Non-Invasive Ventilation


The ambulance bring a patient in on a rebreather. She is elderly and has been unwell for the last few days. Her respiratory rate is 32, heart rate is 125 and sats are 90%. She is afebrile and examination is normal apart for a few creeps in both bases. A set of gases reveals the [...]  Read More »

The Shock Index

Shock Index

The Shock Index. Do you use it? Do you know what it is? Originally it was used to predict shock in medical patients in the Emergency Department, but since then has been evaluated for use in trauma and myocardial infarction.Although it’s been around for over 50 years it’s doesn’t appear to be widely used in [...]  Read More »

New venous thromboembolism treatment guidelines


The American College of Chest Physicians has just produced a treatment guideline for venous thromboembolism(VTE) and Pulmonary Embolism(PE). The primary push in this guideline is for the use of non-vitamin K oral anticoagulants over warfarin. Here is a brief summary DEEP VENOUS THROMBOSIS (DVT) Isolated DVT with no severe symptoms or risk factors: suggest serial [...]  Read More »

Continuous vs Interrupted CPR for Survival


A new paper by the Resuscitation Outcomes Consortium (ROC) was published in the NEJM(November 9th 2015). Nichol et al looked at Trial of Continuous or Interrupted Chest Compressions during CPR and their effect on survival. This was a prospective randomised crossover trial of  26148 patients in the pre-hospital environment. In the test group, CPR was performed [...]  Read More »

Beware the ECG mimic


You have a patient in the emergency department with a history of high fevers and cough. He is initially, very dehydrated, tachycardia and hypoxic on room air. The nurse calls you and says that the patient is going into ventricular tachycardia(VT). His ECG is as below.What do you do now? Scroll down for the answer… [...]  Read More »


Screen Shot 2015-11-09 at 12.32.03 am

It occurs in about 0.3% of the population (1), although this is an underestimate, as evidence of pre-excitation on the ECG my be transient.  The characteristic delta wave indicates that the accessory pathway conducts faster than the Atrioventricular (AV) node, thus resulting in pre-excitation. However, the refractory period of the accessory pathway may change meaning [...]  Read More »

The New Paracetamol Guidelines

Paracetamol guidelines

We have an update on the Management of Paracetamol Poisonings (MJA 203(5). 7 September 2015) (last update was in 2008) and it covers six main areas: Risk Assessment Charcoal Use Modified Release Paracetamol Large/Massive Ingestions Liquid paracetamol in children less than 6 years old. Consulting a Liver Transplant Unit Some Notes: In children less than 6 [...]  Read More »

Effectiveness of Apnoeic Oxygenation Questioned

Apnoeic oxygenation might not work

Everyone knows I’m a huge fan of apnoeic oxygenation. I use it for sedation, for intubation, heck I sprinkle some on my cereal in the morning. But here is a study published this week, whose conclusions do not support the use apnoeic oxygenation during endotracheal intubation of critically ill adults.Semler et al of the Fellow investigators [...]  Read More »

Difficult Airway Cases: What would you do?

Neck CT

Airway management is frightening, especially if you don’t do it often. Having a plan when we approach an airway is important. My plan involves: Maximising oxygenation with apnoea oxygenation Using the right drugs Performing epiglottoscopy, rather than looking for the cords Having a fallback plan. For me this means thinking about the 3 elements that [...]  Read More »

A New way to perform Valsalva for Supraventricular Tachycardia(SVT)


Last month, August 25th, the REVERT Trial was published in the LANCET. This study used a slight modification on the classic Valsalva manoeuvre, to more than DOUBLE the reversion rate from SVT. I’m excited about this. I don’t like giving drugs to patients if I don’t have to. Until Now… The normal cardioversion rates in [...]  Read More »