Pulmonary Hypertension

Definition of Pulmonary HTN (PH)

  • Right heart cardiac catheterisation demonstrating mean pulmonary pressure of >/= 25mmHg whilst patient is at rest

Types of PH

  • Diverse group of disease with similar pathophysiology & clinical presentation
  • Type 1 = primary PH aka idiopathic
  • Type 2 = PH secondary to left heart disease
  • Type 3 = PH owing to lung disease and/or hypoxia
  • Type 4 = Chronic thromboembolic pulmonary hypertension (CTEPH)
  • Type 5 = PH with unclear multifactorial mechanisms
    • Pathological conditions in critical care leading to PH include:
      • Severe respiratory failure
      • ARDS
      • Heart failure
      • Massive PE
      • Post cardiac & thoracic surgery
      • Exacerbation of chronic PH

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Location and type of injuries. Source: Hale et. al.

Absence of clinical findings reliably excludes unstable cervical spine injuries in children 5 years or younger

Ryan Radecki over at Emergency Literature of Note has a great short muse on what we have all suspected in practice; the near impossibility of isolated cervical spine injuries. The article he discusses was a retrospective study of 2972 trauma patients aged 5 years or younger. They essentially found that most kids with c-spine presented with severe trauma (median ISS was 33, GCS 3) and a plethora of other injuries. ALL patients had clinical findings suggestive of CSI; 82% had abnormal neurological examination, 9% had torticollis, and 9% had neck pain. A great read and a link to the original article can be found here.  A short synopsis of the paper can be found below.

Hale, D. F., Fitzpatrick, C. M., Doski, J. J., Stewart, R. M., & Mueller, D. L. (2015). Absence of clinical findings reliably excludes unstable cervical spine injuries in children 5 years or younger. Journal of Trauma and Acute Care Surgery, 78(5), 943–948. http://doi.org/10.1097/TA.0000000000000603 PMID25909413

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Mushroom Poisoning (Mycetism)

“Every mushroom is edible, but some only once.”
 – A Czech adage

It is that time of the year when patients start presenting with mushroom poisoning after heading out to the forest, or garden, to pick themselves a nice basket of free, organic, moon grown, “Straw” mushrooms. Mushroom growing is usually rife in autumn, when soils are still warm and moist, giving ample opportunity for spores to propagate.

Source David Guss [4]

Source David Guss [4]

Contrary to popular belief, the ability to distinguish toxic mushrooms from non-toxic mushrooms can be extremely difficult, often requiring the use of a microscope. Certainly in specific regions around the world there are pockets where differentiation is “easy” however all-in-all, differing one type of mushroom from another can be difficult and rife with danger. Read More »


The renowned team across at ALiEM just announced that they would be starting free MOOC-like courses called ALiEMU. They are envisioning high-quality, vetted courses made by EM educators, for EM educators. This is HUGE! The plan is to roll this out in July 2015 and looks like it has attracted an all-star cast with Michelle Lin, Andy Grock, Anand Swaminathan, Salim Rezaie and many more contributing. Roll over to their site to have a look at their sneak-peak page.

Aortic Dissection

ACS and the need for routine CXR

So I am sitting alone in a rural emergency department when a 55yo female is BIBA c/o of central crushing chest pain radiating around the left side of her chest. Pt describes the pain as 6/10, both constant stabbing plain with pleuritic features – on and off for the last 6-8 hours. Pt was given Aspirin 300 mg + S/L GTN + patch with pain resolving some 5 minutes later when given IV morphine by paramedics. She reports that she is a smoker and has had a non-productive cough for last 3/7. Past medical history was significant for HTN and hypercholesterolaemia. ECG was plum normal. Examination unremarkable with no abnormalities noted on auscultation. No evidence of acute heart failure. Observations are all within normal parameters including SpO2 96% RA. FBE, UEC, troponin requested. CXR requested however NUM informs me that they will need to call in the radiographer which is expensive. Do I really need this X-ray? Read More »

FOAM is the concept

My #FOAMed experience begins…

After following the #FOAMed movement for a number of years, sitting on the sidelines and just absorbing as much as I could, I have decided to give it ago. I am literally diving into this head first. I don’t quite know where the site will end up or what it will look like in 2 months, 6 months, or 12 months time, but we will see.

The thing that has gotten me interested in FOAM has been the huge amount of information floating around, getting passed on, debated, and questioned by a community of doctors from varying specialties. It feels like the emergency community has been taken over by a group of socialites, documenting their every triumph and failure – sometimes mundane, mostly invigorating.  Read More »

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