JC: Duel of the Rules: Which decision rule for head injury in children?

Dual of the Rules

Ladies and Gentlemen! The assessment and investigation of paediatric head injury is a case study in clinical risk management. Similar to chest pain in grown up medicine, it’s a frequent presentation, with a rare but potentially devastating outcome. It’s these kind of patients where we as ED docs come into our own as diagnosticians (or […]

JC: The Trouble With Tonsils. St.Emlyn’s

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Or…. If we’re preaching to the choir, why are they still singing the wrong tune? If you are a up to date, #FOAMed positive practioner, I suspect you already have strong opinions on the matter of antibiotics for sore throat. There has been a wealth of research and blog posts and podcasts on this subject […]

PCI for OOHCA with NSTEMI post ROSC? An acronym too far?


So you’ve done it. In a dazzling display of medical prowess worthy of a medical TV drama you have restored the dead to life! With scrupulous airway management, high quality chest compressions (assisted by some waveform capnography, of course), careful administration of adrenaline boluses (I know, I know) and liberal application of Direct Current, your Out […]

A Snake in the Grass at St.Emlyn’s


While not fortunate enough to actually attend SMACC 2013, I was pleased to catch the much anticipated SimWars event, particularly as Team GB was one of the successful finalists. As we kind of expected, they were presented with a patient who had sustained a snake bite, something maybe a little outside of a British team’s experience. None […]

Review: The Essence of Emergency Medicine


It was  a long day. After getting home from a late shift the night before, I was up at 4 to catch my 0530 train, and toddled off down to London. What, you may ask could be worth all that? Simples: I spent the day at the Essence of EM course, run by Cliff Reid, one of […]

Getting Chilly Quickly 2…. Early hypothermia for ROSC?

Rapid freezing.... it works for peas, why not OOHCA patients?

By now, we all are thoroughly convinced as to the benefit of therapeutic hypothermia after cardiac arrest. (if you don’t do this in your hospital, you really should not be seeing OOHCA patients….).  In addition, the consensus seems to be that time does matter and we should be doing this ASAP after ROSC. The evidence isn’t […]

ALS: Airway, Breathing, Capnography???


A Confession I have a guilty secret. I love cardiac arrests. Yep, I said it. As a brand new doctor, there was something exciting about dashing off to a 2222 call, even if my main contribution was scribing or occasionally getting IV access. This was the medicine I had seen on TV! Even now, as […]

Glasgow Scores… Not just for coma any more!


Quick post… NICE have recently published new guidance on Upper GI bleeding. It is surprisingly sensible. I was pleased with their position on PPI’s for upper GI bleeding (not before endoscopy…). The other point that I was happy to see was the inclusion of the Blatchford score for risk assement of these patients. We all love a good scoring […]



So…. We have just covered the following paper in our journal club at Manchester Royal Infirmary. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60768-5/abstract The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial Background Thrombolysis is of net benefit in patients with […]