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...
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...
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...
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...
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...
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...
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,...
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...
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...
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...
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...
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...
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...
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...
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.
...
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...
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
...
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...
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...
Haber E.N et al. Accuracy of Noninvasive Blood Pressure Monitoring in Critically ill Adults. J Int Care Med. 2024, Jan 12 (Ahead of Print.) PMID: 38215002
I always have anxiety when the sick,...
Cardiac arrest has a poor survival rate. In this study Okubo et al(1) tried to address the question of adrenaline or airway first, in out of hospital cardiac arrest?
We appear to be forever looking...
Bell's Palsy is an ipsilateral Cranial Nerve VII (lower motor neurone) palsy. There is usually a sudden onset of facial weakness, that progressively worsens over 48 hours. The diagnosis...
CASE
A 36 yo woman presented to the emergency department complaining of numb feet. “I can’t feel the pedals in the car when I’m driving…….. It started 2 days...
