Tasty Morsels of EM 059 – Arrhythmogenic Right Ventricular Cardiomyopathy

Arrhythmogenic right ventricular cardiomyopathy

File this under “uncommon but important”. Like a lot of things in Emergency Medicine really… The main paper for this is linked in the references below





Clinical Presentation







The post Tasty Morsels of EM 059 – Arrhythmogenic Right Ventricular Cardiomyopathy appeared first on Emergency Medicine Ireland.

Tasty Morsels of EM 058 – Bariatric Surgery and its complications

tasty morsel 058 bariatric

I don’t see that many of these procedures coming back to our ED. A lot are done privately and even overseas. The overseas ones can be particularly challenging as the paperwork is often not in English and often the patient doesn’t really know what was done. Given the costs associated with travelling for surgery people often leave earlier than they might otherwise and some of the earlier complications might end up in your ED.

Either way there’s lots to learn from what is a really important and really effective surgical procedure (over 50% gaining significant weight loss post procedure)

This is all from a paper by Ellison and Ellison in JEM in 2008 – one EP and one surgeon, I bet they’re married…

Ellison SR, Ellison SD. Bariatric Surgery: A Review of the Available Procedures and Complications for the Emergency Physician. J Emerg Med. 2008 Jan;34(1):21–32. PMID 17976781

There’s lots of pearls and some nice diagrams of the procedures available.

  • a third develop gallstones in the 6 months following a roux-en-y; some places even prophylactically take the GB out
  • vomiting after the procedure is not normal – it may turn out to be benign but usually needs a work up
  • gastric obstruction reasonably common in all of the procedures. most of it is proximal but you can also get “internal hernias” when sections of the bowel herniated through defects in the mesentery created during the procedure
  • GI bleeding can be reasonably late as patients develop “marginal ulcers” or even erosion from lap bands into the stomach lumen
  • lap bands usually have a sub cut balloon that can be inflated/deflated with saline to adjust size. Authors point out that we should not be fiddling with these even if the surgeon asks you to over the phone!
  • the bands can also slip in position creating a large reservoir of stomach above the band leading to lots of vomiting.
  • given the complexity of the procedures and the obesity of the patients simple clinical exam is tricky here and imaging or scopes are frequently needed.
  • always remember the “medical” complications. particularly VTE – the paper quotes a rate of 10% in bariatric procedures.
  • thiamine loss and even wernicke’s can occur in gastric bypass patients so remember your thiamine – it’s not just for the drinkers.

More FOAMed

The post Tasty Morsels of EM 058 – Bariatric Surgery and its complications appeared first on Emergency Medicine Ireland.

Countdown to #smaccDub Registration


Come on out from under that rock you’ve been hiding under and check out the SMACC website for details of registration.

This year it’s capped at 2000 people and it’s expected to sell out. To give you the best chance of getting a ticket they’ll be released in 3 batches with the first batch released next wednesday the 28th October.

The SMACC site has all details so check it out.

It’s hard to really describe how exciting it all is to see SMACC come to my own “turf”. It’s going to be a blast.

The post Countdown to #smaccDub Registration appeared first on Emergency Medicine Ireland.

Eye Injuries at EuSEM15

This is a screencast of a talk I gave at the European Society of Emergency Medicine Congress in Torino, Italy in October 2015

It was an honour to be asked to speak and thanks to everyone who came along to hear it in person.

There are a LOT of #FOAMed resources in this talk so I’ll try and link to all of them here.

Any comments, thoughts, corrections please let me know in the comments.


Myself and Michael Quirke talk about this as well in the the just released RCEM FOAMed podcast on clinical ophtho

Consensual Light Reflex with US


Orbital Compartment Syndrome and Canthotomy

Main ophtho resources

The eye anatomy series

Graphic Design resources (Hat tip Natalie May and Alan Watts)

The post Eye Injuries at EuSEM15 appeared first on Emergency Medicine Ireland.


The Royal college of emergency medicine is having its annual conference starting tomorrow. It’s being organised by RIck Body and all the folk better known as st emlyns

The line up looks amazing and the conference is actually sold out. 

As part of the rcemfoamed network I’ll be one of a group creating a daily  podcast and blog summary of the conference. Be sure to get the feed to follow us

Hashtag is #RCEM15

If you’re at the conference please come along and say hi. 

The post RCEM 15 appeared first on Emergency Medicine Ireland.

Getting started with FOAMed

Just a little note to state that I have collated a few resources for those looking to get started with both consuming and creating FOAMed. There’s a little link at the top right of the page.

I also recorded some talks recently for the RCEM FOAMed network on creating podcast type material. Hopefully they’re of some use:

01 – recording a solo podcast

Scott Weingart on getting started in FOAMed

Andy Neill’s Social Media Workshop


02 – recording a skype interview

03 – recording a screencast

The post Getting started with FOAMed appeared first on Emergency Medicine Ireland.