Category: Emergencies

Atrial Fibrillation

AF is the most common sustained cardiac arrhythmia you will encounter. In this article, we focus on the management of it. Identification of atrial fibrillation is usually fairly easy due to the irregularly irregular pattern (using the RR intervals), typically narrow QRS complexes & the lack of P waves. If you need a quick refresher

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Chest Pain

As a junior doctor, you will also often assess patients complaining of chest pain in the acute admissions setting and on the wards. Reviewing a patient with chest pain can be daunting whatever stage of training you are at. The seriousness of chest pain varies from less concerning pain (i.e musculoskeletal pain) to life-threatening events.

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Hypotension

Expect many bleeps about hypotension from concerned nursing staff. It is a useful way to flag up which patients might be unwell. Although defined as below 90 systolic or 60 diastolic, we usually most heavily rely on the systolic on the wards. The concern is shock – hypotension that leads to hypo-perfusion of organs/tissues resulting

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Alcohol Withdrawal

Suddenly stopping alcohol intake in patients who have been drinking heavily for prolonged periods is dangerous and can lead to severe withdrawal. Delirium tremens can occur in about 10% of patients with withdrawal and carries a 5-10% mortality risk. Certain patients will require pharmacological (and non-pharmacological) tools as part of an inpatient alcohol detoxification programme,

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Hypoxia

As an FY1, you will be called to review hypoxic ward patients. Here we discuss common causes of generalised hypoxia and not focal hypoxia/ischaemia such as in a stroke or heart attack. Insufficient oxygen-carrying capacity due to anaemia, or ineffective use of oxygen at the tissue level (no cyanide management here zebra hunters!) will also

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Neutropenic Sepsis

Please read an overview of the management of sepsis before reading this article. Neutropenic sepsis is defined as a temperature of greater than 38°C or any symptoms and/or signs of sepsis, in a person with an absolute neutrophil count of 0.5 x 109/L or lower. It is a common and potentially life-threatening complication of neutropenia.

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Hyponatraemia

Hyponatraemia (serum Sodium <135 mmol/L) is one of the most common electrolyte abnormalities you will see and so a systematic approach to identifying the underlying cause and management is vital. We will use the algorithm below from ESE which is far easier to use than the antiquated system of first assessing their volume status. Recommended Investigations

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Non-Invasive Ventilation

Non-invasive ventilation is a way of providing ventilatory support to patients in respiratory failure without using an invasive airway device (e.g. ET tube or tracheostomy tube). The devices are becoming increasingly commonplace in medical practice and can be set up by trained professionals in the Emergency Department, on the wards, in ICU or even at

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Acute COPD exacerbation

As an FY1, you are unlikely to be expected to make decisions about long term COPD management therefore focus your efforts on learning how to deal with acute exacerbations. Initial assessment1. If a patient reports having a diagnosis of COPD it is worth asking a few questions to clarify the accuracy of the statement. It

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Upper GI bleed

These patients have the potential to become haemodynamically unstable extremely quickly; try to avoid delays in reviewing them. In-hospital mortality is around 10%. If they are unwell then assess them using A-E and a SAMPLE history and get senior help quickly if you are concerned. Depending on your hospital this may be via the arrest

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