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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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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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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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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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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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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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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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Accuracy of Non-invasive blood pressure in critically ill patients Apr 14, 2024

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,...

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