box
by Chris Nickson in Life in the Fast Lane
The fourth rule of Expensive Scare Medicine: 'If you measure something and it is not normal, make it normal if it is safe to do so'. But beware! This can lead to a dangerous and insatiable desire for 'euboxia' - the pathophysiological state whereby 'all boxes on a pathology print-out are in the normal range'.... Read more »
Reade MC. (2009) Should we question if something works just because we don't know how it works?. Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine, 11(4), 235-6. PMID: 20001869
- May 17, 2010
- 08:44 PM
- 938 views
ED Registrar’s Guide to Clinical Teaching
by sandnsurf in Life in the Fast Lane
A guide for emergency medicine registrars and residents on how to be an effective clinical teacher.... Read more »
Houghland JE, & Druck J. (2010) Effective clinical teaching by residents in emergency medicine. Annals of Emergency Medicine, 55(5), 434-9. PMID: 20031266
- February 8, 2010
- 07:48 PM
- 883 views
Pediatric Perplexity #001
by sandnsurf in Life in the Fast Lane
A 7 year-old girl was brought to hospital with lethargy, irritability and vomiting. A week previously she developed chicken pox, and was treated with regular aspirin and paracetamol for fever and discomfort.... Read more »
Glasgow JF, & Middleton B. (2001) Reye syndrome--insights on causation and prognosis. Archives of disease in childhood, 85(5), 351-3. PMID: 11668090
Schrör K. (2007) Aspirin and Reye syndrome: a review of the evidence. Paediatric drugs, 9(3), 195-204. PMID: 17523700
- May 15, 2010
- 08:35 PM
- 877 views
Getting into hot water
by sandnsurf in Life in the Fast Lane
With ongoing climate change we may find soon find ourselves getting into hot water --- both literally and metaphorico-toxinologically. Sea surface temperature appears to predict the arrival of the box jellyfish at Australia's tropical beaches.... Read more »
Jacups SP. (2010) Warmer Waters in the Northern Territory Herald an Earlier Onset to the Annual Chironex fleckeri Stinger Season. EcoHealth. PMID: 20376549
- January 7, 2010
- 05:14 PM
- 876 views
Ophthalmology Befuddler #001
by sandnsurf in Life in the Fast Lane
An medical student on your team asks you to review an 81 year-old female who speaks little English. She was BIBA to the ED following a fall. Her nursing home transfer sheet says that the fall was witnessed: she tripped and there was no loss of consciousness. The student is concerned that the patient's right pupil is fixed and slightly dilated in the presence of facial abrasions.... Read more »
Hunter, T., Yoshino, M., Dzioba, R., Light, R., & Berger, W. (2004) Medical Devices of the Head, Neck, and Spine. Radiographics, 24(1), 257-285. DOI: 10.1148/rg.241035185
- June 16, 2009
- 12:00 AM
- 870 views
Cement Embolus
by sandnsurf in Life in the Fast Lane
A 62 y/o caucasian female (Mrs S) presented to the Emergency Department with sudden onset of dyspnoea and local back pain. The patient had sustained a compression fracture of the 5th lumbar vertebral body 2 months previously and had Percutaneous Vertebroplasty (PVP) performed 4 days prior to her ED presentation.... Read more »
Kim, Y., Lee, J., Park, K., Yeom, J., Jeong, H., Park, J., & Kang, H. (2009) Pulmonary Cement Embolism after Percutaneous Vertebroplasty in Osteoporotic Vertebral Compression Fractures: Incidence, Characteristics, and Risk Factors. Radiology, 251(1), 250-259. DOI: 10.1148/radiol.2511080854
- September 14, 2009
- 12:00 AM
- 820 views
Isolated Volar Distal Ulnar Dislocation
by sandnsurf in Life in the Fast Lane
Dislocation of the distal radio-ulna joint (DRUJ) is an extremely rare injury, particularly when it occurs without associated fractures of the distal radius and ulna. Isolated volar dislocations of the ulna in relation to the radius are much less common than dorsal dislocations because specific mechanisms are required to generate such an injury. As a result of this, plus the subtlety of clinical signs, they are missed in as many as 50% of cases in the acute period, delaying appropriate treatment.... Read more »
Mittal R, Kulkarni R, Subsposh SY, & Giannoudis PV. (2004) Isolated volar dislocation of distal radioulnar joint: how easy to miss!. European journal of emergency medicine : official journal of the European Society for Emergency Medicine, 11(2), 113-6. PMID: 15028903
- February 1, 2010
- 07:11 PM
- 814 views
Metabolic Muddle #004
by sandnsurf in Life in the Fast Lane
You are asked to review a 73 year old lady who is in hospital for treatment of septic arthritis affecting a prosthetic right hip joint inserted 5 years earlier. The joint has been washed out and debrided twice, and she is receiving IV flucloxacillin and meropenem following culture of a methicillin-sensitive Staphylococcus aureus. She is on regular paracetamol for pain. Unfortunately, she has continued to deteriorate...
Related posts:Metabolic Muddle #003
Metabolic Muddle #001
Metabolic Muddle #002
... Read more »
Dempsey GA, Lyall HJ, Corke CF, & Scheinkestel CD. (2000) Pyroglutamic acidemia: a cause of high anion gap metabolic acidosis. Critical care medicine, 28(6), 1803-7. PMID: 10890623
Mizock BA, & Mecher C. (2000) Pyroglutamic acid and high anion gap: looking through the keyhole?. Critical care medicine, 28(6), 2140-1. PMID: 10890683
Peter JV, Rogers N, Murty S, Gerace R, Mackay R, & Peake SL. (2006) An unusual cause of severe metabolic acidosis. The Medical journal of Australia, 185(4), 223-5. PMID: 16922670
- May 10, 2010
- 09:15 PM
- 742 views
Anaesthetic Addler 001
by sandnsurf in Life in the Fast Lane
A case-based Q-and-A on procedural sedation using ketamine to remove a button battery from a child's nose. What would you do? What if laryngospasm occurs?... Read more »
GREEN, S., & JOHNSON, N. (1990) Ketamine sedation for pediatric procedures: Part 2, review and implications. Annals of Emergency Medicine, 19(9), 1033-1046. DOI: 10.1016/S0196-0644(05)82569-7
- May 16, 2010
- 09:42 PM
- 736 views
When the elephant awakens…
by sandnsurf in Life in the Fast Lane
A chronic shortfall in doctors has led to a great increase in new medical graduates in Australia. What does this mean for emergency medicine and the training of junior doctors?... Read more »
Chong, A., Weiland, T., Mackinlay, C., & Jelinek, G. (2010) The capacity of Australian ED to absorb the projected increase in intern numbers. Emergency Medicine Australasia, 22(2), 100-107. DOI: 10.1111/j.1742-6723.2010.01268.x
- May 30, 2010
- 09:35 PM
- 711 views
Ethylene glycol inebriation
by sandnsurf in Life in the Fast Lane
A year-old boy is 'off his face' after drinking what looked like a nice bottle of cordial. It was actually radiator coolant. You are called for advice.... Read more »
Lepik KJ, Levy AR, Sobolev BG, Purssell RA, DeWitt CR, Erhardt GD, Kennedy JR, Daws DE, & Brignall JL. (2009) Adverse drug events associated with the antidotes for methanol and ethylene glycol poisoning: a comparison of ethanol and fomepizole. Annals of emergency medicine, 53(4), 439-2147483647. PMID: 18639955
- June 1, 2010
- 08:42 PM
- 675 views
Seafood poisoning
by sandnsurf in Life in the Fast Lane
A couple present to the ED with vomiting and paraesthesiae after eating at a seafood restaurant. Can you help them by solving the seafood poisoning conundrum?... Read more »
Friedman MA, & et al. (2008) Ciguatera fish poisoning: treatment, prevention and management. Marine Drugs, 6(3), 456-79. PMID: 19005579
- February 4, 2010
- 07:22 PM
- 665 views
Toxicology Conundrum #024
by sandnsurf in Life in the Fast Lane
A 23 year-old male is brought to your ED by a friend. He appears anxious, distressed and confused. His friend volunteers that the patient had seen a GP in the past few weeks as he was feeling depressed. The friend also admitted that the patient occasionally used recreational drugs such as marijuana and ecstasy. Further of examination of the patient was notable for the presence of shaking eye movements, brisk deep tendon reflexes and stiffness of the lower limbs...
Related posts:Toxicology Conundrum #017
Toxicology Conundrum #023
Toxicology Conundrum #014
... Read more »
Boyer EW, & Shannon M. (2005) The serotonin syndrome. The New England journal of medicine, 352(11), 1112-20. PMID: 15784664
Dunkley EJ, Isbister GK, Sibbritt D, Dawson AH, & Whyte IM. (2003) The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic decision rules for serotonin toxicity. QJM, 96(9), 635-42. PMID: 12925718
Isbister GK, Buckley NA, & Whyte IM. (2007) Serotonin toxicity: a practical approach to diagnosis and treatment. Medical Journal of Australia, 187(6), 361-5. PMID: 17874986
- February 24, 2010
- 03:45 AM
- 656 views
Toxicology Conundrum #028
by sandnsurf in Life in the Fast Lane
A pharmacist in the Gibson Desert wanted to take part in the recent mass homeopathic overdose protest organized by the 10:23 movement. Unbeknown to him, the cleaning lady had been around and accidentally mixed up the homeopathic pills with slow release verapamil. After gulping down a couple of handfuls of pills, the pharmacist's heightened gustatory awareness alerted him to the presence of verapamil in the tablets. Although he remains asymptomatic, he has a feeling that something bad might happen.
Can you answer these questions and help stop the unfortunate pharmacist from biting the dust?...
Related posts:Insulin for verapamil overdose
Toxicology Conundrum #022
Toxicology Conundrum #023
... Read more »
Nickson CP, & Little M. (2009) Early use of high-dose insulin euglycaemic therapy for verapamil toxicity. The Medical journal of Australia, 191(6), 350-2. PMID: 19769561
- May 19, 2010
- 03:53 PM
- 591 views
Toxicology Conundrum 033
by sandnsurf in Life in the Fast Lane
Two chloroquine tablets have gone missing and the 2 year-old suspect is 'keeping mum' about it. Now what do you do? What if life-threatening toxicity occurs?... Read more »
Riou B, Barriot P, Rimailho A, & et al. (1988) Treatment of severe chloroquine poisoning. The New England journal of medicine, 319(1), 49-51. PMID: 3132617
- January 18, 2010
- 03:10 AM
- 583 views
Signs of Imminent Admission
by sandnsurf in Life in the Fast Lane
Having trouble complying with the new 4 picosecond rule introduced by UCEM? Do not fret, you can improve your department's efficiency a thousandfold by religiously employing the 'Signs of 'Imminent Admission' as a disposition decision aid.... Read more »
Silverman JA, Kohn ML, & Referrals From the ER (REFER) Investigators. (2000) Will this emergency department patient be referred to internal medicine?. CMAJ : Canadian Medical Association journal , 163(12), 1566-7. PMID: 11138414
- February 6, 2010
- 05:23 AM
- 562 views
Sternoclavicular Joint Dislocations
by sandnsurf in Life in the Fast Lane
Sternoclavicular dislocation is a relatively uncommon injury that can be easily missed or misdiagnosed. The importance in determining the direction of dislocation is emphasised by the dichotomy of management.... Read more »
Saltzman, M., Mercer, D., Bertelsen, A., Warme, W., & Matsen, III, F. (2009) Bilateral posterior sternoclavicular dislocations. Radiology Case Reports, 4(1). DOI: 10.2484/rcr.v4i1.256
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