Author Archives: EMergucate

10.04.12

by EMergucate

The daily educational pearl – non-dominant parietal lobe signs

An earlier post was about signs that constitute Gerstmann’s syndrome, or findings in lesions (vascular / trauma / space-occupying) of the dominant parietal lobe (usually left). What do we find when the non-dominant parietal lobe is involved? dressing apraxia sensory and visual … Continue reading →

10.02.12

by EMergucate

The daily educational pearl – Jones criteria rheumatic fever

The diagnosis of rheumatic fever can be made when 2 major criteria, or 1 major criterion plus 2 minor criteria, are present as well as evidence of previous streptococcal infection. The are known as revised Jones criteria. In a patient … Continue reading →

10.02.12

by EMergucate

The daily educational pearl – Aortic regurgitation

Aortic regurgitation Causes: chronic - rheumatic heart disease - congenital – bicuspid aortic valve, VSD - seronegative arthropathies, ankylosing spondylitis in particular - aortic root dilatation in Marfan’s syndrome, aortitis (rheumatoid, syphilis) - idiopathic - secondary to some medications (e.g. … Continue reading →

10.01.12

by EMergucate

Imaging Case of the Week 15

It is 2 am and you are about to see a 19 year old female patient with abdominal pain. As you approach her cubicle, you can hear her screaming. You find the patient holding her abdomen and crying out in pain. She is holding a … Continue reading →

10.01.12

by EMergucate

The daily educational pearl – Mitral stenosis

For those sitting exams soon. And for those who haven’t opened Talley & O’Connor’s for a while. Mitral stenosis Normal surface: 4 – 6 cm2; patients become symptomatic when surface < 2 cm2 and life expectancy (without surgical treatment) is … Continue reading →

09.27.12

by EMergucate

The daily educational pearl – Myth or fact: topical ophtalmic medications can’t cause systemic effects?

Myth. The Pharmacy Department at Repatriation General Hospital in Daw Park (Adelaide) in South Australia have recently published a very interesting bulletin on the systemic effects of topical ophthalmic preparations. They are generally safe, however, they can potentially cause adverse systemic effects if … Continue reading →

09.26.12

by EMergucate

The daily educational pearl – Is your confused patient delirious?

Your next patient is brought it for disturbing behaviour. Most likely to be an elderly patient from a nursing home with longstanding history of dementia who is now violent towards staff. But could be younger as well, with known psychiatric … Continue reading →

09.25.12

by EMergucate

The daily educational pearl – Cerebral hyperperfusion syndrome

Cerebral hyperperfusion syndrome (CHS) - unlikely to see it in ED, but worth knowing about if you work in a hospital where you are part of the medical emergency team - occurs after carotid endarterectomy or carotid angioplasty in up to 3% … Continue reading →

09.24.12

by EMergucate

Sizing IDCs in children

Staying with your patient from yesterday, you decide that he needs an indwelling urinary catheter. But what size? There’s another formula for this, of course. But to make it easier, size of IDC = 2 x size ETT Actually, after … Continue reading →

09.24.12

by EMergucate

Imaging Case of the Week 14

This patient has had a fall off his bike and comes in with a painful wrist.The area of interest has been x-rayed and the x-ray is here. What can you see?  

09.23.12

by EMergucate

What is the normal bladder volume in a 4 yo child?

Your next patient is a 4 yo who has a UTI and his mother tells you that he hasn’t passed urine for more than 10 hours. Your nurse does a bladder scan…. but you’re not sure what to do when … Continue reading →

09.20.12

by EMergucate

The daily educational pearl – Gerstmann’s syndrome

Gerstmann’s syndrome = lesions affecting the dominant (usually left) parietal lobe (CVA / space occupying lesion etc.) Clinical features are: Acalculia (when asked to do serial 7s) Agraphia Left-right disorientation Finger agnosia (the inability to recognize, name or appropriately move fingers)

09.19.12

by EMergucate

The daily educational pearl – management of increased intracranial pressure

Management of increased intracranial pressure in the emergency department 1. head elevation (~30 degreees) (or bed-tilt if patient on spinal precautions) 2. avoid any constrictions on the neck (on the jugular veins) (e.g. replace hard collars as soon as practicable … Continue reading →

09.18.12

by EMergucate

The daily educational pearl – Yamaguchi Cardiomyopathy

Yamaguchi Cardiomyopathy or apical hypertrophic cardiomyopathy This is the ECG of an 83 yo woman who presents to the emergency department complaining of shortness of breath.   Yamaguchi cardiomyopathy  is a variant of hypertrophic cardiomyopathy that is nonobstructive with predominant involvement of … Continue reading →

09.17.12

by EMergucate

The daily educational pearl – dermatitis herpetiformis

Dermatitis herpetiformis = symmetric grouped vesicles, papules, and wheals that are extremely pruritic, that occur on the elbows, knees, scalp, and buttocks It is associated with gluten-sensitive enteropathy and patients should be tested for this if diagnosed with dermatitis herpetiformis. … Continue reading →

09.17.12

by EMergucate

Imaging Case of the Week 13

A 52 year old female presents to you with a history of constant low back pain which has been going on for about 3 weeks. She has been previously well and is a nonsmoker. There is no history of trauma. You want to request an x-ray of her lumbar spine but, … Continue reading →

09.16.12

by EMergucate

The daily educational pearl – a bit of history

Monteggia fracture dislocation was first described in 1814 by Giovanni Battista Monteggia, 81 years before Roentgen described use of Xrays for medical purposes in a paper in 1895. Giovanni Battista Monteggia was an Italian physician, pathologist and surgeon. He died of syphilis, acquired … Continue reading →

09.14.12

by EMergucate

Beginner’s Guide to WordPress – Show / Hide Text using Peekaboo

So we’ve log-in, looked around the dashboard, started posting, and added some pictures. Now onto something completely different. You want to blog about a case but want to include some questions for the reader, how can you hide part of … Continue reading →

09.14.12

by EMergucate

Beginner’s Guide to WordPress – Picture Time

You’re on a roll. You can log-in, navigate the Dashboard,and you’ve started posting. But a picture tells a thousand words so let’s get some images into our posts. Click on Upload/insert or click the add media symbol which looks like … Continue reading →

09.14.12

by EMergucate

Beginner’s Guide to WordPress – Get Posting

You’ve managed to log-in and get to the Dashboard, now it’s time to get posting. To get posting click on the Post link in the dashboard and “Add New”. The post field looks like this: You can enter the title … Continue reading →

09.14.12

by EMergucate

Beginner’s Guide to WordPress – Log-in & Dashboard

You’ve been invited to start blogging on a WordPress site but you’ve never done anything like this before, how do you start ? This and the next few posts will go through some of the basics of getting started with … Continue reading →

09.13.12

by EMergucate

The daily educational pearl – Acrodermatitis enteropathica

Acrodermatitis enteropathica = skin condition characterised by pustules, bullae, and scaling in an acral and periorificial distribution that occurs secondary to zinc deficiency Picture from Dermatlas can be found here. There are 2 types: - inherited (mutation in the gene which … Continue reading →

09.12.12

by EMergucate

The daily educational pearl – a bit of history

A famous patient suffered aortic dissection at age 97; he refused surgery but then became comatose and the hospital ethics commission decided to go ahead with surgery. He had a long postoperative hospital stay (8 months) and died at 99 years of age. … Continue reading →

09.11.12

by EMergucate

The daily educational pearl – grading SAH

With thanks to Conway. This is the CT brain of a 43 yo man brought in by ambulance after he collapsed at home. GCS is 3. What does the CT show? The Neurosurgical Registrar is asking you what grade it … Continue reading →

09.10.12

by EMergucate

The daily educational pearl – fractures of the base of the 5th metatarsal

Your next patient is a 27 yo woman who inverted her foot while playing netball and is now unable to weight bear due to pain. This is her Xray: You know there are 2 types of fractures of the base … Continue reading →

09.10.12

by EMergucate

Imaging Case of the Week 12

It is 3am and your next patient is a 70 year old female with abdominal pain and vomiting. To make things complicated, she also gives a history of runny stools. Her supine abdominal x-ray is as follows. You are not too sure of what … Continue reading →

09.10.12

by EMergucate

An Interesting AXR

Lapband O sign. A slipped lapband (tumbled upon itself). For further information, please refer to the imaging case of the week 2 and a nice article from AJR sent in by John. http://www.ajronline.org/content/195/1/137.full.pdf+html?sid=3a378c55-eb66-4829-96f3-6b9d3ef531d5      

09.09.12

by EMergucate

The daily educational pearl – abdominal compartment syndrome

Abdominal compartment syndrome = organ dysfunction caused by intra-abdominal hypertension It can be: - Acute – caused by  acute intra-abdominal pathology or large fluid volume resuscitation - Chronic  - occurs in the presence of ascites, peritoneal dialysis or an intraabdominal mass, often … Continue reading →

09.06.12

by EMergucate

The daily educational pearl – sinuses

Which sinuses are pneumatized at birth? Ethmoid and maxillary only, so don’t diagnose frontal  sinusitis in young children! The sphenoid sinus is pneumatized by 2 – 4 years of age, while the frontal sinuses are not pneumatized till 8 – … Continue reading →

09.05.12

by EMergucate

The daily educational pearl – a bit of history

Who said “I want to go when I want. It is tasteless to prolong life artificially. I have done my share, it is time to go. I will do it elegantly.” Answer He died of a ruptured AAA at 76 … Continue reading →