Ventricular tachycardia (Brugada criteria) vs Atrial Flutter with regular block (Golden numbers)

Remember the ‘Golden Numbers’ - 75, 100, 150, 200. Atrial Flutter 2:1 block can present as broad complex tachycardia at rate 150 if bundle branch block exists. Be wary of rates that are perfectly regular with rates of 75, 100, 150, 200 - they may represent atrial...

Guillain Barre in ED – acute inflammatory demyelinating polyneuropathy – ascending motor paresis with lower motor neurone features with some dyautonomia and cranial nerve abn – don’t forget to check FVC and FIP.

GBS presents occasionally to ED as paediatric or adult weakness. Key components of the clinical picture include -varying degrees of lower limb weakness ( sometimes presenting as new onset ‘cannot walk’), LMN signs in ascending pattern -usually mostly motor, but some...

Burns in the ED

The ED PHYSICIAN considerations are the difficulty excluding airway inhalational burn, overestimation of TBSA and the evidence deficit for what formula and type of fluid to use for resuscitation.

Inhalational burns – use awake oral anaesthetic fibreoptic or video laryngoscopy

The best clinical indicator of inhalational burn is stridor - if absent - facial or lip signs are inaccurate at predicting supraglottic or glottic injury. Use awake oral anaesthetic laryngoscopy with ketamine dissociation to exclude inhalational injury with fibreoptic...

Overestimation of TBSA leads to ARDS and Abdominal compartment syndrome

Use a Lund and browder chart in children and Wallace’s rule of nines in adults.

Evidence deficit for burns formulas and fluid type – ANZBA recommends parklands formula in adults using Hartmanns

4ml/kg/tbsa has been the standard formula used in most ed settings in Australia and ANZBA has further endorsed this for adults. Most Paediatric centres in Australia actually suggest 2 or 3 ml/kg / tbsa - which is a modified formula Hartmanns is the suggested fluid...

Myasthenic crisis in ED- check the negative inspiratory pressure (<25) and Fvc (15L/kg)

Myasthenic patients may present to ED with shortness of breath without obvious signs of distress ( because resp accessory muscles are weak and fatiguing !) Common precipitants are infections and antibiotics or other meds - sometimes disease course Measure the negative...

Abnormal Uterine Bleeding – causes classified by PALM COEIN – Polyp – Adenomyosis- Leiomyoma – Malignancy – Coagulation – Ovulatory – Endometrial – Iatrogenic – not classified

ACOG 2011 updated their approach to classification of abnormal uterine bleeding in non pregnant patients. PALM - structural vs COEIN - nonstructural.