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Prof. Bruce Arroll talks anxiety, asthma, breathing techniques and the polyvagal theory
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Professor Bruce Arroll talks to us about a practical technique that can help regulate breathing in people having panic attacks or during an asthma attack. The conversation then leads into discussing the Polyvagal Theory, physician wellness, and chronic pain. Check out the Goodfellow unit resources. The Gem mentioned The Polyvagal Theory webinar The…
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Remember to consider an ASIS avulsion in young athletes who experience pain and a pop around their hip when sprinting. Check out the Orthobullets page https://www.orthobullets.com/knee-and-sports/3091/anterior-superior-iliac-spine-asis-avulsion www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc Music …
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A differential to consider when examining a dorsal wrist swelling. Check out the Radiopaedia pages On Ganglion cysts On Carpal Boss www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc Music licensed from www.premiumbeat.com Full Grip by Score Squad This podcast is intended to assist in ongoing medical …
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Urgent Bite 215 - The World's Strongest CPD
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Much like going to the gym, CPD can be a hassle or an imposition, but it can also be fun and hugely rewarding. Check out the paper mentioned Jeong D, Presseau J, ElChamaa R, Naumann DN, Mascaro C, Luconi F, Smith KM, Kitto S. Barriers and Facilitators to Self-Directed Learning in Continuing Professional Development for Physicians in Canada: A Scopi…
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Urgent Bite 214 - Are Borborygmi useful?
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Should we be listening for bowel sounds? Despite evidence suggesting they are not useful, I still think it is an important part of an urgent care assessment. Check out the papers mentioned. Elhardello O, Macfie J. Bowel Sounds: Is it Time for Surgeons to Hang-up their Stethoscopes?. World J Surg Surgical Res. 2018; 1: 1066. Link to paper. Breum BM,…
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Urgent Bite 213 - Differentials and the importance of the referral letter
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What impact do your acute referral letters have on the admitting team? You may have noticed the initial upload contained the wrong audio file of an old podcast. Sorry, this has been corrected. Check out the papers mentioned Chauveau P, Mazet-Guillaume B, Baron C, Roy PM, Tanguy M, Fanello S. Impact du contenu du courrier médical sur la qualité du t…
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Urgent Bite 212 - The Cozen Phenomenon
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We must be aware of the possibility of Cozen's phenomenon in urgent care. Check out the Radiopedia page by Tim Luijkx https://radiopaedia.org/articles/cozen-fracture-1 Check out the Orthobullets page by Macknett MD et al https://www.orthobullets.com/pediatrics/4025/proximal-tibia-metaphyseal-fractures--pediatric Check out the obituary of Dr Lewis C…
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Thinking about Chopart injuries - with Dr Antonio Castro
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Today we hear of a case of Chopart injury presenting through urgent care. Thanks to Dr Antonio Castro. Check out the paper mentioned Metcalfe TSN, Aamir J, Mason LW. Chopart dislocations: a review of diagnosis, treatment and outcomes. Arch Orthop Trauma Surg. 2024 Jan;144(1):131-147. doi: 10.1007/s00402-023-05040-4. Epub 2023 Sep 15. PMID: 37715068…
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2 years ago we spoke with Dr Tamsin Lillie, a Fellow of the RNZCUC who runs a medical charity that helps fund African students through medical training. Last time we spoke she was calling in from Malawi, but a chance meeting in person prompted a quick catch-up about what has been going on over the last 2 years and her hopes for the charity moving f…
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Urgent Bite 211 - Thinking about medication history taking
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Some common, non-psychotropic medications can have psychiatric side effects. Check out the article mentioned Prescriber Update 45(1): 5-8 March 2024 https://www.medsafe.govt.nz/profs/PUArticles/March2024/Unexplained-mood-and-behavioural-changes.html www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc M…
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Hoffmann's sign is a simple test that can help in diagnosing cervical myelopathy and upper motor neurone disease as part of a thorough history and examination. Check out the paper mentioned Nemani VM, Kim HJ, Piyaskulkaew C, Nguyen JT, Riew KD. Correlation of cord signal change with physical examination findings in patients with cervical myelopathy…
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Wellens' Syndrome - with Dr Ivan Koay and Dr Yoosuf
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Wellens' Syndrome is an ECG finding indicative of critical LAD stenosis. Recognising this ECG change is vital. Check out the Life in the Fast Lane post by Dr Mike Cadogan and Dr Robert Buttner from September 2021 https://litfl.com/wellens-syndrome-ecg-library/ This is a BMJ case report that is worth reading. Ramires TG, Sant'Anna J, Pais J, Picarra…
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Urgent Bite 209 - Abnormal Uterine Bleeding when commencing anticoagulation
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We must counsel about the possibility of abnormal uterine bleeding starting, or worsening when commencing oral anticoagulation. Check out the Prescriber update - December 2023 edition - https://www.medsafe.govt.nz/profs/PUArticles/PDF/Prescriber-Update-44-No.4-December-2023.pdf Check out the paper mentioned de Jong CMM, Blondon M, Ay C, Buchmuller …
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An interesting eponymous syndrome with a Kiwi connection. Check out the Stat Pearls Page Tafti D, Cecava ND. Poland Syndrome. [Updated 2023 May 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532259/ https://www.ncbi.nlm.nih.gov/books/NBK532259/ Read more …
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In cases of ongoing post-prandial epigastric pain and sitophobia despite endoscopy work up and treatment perhaps we should remember to recall Dunbar Syndrome to our differential list. Check out the paper mentioned Li J, Tan XY, Megahed A, Evangelista A. Dunbar syndrome: An unusual cause of chronic postprandial abdominal pain. Radiol Case Rep. 2020 …
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Grover disease might present through your urgent care. While not a critical or life-threatening condition, recognising it so we can advise and support your patient is important. To help us consider differentials for various presenting complaints there is a useful website you can use. Check out the Cunneliffe (TP) General Dermatology Diagnostic Tool…
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Urgent Bite 205 - The Böhler angle and angle of Gissane
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When considering calcaneal fractures we must remember the Böhler angle and the angle of Gissane. Check out the Orthobullets page written by Crag Forsthoefel MD. https://www.orthobullets.com/trauma/1051/calcaneus-fractures Check out the Radiopaedia articles Benoudina S, Worsley C, Knipe H, et al. Gissane angle. Reference article, Radiopaedia.org (Ac…
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The Corona Mortis - with Dr Tim Brabants
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Do you know about the Corona Mortis? Today with chat to Dr Tim Brabants who has seen a case and feels we should be aware of its potential in urgent care. Tim is a UK-trained doctor who has worked in the UK and South Africa, predominantly in emergency medicine. Now based in New Zealand, he is a senior Registrar with the RNZCUC Check out these resour…
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Urgent Bite 204 - Thinking about caffeine withdrawal
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Could caffeine withdrawal result in an urgent care visit? Check out the paper mentioned Sajadi-Ernazarova KR, Anderson J, Dhakal A, et al. Caffeine Withdrawal. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430790/ https://www.ncbi.nlm.ni…
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Urgent Bite 203 -The Hoagland Sign
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An eponymous sign that helps in the diagnosis of glandular fever. Check out the paper mentioned. Otsuki T, Ishizuka K, Hirose M, Ie K. Hoagland sign in infectious mononucleosis. BMJ Case Rep. 2022 Nov 16;15(11):e252839. https://pubmed.ncbi.nlm.nih.gov/36384885/ Check out the obituary of Colonel Robert. J. Hoagland MD - https://courierpostonline.new…
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Urgent Bite 202 - Thinking about Neuroendocrine Tumours
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This week, the world's best snooker players are competing for the Paul Hunter Trophy at the Masters in London. Paul sadly died of neuroendocrine tumours in 2006 whilst in his snooker prime. Check out the paper mentioned Ahmed M. Gastrointestinal neuroendocrine tumors in 2020. World J Gastrointest Oncol. 2020 Aug 15;12(8):791-807. doi: 10.4251/wjgo.…
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Urgent Bite 201 - Thinking about referrals from UC
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What is your acute referral rate from UC to secondary care? Check out the paper mentioned. Blinkenberg J, Hetlevik Ø, Sandvik H, Baste V, Hunskaar S. The impact of variation in out-of-hours doctors' referral practices: a Norwegian registry-based observational study. Fam Pract. 2023 Dec 22;40(5-6):728-736. https://pubmed.ncbi.nlm.nih.gov/36801994/ w…
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Thinking about Jean Batten and Empyema
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Jean Batten was a New Zealand pioneering aviatrix who died of empyema. Check out Jean Batten's history. From the NZ History website - https://nzhistory.govt.nz/people/jean-batten From Te Ara, the Encyclopedia of New Zealand - https://teara.govt.nz/en/biographies/4b13/batten-jean-gardner From Wikipedia - https://en.wikipedia.org/wiki/Jean_Batten# Ch…
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A Bite of Christmas - The Ice Cream Headache
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You might encounter an Ice Cream Headache over Christmas. Check out the International Classification of Headaches - Third Edition) Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013 Jul;33(9):629-808. doi: 10.1177/033310…
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The 2024 Urgent Care Bootcamp conference will be held at the Rydges Hotel in Wellington on September 14th and 15th. If you would like to express an interest in presenting a talk, abstract or poster, go to this link - https://rnzcuc.org.nz/urgent-care-bootcamp-2024/ www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twit…
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We should be reporting suspected medication-induced anaphylaxis to CARM. Likewise, remember to report cases of ACE-induced angioedema. Review the June 2023 Prescriber update from Medsafe - https://www.medsafe.govt.nz/profs/PUArticles/PDF/Prescriber-Update-Vol-44-No.2-June-2023.pdf www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnz…
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Words change but conditions stay the same. Check out the paper mentioned. Strupp M, Bisdorff A, Furman J, Hornibrook J, Jahn K, Maire R, Newman-Toker D, Magnusson M. Acute unilateral vestibulopathy/vestibular neuritis: Diagnostic criteria. J Vestib Res. 2022;32(5):389-406. doi: 10.3233/VES-220201. PMID: 35723133; PMCID: PMC9661346. https://www.ncbi…
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Urgent Bite 198 - Thinking about Exostoses of the Ear
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Whether an incidental finding or related to a presenting issue, advising a surfer about preventing exostosis progression is important in urgent care. Check out the Stat Pearls page for a great review. Landefeld K, Bart RM, Lau H, et al. Surfer's Ear. [Updated 2023 Apr 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023…
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Whether reviewing a possible subungual haematoma or an opportunistic finding, urgent care clinicians need to be aware of subungual melanoma. Check out the Dermnet page by Dr Nicole Seebacher - https://dermnetnz.org/topics/melanoma-of-the-nail-unit www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc Mus…
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We should always observe our patient's gait and make sure to look our for a foot drop. Check out the Stat Pearls page. Nori SL, Stretanski MF. Foot Drop. [Updated 2022 Jun 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554393/ www.rnzcuc.org.nz podcast@rn…
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Urgent Bite 195 - The Zurich Tongue Scheme
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The Zurich Tongue Scheme may help you in assessing tongue lacerations in kids. Check out the papers mentioned. Seiler M, Massaro SL, Staubli G, Schiestl C. Tongue lacerations in children: to suture or not? Swiss Med Wkly. 2018 Oct 28;148:w14683. doi: 10.4414/smw.2018.14683. PMID: 30378089. https://doi.org/10.4414/smw.2018.14683 Sibley AK, Atkinson …
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What would you think if a patient presents with a spontaneously bruised digit? Check out the Dermnet page - https://dermnetnz.org/topics/achenbach-syndrome Check out the paper mentioned Azarfar A, Beg S. Achenbach Syndrome: A Case Series. Cureus. 2022 Mar 3;14(3):e22824. doi: 10.7759/cureus.22824. PMID: 35382203; PMCID: PMC8976592. www.rnzcuc.org.n…
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Urgent Bite 193 -Feline therapy and take home information
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It is important to remember our role in recommending simple measures to help our patients and it is worth thinking about the power of take-home information that details the advice you have given. Check out the Stuff article here - https://www.stuff.co.nz/life-style/wellbeing/300992867/a-virginia-woman-was-feeling-sad-her-doctor-prescribed-her-a-cat…
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Urgent Bite 192 - Urinary Alkalinisers and Antibiotics
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Urinary alkalinisers can reduce the effectiveness of certain antibiotics Check out the BPAC article - https://bpac.org.nz/2021/uti.aspx Check out the NZF page - https://nzf.org.nz/nzf_4329 www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc Music licensed from www.premiumbeat.com Full Grip by Score Squ…
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Talking the Jump Test for Appendicitis with Dr David Sorrell
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Dave has used this test for years to help with his diagnosis, so he was relieved to find a paper that supported its use. Check out the paper here. Tzortzopoulou AK, Giamarelou P, Tsolia M, Spyridis N, Vakaki M, Passalides A, Zavras N. The Jumping Up (J-Up) Test: Making the Diagnosis of Acute Appendicitis Easier in Children. Glob Pediatr Health. 201…
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Does colder air help ease croup? Check out the paper here Siebert JN, Salomon C, Taddeo I, Gervaix A, Combescure C, Lacroix L. Outdoor Cold Air Versus Room Temperature Exposure for Croup Symptoms: A Randomized Controlled Trial. Pediatrics. 2023 Sep 1;152(3):e2023061365. doi: 10.1542/peds.2023-061365. PMID: 37525974. https://pubmed.ncbi.nlm.nih.gov/…
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Urgent Bite 190 - Effect of burnout on prescribing
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Being burnt out can change the way we prescribe. Check out the BJGP paper mentioned. Hodkinson A, Zghebi SS, Kontopantelis E, Grigoroglou C, Ashcroft DM, Hann M, Chew-Graham CA, Payne RA, Little P, de Lusignan S, Zhou A, Esmail A, Panagioti M. Association of strong opioids and antibiotics prescribing with GP burnout: a retrospective cross-sectional…
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Urgent Bite 189 -A Simple Nausea treatment
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Smells can be nostalgic, but can they be antiemetic? Check out the ALIEM page Check out the Paper Mentioned Veldhuis, P., Melse, M. & Mullaart, N. Implementation of isopropyl alcohol (IPA) inhalation as the first-line treatment for nausea in the emergency department: practical advantages and influence on the quality of care. Int J Emerg Med 14, 15 …
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Urgent Bite 188 - Thinking about B12 deficiency
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B12 deficiency is worth considering in some of the patients who present through UC. Check out the Stat Pearls page Ankar A, Kumar A. Vitamin B12 Deficiency. [Updated 2022 Oct 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441923/ Check out the NIH informa…
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Urgent Bite 187 - Traumatic Tympanic Membrane Rupture
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Døds Diving, or death diving, is a Norwegian extreme sport. Watching it made me consider traumatic tympanic membrane ruptures. Check out the paper mentioned Carniol ET, Bresler A, Shaigany K, Svider P, Baredes S, Eloy JA, Ying YM. Traumatic Tympanic Membrane Perforations Diagnosed in Emergency Departments. JAMA Otolaryngol Head Neck Surg. 2018 Feb …
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Urgent Bite 186 - Cervical Lymphadenitis in Kids
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Palpating the cervical lymph nodes is a vital part of our examination of febrile kids. Check out the Starship Hospital page. https://starship.org.nz/guidelines/cervical-lymphadenitis/ Check out the RCH Melbourne page. https://www.rch.org.au/clinicalguide/guideline_index/cervical_lymphadenopathy/ www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.f…
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Today we look back at 5 years of the Royal New Zealand College of Urgent Care podcasts. If you want to get involved with the next 5 years of podcasts, email the address below. www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc Music licensed from www.premiumbeat.com Full Grip by Score Squad This podca…
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Urgent Bite 185 - Carnett and Fothergill signs
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A couple of eponymous signs to use in evaluating abdominal pain that helps determine a rectus sheath haematoma. Check out the Stat Pearls page Allen M, Sevensma KE. Rectus Sheath Hematoma. [Updated 2023 Jan 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK5…
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Look for the cardinal signs of Kawasaki disease in kids with persisting fever. Check out the Starship page - https://starship.org.nz/guidelines/kawasaki-disease/ Check out the Dermnet page https://dermnetnz.org/topics/kawasaki-disease www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc Music licensed f…
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Elson's test is an important test to know in urgent care. Check out Elson's original paper. Elson RA. Rupture of the central slip of the extensor hood of the finger. A test for early diagnosis. J Bone Joint Surg Br. 1986 Mar;68(2):229-31. doi: 10.1302/0301-620X.68B2.3958008. PMID: 3958008. https://pubmed.ncbi.nlm.nih.gov/3958008/ Check out the Orth…
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Urgent Bite 182 - High Pressure Injection Injuries
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High-pressure injection injuries might look innocuous on the surface, but they need an immediate surgical referral. Check out the video mentioned from the Hydraulic Press Channel - https://www.youtube.com/watch?v=mFea7RNhw2w Check out the OrthoBullets page - https://www.orthobullets.com/hand/12104/high-pressure-injection-injuries#:~:text=High%2DPre…
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Urgent Bite 181 - Thinking about Bell’s Palsy
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Bell's palsy can be diagnosed clinically, but it is important to exclude other differentials. Check out the paper mentioned Induruwa I, Holland N, Gregory R, Khadjooi K. The impact of misdiagnosing Bell's palsy as acute stroke. Clin Med (Lond). 2019 Nov;19(6):494-498. doi: 10.7861/clinmed.2019-0123. PMID: 31732591; PMCID: PMC6899254. https://www.nc…
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Always look for Kanavel's sign and refer if present. Check out the OrthoBullets page on pyogenic tenosynovitis - https://www.orthobullets.com/hand/6105/pyogenic-flexor-tenosynovitis www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc Music licensed from www.premiumbeat.com Full Grip by Score Squad This…
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Urgent Bite 179 - Looking at the Tongue
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Why should we look at the tongue in urgent care? And why does it sometimes stick out when we are thinking? Check out the Live Science article https://www.livescience.com/why-stick-out-tongues-concentration Check out the New Scientists article https://www.newscientist.com/lastword/mg25333781-200-why-does-sticking-my-tongue-out-seem-to-help-me-concen…
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Urgent Bite 178 - Tibial Stress Fracture
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A tibial stress fracture in a golfer. Unusual, given that they are often associated with runners, but it does highlight how listening to your patient when they say something is wrong is important. Interview between David Feherty and Richard Boxall - https://youtu.be/_82qJCndF90 OrthoBullets - Tibial Stress fractures - https://www.orthobullets.com/k…
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