Meningococcal sepsis – lest we forget

  Meningococcal sepsis and meningococcal meningitis Meningococcal infections are something we don’t see often but we need to know about.  There was an outbreak in Suva, Fiji while I was there. They may present with meningococcal sepsis, meningitis or both.  They may or may not have a rash.  They may or may not have neck […]


A Beginner’s Guide to STEMI Thrombolysis: 5 Minutes Door to Needle

The Case A 57-year-old man was brought in by ambulance with 1 hour of left shoulder pain, nausea and feeling faint. He had a history of obstructive sleep apnoea and recurrent low back pain. Paramedics had given aspirin and clopidogrel, obtained IV access and called us saying probable inferior STEMI. He goes into a resus […]

ketafol bigger

A Beginner’s Guide to Procedural Anaesthesia in ED

Procedural anaesthesia is providing IV anaesthesia to allow a painful procedure to be performed.  Very rarely it will be performed to rapidly control dangerous behaviour. It has also been called conscious sedation or procedural sedation but usually we don’t want our patient to be conscious and we want them to be anaesthetised, not just sedated.  […]

Master Splinter

Contagious Calmness. Mindfulness at Work

By practicing mindful meditations we can find calmness within us and then bring this into our work. We may find that the calmness starts to spread and appears in unexpected places. Be the calmest person in the room no matter what is going on. Focus on the people around you, patients, family, workmates, as a […]

A flutter name erased

Renal failure, hyperkalaemia, tachycardia. What’s going on?

    Audio   A 67-year-old with a Hx of dilated cardiomyopathy, atrial fibrillation and obstructive uropathy presented after a collapse at home.  He said his urine has been white recently. His temperature was 37.9 in the ambulance, 37.4 in ED. He was tachycardic at 125, BP 90/60 (it had been 69/49 in the ambulance, […]

Inferio posterior STEM

Burn this ECG into your brain

63-year-old male with 5 hours of central chest pain   What is the diagnosis?   Click for answer   This is a posterior and probably inferior STEMI. Anterior ST depression is a posterior STEMI (or a Sgarbossa +ve STEMI in the presence of LBBB) till proved otherwise. To confirm that the anterior ST depression is […]

R main stem intubation

The crashing intubated patient: DOTTS

Whenever a patient you have just intubated deteriorates, or a patient on a ventilator deteriorates quickly: DOTTS Disconnect and let them exhale: This gets the ventilator out of the equation and simplifies things / reduces our cognitive load: we understand BVMs (bag-valve-mask), ventilators and circuits confuse and scare us.  It also stops ventilation for a […]

Sgarbossa 10.13.23 pm

LBBB and Sgarbossa

  Left bundle branch blocks cause a lot of confusion. People often mistake the normal anterior ST elevation of LBBB as an MI Less frequently people miss significant concordant ST segment changes which may be a STEMI (by Sgarbossa Criteria) The Law of Discordance or the Law of Appropriate Discordance In a normal LBBB the […]

5 lessons

The future funding of FOAM

Free Open Access Medical Education or FOAM has been free to users and producers largely due to the generosity of this man the Godfather of FOAM, Mike Cadogan. When I last spoke to him over a year ago, he was pouring over $75,000 a year of his own money to pay for technical support, Word […]

Military trauma

Trauma: Lessons from the Military. Wing Commander Dr Paul Nealis

    Key points Stop bleeding! Tourniquets are great. Pack bleeding wounds firmly.  A roll of gauze works well. “Haemostatic dressings” eg quik clot, don’t seem to make much difference.  It appears the pack needs to be absorbent probably because they absorb water out of the blood in the wound thereby increasing the concentration of […]