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Papercut: Adrenaline vs Noradrenaline in Post Arrest Hypotension May 20, 2024

Up to one third of patients with out-of-hospital cardiac arrest(OHCA) have impaired myocardial contractility and vasodilatation. The mainstay of treatment is either adrenaline or noradrenaline.

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Papercut: The CLOVER Trial May 19, 2024

Dr James Edwards discusses the CLOVER Trial comparing restrictive to more liberal fluid management of hypotension in Sepsis.

Reference

The National Heart, Lung and Blood Institute Prevention and...

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Papercut: Subsegmental PE May 19, 2024

Dr Adam Micheal reviews the  2021 Update to the CHEST VTE Treatment Guideline. Stevens SM et al. Chest 2021

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Practice Changing Resuscitation Papers May 19, 2024

Prof Paul Middleton brings us two practice changing papers

  1. Cretinous M A et al. Respiratory Rate: The Neglected Vital Sign. MJA 2008;188: 657-659
  2. Garcia-Alvarez M et al. Sepsis-associated...
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Mastery: PEA. Do you Hocus Pocus? May 18, 2024

A 68 yo patient is brought into the ED, post cardiac arrest.

The patient collapsed whilst out. Down-time was approximately 5 minutes; bystander CPR was commenced. ROSC was present when the...

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GARFIELD-AF Risk Score for Mortality Stroke and Bleeding May 16, 2024

The GARFIELD-AF tool allows a single calculation for mortality, stroke and bleeding and can assist in risk/benefit decision-making.

The GARFIELD-AF(Global Anticoagulant Registry in the...

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What Energy to Use when Cardioverting AF May 15, 2024

When I cardiovert AF, I use the highest energy possible energy in the first cardioversion attempt. I consider this to be a resistant arrhythmia and want to have the best chance of...

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Acute Atrial Fibrillation: What we do. May 15, 2024

In this podcast we go on the patient journey, of a 61 yo patient who presents at 11pm at night with an irregularly irregular pulse, at a rate of 167 bpm and a complaint of palpitations.

How do you...

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Subclinical Atrial Fibrillation May 15, 2024

You might ask; "Why's is subclinical Atrial fibrillation important?" We know that patients in atrial fibrillation(AF) have a 5 x risk of stroke compared to those not in AF and that even short...

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The EPIC Trial: Pad placement for cardioverting AF May 15, 2024

When cardioverting patients in new atrial fibrillation, we want our first attempt to be our best attempt. 

The EPIC Trial(1) (Electrode Position In cardioverting Atrial Fibrillation) helps us...

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How do you cardiovert AF: Drugs of Electricity? May 15, 2024

Atrial Fibrillation is the most common arrhythmia we see. Conversion to sinus rhythm of recent-onset of atrial fibrillation is proven to be safe. How do you cardiovert? Is a pharmacological...

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Papercut: The Timing of Cardioversion in AF May 15, 2024

Here we review the RACE7 ACWAS (Rate Control vs Cardioversion Trial7-Acute Cardioversion versus Wait and See) Trial (1).

What they did

This was a multicenter, randomised, open label,...

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When to treat Hyperkalaemia May 06, 2024

Does a normal ECG exclude Hyperkalaemia?
Do we treat patients with a K+ < 6.5 mmol/L?
Do ECG changes in hyperkalaemia predict a adverse outcome?
Should we treat patients with hyperkalaemia and...

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Podcast: Airway Pearls for Intubating the Obese Patient May 01, 2024

AIRWAY PEARLS

  • Consider every case a difficult Intubation due to effects on anatomy and physiology
  • Normal airway techniques may not be effective.
  • Positioning of the patient is critical- aim for...
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A Meta-analysis of NOAH-AFNET 6 and ARTESiA Trials May 01, 2024

Patients with subclinical atrial fibrillation, detected by implantable devices, have an increased stroke risk, although not as great as that of patient with clinical atrial fibrillation. I also...

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Papercut: Apixaban for Stroke prevention in Subclinical Atrial Fibrillation May 01, 2024

The first thing you might say is, "Why's should I care about subclinical Atrial Fibrillation, I work in Emergency Medicine?" Perhaps, this will guide us to making better decisions on...

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Resuscitative Sequence Intubation Apr 25, 2024

There are 4 main physiological areas, we need to target, as they can result in peri-intubation cardiac arrest.

Hypotension

Positive pressure ventilation secondary to intubation, increases...

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Cardiac Arrest complicating emergency airway management Apr 25, 2024

Emergency airway management and specifically intubation can be associated with significant adverse events, related to the airway itself (failed intubation, oesophageal intubation and hypoxia being...

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Methylene Blue for Septic Shock: Prime Time? Apr 25, 2024

Open Access article.
A 78 yo patients presents with tachycardia and hypotension. There has been a recent episode of dysuria and the diagnosis of urosepsis is made. Antibiotics are given as you give...

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4 of the best cardiac arrest RCT's of 2023 Apr 25, 2024

This papercut comes from an editorial in Resuscitation, where they chose four important multi centre RCTs with large sample sizes, published in 2023.... and not necessarily in their journal.

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ICU will not take the patient Apr 16, 2024

An 88 yo patient who is fully independent, is brought into ED by ambulance in Cardiogenic Shock. The only past history the patient has is hypertension and hypercholesterolaemia.

Earlier that...

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Management of Cardiogenic Shock in Elderly Patients Apr 16, 2024

Mortality in elderly patients with cariogenic shock is high... in some studies, greater than 75%. This review is of an AHA Scientific Statement  Circulation. 2024;149:e1051–e1065
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BRASH Syndrome: A Case Apr 14, 2024

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An 88 yo patient is brought into the emergency department with significant bradycardia. During the evening the patient has been at home and has become incontinent, lethargic...

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Timing of Vasopressin initiation in septic shock Apr 14, 2024

Vasopressin is often used as a second line agent to Noradrenaline in septic shock. The usual approach to sepsis is commencement of fluids and if a mean arterial pressure (MAP) >65, is not...

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