Clinical Podcasts, Mastery Lectures and the Latest Literature Reviews, in one place.

Here is a common scenario: The resident presents a case of a 58 yo patient who has presented with shortness of breath. They go over the examination, the ECG findings and then say ".... and the...

 The 'zero-point survey' is the pre-primary survey. It is about preparing self, the team, the environment and the equipment. It is a 'cognitive roadmap' to prepare for complex resuscitation...

Survival from out of hospital cardiac arrest varies from region to region. This makers sense as it depends on resources, such as medical and nursing staff, expertise of that staff and resources...

Cohen AL et al. Femoral artery Doppler ultrasound is more accurate than manual palpation for pulse detection in cardiac arrest. Resuscitation 2022;173: 157-165.

When we are in the ACLS...

Non-traumatic subarachnoid haemorrhage (SAH) accounts for 5% of acute headache presentations to the emergency department. The urgency to make a diagnosis when patients have a 'warning leak'...

This is a review of the Pragmatic Trial Examining Oxygenation Prior to Intubation (PREOXI) trial(1).

The aim of this trial was to determine to determine the effect of preoxygenation with...

Paroxysmal Supraventricular Tachycardia (PSVT), is a non-ischaemic tachyarrhythmia, with which patients, not uncommonly, present to the emergency department. Methods currently available for...

The HALT-IT Trial(1) is an important trial and one we should know well. It looks at the use of Tranexamic Acid (TXA) in gastrointestinal bleeding. Prior to this trial a Cochrane systematic review...

Upper Gastrointestinal bleeding (UGIB) affects approximately 1 in 1000 of the population per year and has an overall mortality of up to 10%. 

The cause of the UGIB in the patient in front of...

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...

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.

...

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...

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,...

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...

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...

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
...

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,...