Empathy refreshment

I’ve never met a patient with a substance problem that says they’re happy to have it.

I’m not referring to the casual misadventure with recreational drugs or alcohol, but the patients we can recognise from a distance, or the acute-on-chronic presentation that needs our interventions.

If you were to spare a few minutes and read this wonderful post by Phil Berry, perhaps your next fatigued encounter won’t be quite as difficult;



Take a look at aVL

Following on from this post where I mentioned that I always look for reciprocity when interpreting an ECG, I’ve been meaning to link to this post for some time.

ECG Medical Training‘s posts are to the point, and this one highlights aVL as a lead that might be overlooked when contemplating reciprocity for inferior STEMI (which you might not see in lead I) ;



Mental toughness – a backgrounder

“I could never do your job…” – this may have been said to you on more than one occasion, but have you thought about why that might be ?

Over the last couple of years I’ve been hearing more about performance psychology, stress inoculation and mental toughness as reasons that we can do what we do, and how we might be able to become even better at it.

This post by Mike Lauria is a comprehensive backgrounder (with links to even more resources) that’s well worth the 5 minutes it will take you to read;



At-Risk ECGs

I’m not one for pattern recognition – I try to stick to a systematic review of the rate, intervals, regularity, origin and then work through the leads, where they physically map to, and look for reciprocity..

This image from LITFL is one of my favourite desktop backgrounds (but I digress);

The team at RebelEM put together great posts, and this highlights that just because the ECG you’re reading doesn’t meet ‘the criteria’ for immediate intervention, it won’t evolve into something that does.



New year celebrations

I’m working on an event car tonight (yes, I know) and it occurred to me that there are likely a number of people presenting at hospital over the next 24 hours that might not really need to be there.

Here’s a great (albeit older) article from the folk at Guy’s & St Thomas’  via PubMed that discusses their revised recommendations for revellers who appear to be unwell, but in context, might not need to present at the local emergency department.

Something to think about.



My best wishes for your year ahead.

Paucis Verbis (in a few words)

As you may have noticed, I’m a huge fan of the work of the Academic Life in Emergency Medicine (ALiEM) team.

They’ve had the foresight to put together an app for the two most popular flavours of handheld devices to access their library of Pacius Verbis (PV) cards which are short, right-to-the-point references for 146 topics (at last count) that you are likely to be interested in;


You’ll also see that you can purchase some paid content through the various app stores, but take some time to browse through the free stuff first..

Ketamine for acute pain

We’ve recently updated our pain management guideline to include Ketamine in addition to IV opioids for severe pain.

Here’s a marvellous post from the Skeptics’ Guide to Emergency Medicine that should give you a better understanding of where the evidence is, and why this is an outstandingly good idea;


Be sure to scroll all the way to the end where you’ll find a couple of ‘paper in a picture’ graphics that summarise the literature !