EM Clinical Updates
Please note that these updates are a review of current literature and do not replace local treatment protocols and policy. Treating doctors are individually responsible for following standard of care.
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Clinical Updates for 2020
- Index to September 2020 - Queries re updates not available on the HETI website should be directed to Dr Brendon Smith
- Clinical Update 563 - 30 September 2020 - Guidelines on Contrast Induced Nephropathy - If needed for CT then give it
- Clinical Update 562 - 23 September 2020 - Pulmonary Embolus - A useful guide from the ESCG 2019 revision
- Clinical Update 561 - 22 June 2020 - Opiate Misuse - ED management of acute pain is not the problem
- Clinical Update 560 - 5 June 2020 - TIA - Evolving concepts on diagnosis, risk stratification and management
- Clinical Update 559 - 20 May 2020 - Anaphylaxis - Where did 4 hours observation come from, biphasic reactions and the limited role of medications other than adrenaline
- Clinical Update 558 - 8 May 2020 - Improving Outcomes in Stroke - Better patient selection with perfusion imaging will likely help
- Clinical Update 557 - 9 April 2020 - Liver Failure - What's useful to know
- Clinical Update 556 - 26 March 2020 - COVID - not trying to overload, but some useful links and summaries
- Clinical Update 555 - 23 March 2020 - Hydatid Disease - not exactly on the differential, but common on a global basis
- Clinical Update 554 - 4 March 2020 - Oncological Emergencies - they can be mimics
- Clinical Update 553 - 19 February 2020 - The new paracetamol poisoning treatment guideline. It's changed...
- Clinical Update 552 - 5 February 2020 - Observational approach to spontaneous pneumothorax: an Australian trial shows it's safe
Clinical Updates for 2019
- Clinical Update 551, 18 December 2019 - More Literature of note in 2019
- Clinical Update 550, 11 December 2019 - Literature of note in 2019
- Clinical Update 549, 27 November 2019 - When to image in strangulation and how much antivenom for snake bite. Spoiler - we still don't really know
- Clinical Update 548, 13 November 2019 - 2019 ATS Pneumonia Guidelines - A Useful Guide to Workup and Treatment
- Clinical Update 547, 16 October 2019 - ACEP 2019 Clinical Policy on SAH. 4 critical questions answered kind of
- Clinical Update 546, 2 October 2019 - Coronary vasospasm - STEMI pattern from 5FU chemotherapy and other cases ECGs
- Clinical Update 545, 18 September 2019 - Paediatric status epilepticus. Two studies comparing phenytoin and levetiracetam. Levetiracetam is no better
- Clinical Update 544, 4 September 2019 - Adrenal crisis - Cases and a NEJM review
- Clinical Update 543, 21 August 2019 - Paediatric Metabolic Derangements - 3 Cases
- Clinical Update 542, 7 August 2019 - Perfusion mismatch to guide thrombolysis up to 9hr for delayed presentations and wake-up stroke a meta-analysis
- Clinical Update 541, 25 July 2019 - So you think interpreting troponins is straightforward
- Clinical Update 540, 3 July 2019 - Endocarditis - we miss you a lot though maybe don't think about you as much as we should
- Clinical Update 539, 19 June 2019 - How to correctly dose frusemide and why ABGs are still useful
- Clinical Update 538, 29 May 2019 - Propofol and unscheduled procedural sedation - new Guidelines and recommendations
- Clinical Update 537, 15 May 2019 - Stroke - extending the window with imaging v time based reperfusion. A good theory pity about the evidence - the EXTEND trial and others
- Clinical Update 536, 1 May 2019 - Not so fast - urgency of cardioversion in new onset AF and timing of post arrest cath if NSTEMI
- Clinical Update 535, 17 April 2019 - Workup for pulmonary embolus in pregnancy. Two new studies and coroners cases
- Clinical Update 534, 3 April 2019 - Venous thromboembolic disease 2019 Australian Guidelines - Part 2
- Clinical Update 533, 20 March 2019 - Venous thromboembolic disease 2019 Australian Guidelines - Part 1
- Clinical Update 532, 6 March 2019 - When urgent cardiac cath isn't always the answer - Wellens pattern ST elevation in aVR with diffuse ST depression
- Clinical Update 531, 20 February 2019 - Clinical decision rules for pariatric head injury - NEXUS II examined. The rules have problems.
- Clinical Update 530, 6 February 2019 - Methotrexate for ectopic pregnancy - expect problems
- Clinical Update 529, 23 January 2019 - Ventilation Strategies in non ARDS Patients - Low TV Strategies are Less Critical though Avoid High Plateau Pressures
- Clinical Update 528, 9 January 2019 - Learning by Pictures
Clinical Updates for 2018
- Clinical Update 527 - Year in Review Part 2
- Clinical Update 526 - Year in Review Part 1
- Clinical Update 525, 7 November 2018 - So you want to reverse a DOAC. Good luck
- Clinical Update 524, 24 October 2018 - Work up of fever in infants 0-90 days. The Step by Step Approach, and what about the LP
- Clinical Update 523, 10 October 2018 - Angioedema - adrenaline and steroids don't help, but a possible role for bradykinin antagonists
- Clinical Update 522, 19 September 2018 - CT-coronary Angiogram. Implausible outcome benefits suggested, and still no reason to order from ED
- Clinical Update 521, 5 September 2018 - Atrial Fibrillation - NHF Australia 2018 Guidelines. Some important changes
- Clinical Update 520, 22 August 2018 - Thunderclap Headache - its more than aneurysms, and LP is still part of the workup
- Clinical Update 519, 8 August 2018 - Opiod prescribing in ED - there are alternatives
- Clinical Update 518, 25 July 2018 - New stroke trials - WAKEUP, tPA in minor stroke, low dose tPA and dual antiplatelet therapy. Should practice change?
- Clinical Update 517, 11 July 2018 - Syncope - new 2018 ESC Guidelines allow for risk stratification and potential early discharge from ED
- Clinical Update 516, 27 June 2018 - Pediatric DKA - a major study on fluid administration debunks some myths
- Clinical Update 515, 13 June 2018 - Brugada Syndrome - who needs an AICD, what to do with AF, and drugs to avoid
- Clinical Update 514, 30 May 2018 - Sepsis Update. The new SSC 2018 1 hour bundle, and the limitations of evidence
- Clinical Update 513, 2 May 2018 - ACEP 2018 Clinical Policy on DVT-PE - maybe practice not as evidence based as we would like
- Clinical Update 512, 18 April 2018 - High flow nasal O2 in bronchiolitis - still hard to see a patient centred benefit in this new study
- Clinical Update 511, 28 March 2018 - AHA 2018 Stroke Guidelines - incorporating the DAWN and DEFUSE - 3 trials on delayed thrombectomy beyond 6 hours
- Clinical Update 510, 21 March 2018 - Fluids - maybe normal saline is not that normal, though not much in it. The SMART and SALT-ED trials
- Clinical Update 509, 7 March 2018 - Sepsis Update - recognition is still not straightforward, and 2 studies on steroids give conflicting results
- Clinical Update 508, 21 February 2018 - TB or not TB, and when it threatens the airway
- Clinical Update 507, 7 February 2018 - Suicide risk assessment, and workup of the psychiatric patient aka medical clearance
- Clinical Update 506, 10 January 2018 - Lack or benefit of provocative testing for chest pain work up, no benefit of PCI in stable angina, and the ACEP STEMI Policy
- Clinical Update 505, 3 January 2018 - Pictures to learn by - interesting imaging