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NIV of comatose patients with acute poisoning: The NICO Trial Apr 03, 2024

The CASE

A 28 yo patient is brought in by ambulance with a depressed conscious state. The ambulance was called by friends who give a history of the patient drinking all night. There is no known...

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STEMI Equivalents Update Apr 03, 2024

What is a ST Elevation Myocardial Infarction (STEMI) Equivalent?

These ECG criteria identify patients who require immediate reperfusion therapy as per the 2013 STEMI Guidelines (1). The ecg changes...

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EM Mastery
A Case of Electrical VT Storm
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A Case of Electrical VT Storm Mar 29, 2024

The CASE

A 58 yo patient has called the ambulance, as he is having palpitations and is feeling unwell. He has a past medical history of ischaemic heart disease with two coronary stents placed 10...

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EM Mastery
Shock: Choosing Inotropes and Vasopressors
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Bronchiolitis, Steroids and Adrenaline, and Thermometers Mar 27, 2024

 A literature review of the latest in Bronchiolitis management. Also a review of thermometers (or as we like to call them random number generators)

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Capnography to guide ventilation in cardiac arrest Mar 27, 2024

The End tidal CO2 (ETCO2), is measured at the end of expiration and used to confirm that the patient is being ventilated and during cardiac arrest. It is also used as a surrogate marker for cardiac...

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EM Mastery
Oxygen Targets in Cardiac Arrest
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Oxygen Targets in Cardiac Arrest Mar 27, 2024

 The purpose of resuscitation in cardiac arrest, is to restore oxygenated blood supply to the organs, most importantly the brain. What are the oxygen targets in cardiac arrest and post arrest...

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Do Smaller BVM's Increase ROSC? Mar 27, 2024

The best way to manage the airway during cardiac arrest, has remained somewhat of a mystery. We don’t know how much tidal volume to give, were not sure of what percentage FiO2 to deliver and...

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Do Steroids Decrease Mortality in Severe CAP? Mar 27, 2024

Do steroids decrease mortality in patients with severe community acquired pneumonia?

Community acquired pneumonia is the leading cause of death from infection, approaching 10% mortality. In those...

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EM Mastery
Pericarditis
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Pericarditis Mar 27, 2024

Case 1

A 35 yo male presents with palpitations and pleuritic chest pain. He’s recently had a viral illness but has no other medical history. At 1am in the morning, the patient was woken by...

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Guillain Barre Syndrome: A Case Mar 27, 2024

 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...

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EM Mastery
Atrial Flutter with a High Degree Block
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Atrial Flutter with a High Degree Block Mar 27, 2024

A 78yo male woke up in the morning feeling dizzy. The patient was well when lying down, but became light headed every time he got up. He waited, but symptoms did not improve, so later in the...

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EM Mastery
Hypertensive Emergencies
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Hypertensive Emergencies Mar 27, 2024

Hypertensive emergencies are defined as sudden and prolonged increases in the arterial blood pressure, with associated organ damage. The degree of increase above that which the patient normally...

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Status Epilepticus in a Child Mar 27, 2024

 The CASE

A 7 yo child is brought in by ambulance after having tonic clonic seizures that morning. The whole family had been travelling for a holiday. Her mother tried to wake her in the...

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Bells Palsy: Diagnosis and Management Mar 25, 2024

 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...

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The Ominous Spiked Helmet Sign on ECG Mar 25, 2024

 The Case

A 35 year old woman, who is a known intravenous drug user, is admitted with septic shock secondary to bacterial endocarditis. She is acidotic and hypotensive. Her ECG is shown. Here...

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A Strange Case of Chest Pain and Hypotension Mar 24, 2024

 The CASE

52 yo with chest pain and hypotension

It’s a busy afternoon in a rural emergency department and the ambulance bring in a 52 yo with central chest pain and a blood pressure of...

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Adrenaline: What's the best dose? Mar 23, 2024

In this Papercut review we look at some major studies and what they tell us about the use of Adrenaline in cardiac arrest. Adrenaline is the most used drug in cardiac arrest. However we...

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