SUBSCRIBE NOW

 

 

 

 

 

 

 

Clinical Podcasts, Mastery Lectures and the Latest Literature Reviews.

Enjoy all the free 'open' content on the site and for a small subscription you can get access to all the podcasts, lectures and papercut reviews.

Does IM Adrenaline improve survival in OHCA? Sep 08, 2024

Adrenaline is recommended for all cardiac arrests not due to shockable rhythms and is associated with increased survival, especially if given in the first 10 minutes post arrest (1).

The rate...

Read More...
The PROFUNDUS Study Aug 28, 2024

 

A 62 yo patient with a previously diagnosed spontaneous coronary artery dissection (SCAD) presents with sudden onset 10/10 central severe chest pain. Examination is normal, with no pulse...

Read More...
Otitis Media: Antibiotics or Not? Aug 22, 2024

We're back to an old question of should we give antibiotics for otitis media? The factors always being weighed up have been around the benefit which includes reduction in pain and resolution...

Read More...
A Clinical Risk Score for Vertigo Aug 14, 2024

The patient with vertigo can be a clinical challenge. Patients may describe their symptoms as vertigo, or the room spinning, or dizziness, or a problem with balance, or use other descriptors....

Read More...
Elderly Patients with low Energy Blunt Trauma: Head CT? Aug 12, 2024

Here's a case I have presented to me frequently. The resident presents the case of a 78 yo who had a mechanical fall at home. The patient may or may not remember a head strike. I am asked the...

Read More...
Papercut: D-dimer to rule out Acute Aortic Syndrome Aug 07, 2024

Patients with acute aortic syndrome, may be very difficult to diagnose. Patients who present with textbook ripping severe chest pain and accompanying focal neurology and have findings of a pulse...

Read More...
D-Dimer only testing for PE Jul 23, 2024

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...

Read More...
Zero Point Survey Jul 23, 2024

 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...

Read More...
The ARREST Trial Jul 23, 2024

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...

Read More...
Femoral Artery Ultrasound in Cardiac Arrest Jul 23, 2024

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...

Read More...
Diagnostic Testing for Suspected SAH Jul 23, 2024

 

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'...

Read More...
The PREOXI Trial: NIV for pre-oxygenation Jul 23, 2024

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...

Read More...
Modified Valsalva PLUS Adenosine to revert SVT Jul 23, 2024

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

Read More...
The HALT-IT Trial Jul 23, 2024

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...

Read More...
Massive Upper GI Bleed Jul 23, 2024

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...

Read More...
Subclinical Atrial Fibrillation: A review of 11 studies Jul 23, 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...

Read More...
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.

...

Read More...
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...

Read More...
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...

Read More...
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...

Read More...
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...

Read More...
How do you cardiovert AF: Drugs or 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...

Read More...
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,...

Read More...
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...

Read More...
1 2