Category: cases

Hans’ Holler – clip climb and learn – Wednesday July 26th

A fantastic team building activity organised by Karen!

(from top to bottom; L-R: Liz Wyatt, Mohsin Ejaz, Mike Gibbons, Lucy Selleck, Karen Winter)


The anticlimax afterwards – case presentations by Hans:

Here’s a wrap of take home messages – due to privacy issues it is not possible to post detailed case reports:

  1. a dislocated knee causing popliteal artery dissection:
    1. know your injury patterns and complications
    2. think about other trauma according to mechanism and do not fixate on the obvious
  2. incidental finding of low bicarbonate
    1. look at kidney and lung (ABG, U+E, urine PH)
    2. try to take note of all abnormalities
  3. Torsade de pointe in low Potassium and bradycardia
    1. keep the HR up – if needed with Isoprenaline or overdrive pacing
    2. it is the absolute QT that counts – use a nomogram
    3. serum K+ accounts only for 2% of body potassium – required ┬áreplacement may be quite large
    4. use Chlorvescent when possible
    5. give concomitant Mg to fuel the “pump”
  4. chest pain in someone with Myotonia and preexcitation syndrome
    1. don’t be scared by weirdomas – rely on your history
    2. caveats of neuromuscular junction disorders
      1. difficult induction when intubating
      2. be aware of high risk drugs (Gentamicin, Benzos and many more….)
    3. avoid ABCD drugs in WPW rapid AF with antidromic circuit (Adenosine/Beta Blockers/Ca channel blockers/Digoxin)
  5. mastoiditis in a nonspecific presentation
    1. be aware of POOP (pain out of proportion to physical signs)
    2. careful with NESB
  6. trauma that eventually turned out to be a renal colic
    1. avoid diagnostic momentum
    2. if things don’t quite add up – create a “safety net”
  7. bilateral carotid artery dissection
    1. if sensible relatives are concerned – you should be concerned
    2. avoid heavy metal head banging beyond your 20s


An in-depth look at the management of hyponatraemia, with special attention to a new concept called the “dDAVP clamp.”


– only treat hyponatraemia if symptoms are severe – coma, seizures or severe delirium
– use 3% saline 100ml, up to three doses
– consider giving dDAVP to prevent a rapid climb in the serum sodium
– aim to correct the serum sodium by only 3-6mmol/L in the first 24 hours

For more information, have a look at Scott Weingart’s EMCrit Wee, and Josh Farkas’s blog post.