Winter’s Wrap 25.10.2017 – CTB, HOCM, Decision making

To scan or not to scan – Dr Mike Gibbons

Ordering of CT brain for trauma without radiology registrar approval – consider whether other imaging is required ie: Cervical spine or facial bones

Consideration of anti-platelet therapy as a risk factor for occurance or increased size of intracranial haemorrhage

Low risk of delayed bleed in anticoagulated patient and bleed may occur up to 2 weeks after initial trauma so admission for repeat scan is not usually indicated

Ensure clear documentation of decision to scan or not to scan and that appropriate discharge instructions are given to patient and carer



HOCM and the bands – Dr Hans Hollerer

Dynamic presentation of HOCM:

Left Ventricular Outflow Tract obstruction

Mitral regurgitation

Diastolic dysfunction




“dagger-like” Q waves in lateral and inferior leads

atrial enlargement

atrial tachycardias – AF, SVT



Treatment of collapse in HOCM:


IV fluids

elevate legs

IV b-blocker

NOTE: Metaraminol contraindicated in structural heart disease


Other key points:

  • Tamiflu – reduces symptoms by 3 days, indicated in first 48 hours in some populations
  • “Band forms” on blood film – white cell progenitors pushed out of bone marrow, indication of early stages of sepsis
  • “The blue book” – communicable diseases, incubation, notifiable illnesses



“It is in moments of decision that your

destiny is shaped”

Decision Making – Dr David Mai

heuristics and metacognition
croskerry - cognitive forcing strategies (1)
croskerry - cognitive debiasing 2
croskerry achieving quality in decision making
croskerry - cognitive forcing strategies


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