Joe

1/8 In cardiac arrest, adrenaline reliably improves ROSC - but has not consistently translated into better long-term neurological survival. Our comment asks whether the problem is not adrenaline itself, but how and where we deliver it.. Open access: tinyurl.com/aortic-epi

1/ New from @EAAARAID in @SJTREM: observational review of Penthrox for prehospital fracture/dislocation manipulation & reduction in HEMS practice. In selected limb trauma, methoxyflurane supported successful M&R without IV procedural sedation in more than half of patients.

🚨 ED Challenge: Chest Pain Showdown 🚨 4 patients. 1 emergency department. Countless ways this could go wrong… or right. Each presents with chest pain - but only some stories end in the cath lab. ⚡ Who’s having a true coronary occlusion? ⚡ Who’s a mimic? All or none? #ECG

See what happens when #ThePitt meets the Queen of Hearts. This EKG was shown on the Pitt and interpreted as negative. But we caught it and put it through the queen. She of course diagnosed the OMI perfectly.

A 42-year-old diabetic patient presents to the ER with dyspnea and palpitations. His blood pressure is 80/45 mmHg. The next step in the management of the patient is: A. Activate the cath lab B. Perform cardioversion with amiodarone C. Start norepinephrine D. Administer adenosine

I am impeaching Secretary Kristi Noem, who is an incompetent leader and a disgrace to our democracy. She wreaked havoc in the Chicagoland area and has brought her reign of terror to Minneapolis. One of her rogue ICE agents shot and killed an innocent woman today. It must come to an end.

Look closely at the ST segment in V1–V2 What is this sign called, and why does it matter?

Easy one? Management?

How bad is peri-PHEA hypotension in head injury? Great paper from @EAAARAID reviewed by @richcarden on @stemlyns goes some way to quantify it. Read more here stemlynsblog.org/is-post-intuba…

1/ 🧵 Contemporary evidence supports moving from EtCO₂ ventilation strategies toward precision guided ventilation using real-time PaCO₂. That’s the direction of travel for prehospital neurocritical care—and it’s how we tighten neuroprotection. I will explain in this thread

“Physiology-Guided CPR” 🚨🚨🚨 The inclusion of “physiology-guided CPR” in the ERC resuscitation guidelines marks a significant milestone in progress. So here are my reflections on the journey we have undertaken and thoughts on the future directions #SPEAR 🧵

Interesting bmcemergmed.biomedcentral.com/articles/10.11…

50 year gentleman with underlying diabetes mellitus presented with lethargy. Went to outpatient clinic , was given iv hydration then developed shortness of breath.

A friend sent this beautiful ECG to me with the following information: a smoker patient in his 30s came with chest pain radiating to the back, headache, vomiting and high blood pressure, What do you think?

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A nice one! This ECG was sent to me with the following information: ~ 70 yo man with known LBBB, now ongoing chest pain. What`s your take?

Avoiding unrecognised oesophageal intubation The @RCoA & @dasairway have agreed to drop ‘no trace wrong place’ The message now is that we need to exclude oesophageal intubation by identifying SUSTAINED EXHALED CO2 This requires 4 elements -CO2 rises & falls with respiration -sustained (non-fading, >7 cycles) -amplitude >1 KPa -clinically appropriate It replaces ‘no trace wrong place’ which is insufficient & therefore inadequate See these two updated webpages Sustained exhaled CO2 rcoa.ac.uk/safety-standar… Prevention of future deaths rcoa.ac.uk/safety-standar… @AAGBI @AndyHiggsGAA @NicholasChrimes

Interesting case: What's the Rhythm!? @TrackYourHeart @radcliffeCARDIO @Interve15538505 @HeartAssociatn @HeartUganda @ZHeart11768530 @kisubi_hospital @kirudduNRH @InternalmedMak @MakCHS_SOM @UgandaPhysician @PMcardioApp @smithECGBlog @Ecgloverr @BerkBmf @DilipMysore @Asadthegeek

An old woman with HTN and DM 2 after syncope. What is wrong here?

Rhythm ?