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Emergency Medicine Cases

Best Case Ever 46 – Chris Nickson on Hickam’s Dictum

Emergency Medicine Cases

Dr. Anton Helman

Science, Courses, Medicine, Health & Fitness, Education

4.7602 Ratings

🗓️ 21 June 2016

⏱️ 12 minutes

🧾️ Download transcript

Summary

EM Cases Best Case Ever - Chris Nickson on Hickam's Dictum. Usually we use the heuristic of Occam's razor to help us arrive at one diagnosis that makes sense of all the data points that a particular patient presents to us. However sometimes it's not so straight forward and we need to think about multiple diagnoses that explain a patient's condition - Hickam's Dictum. Dr. Chris Nickson, the brains behind the Life in the Fast Lane blog tells his Best Case Ever from the SMACC Conference in Dublin, in which a patient thrombolysed for massive pulmonary embolism suffers a cardiac arrest, and the thought process he went through to discover the surprising complicating diagnoses that ensue...

Transcript

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0:00.0

Yes, this is E.MK's best case ever mini podcast series, and I'm your host, Dr. Anton Hellman.

0:29.6

We're live from Smack Dublin with one of the creators of Smack, Dr. Chris Nixon himself, and for the first time we have him on

0:42.3

EM cases. You know, normally we have Canada's brightest minds in emergency medicine, but Chris,

0:47.8

I understand you've really had nothing to do with Canada your whole life. Tell us a little

0:52.3

bit about your background. So, well, first of all,

0:55.7

Anton, it's great to be talking to EM cases. I've followed it for a long time. I remember years ago

1:01.8

we met essentials as delegates, and so it's been fantastic to see how it's evolved, and I guess

1:08.6

we've run these parallel paths into free open access medical education.

1:14.4

From me, I'm a New Zealander. Let me just reiterate that. I'm a New Zealander, but I live in Australia

1:20.2

and I'm in Melbourne, trained in emergency medicine and intensive care. I currently work as an

1:25.8

intensivist at the Alfred in Melbourne.

1:28.3

Awesome. So let's cut to the chase. Chris, tell us your best case ever.

1:38.1

One that does stick in my mind was a case where we were called to see if we should put a patient on ECMO.

1:46.3

Now, I understand that in your neck of the woods, Anton, the idea of crashing,

1:52.6

hypotensive, shocky patients onto ECMO isn't often an option.

1:57.0

That's right.

1:57.6

But this one, I think, has lots of lessons in it.

2:00.0

So we got a call about a bloke, that's a man this one i think has lots of lessons in it so uh so we got a call about a

2:02.9

a bloke that's a man who's uh it was in his mid 50s uh from another hospital and uh what

2:10.2

had happened was that he just had a hip operation and within 24 hours of that became very

2:15.7

unwell difficulty breathing hypot, you know the story.

2:20.3

It's a PE.

...

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