24/5/26 Diphtheria alert
There is currently an outbreak of Diphtheria in parts of the Northern Territory, Western Australia and South Australia. Please be alert for cases of oropharyngeal and cutaneous Diphtheria in patients who have been to these regions, particularly Indigenous patients.
Important copyright and AI information
Please be reminded that unauthorised reproduction of the Manual in any form, including creation of summaries, audio or animation, or copying content into any machine learning tool is not permitted. Breaches of this agreement will result in immediate, and permanent, termination of access and legal action for breach of copyright.
Dedication
This manual is dedicated to the memory of Dr Edward William Brentnall FACEM, MBE, OAM, KStJ 05/08/1929-01/10/2024. Ed was a guiding light for generations of emergency physicians who sheltered, mentored and inspired many of us. See the full dedication here.
Latest updates
Limitations of the CHA2DS2VA score
The Stroke prevention in atrial fibrillation page has been updated with additional information about the limitations of the CHA2DS2VA score.
CHA2DS2VA and stroke risk table
The table on the Stroke prevention in atrial fibrillation page previously demonstrating the CHA2DS2Vasc score and stroke risk has been updated to demonstrate the CHADS2VA score and stroke risk.
Atrial fibrillation stroke risk
The Stroke prevention in atrial fibrillation page has been updated with a revised segment on AF stroke risk.
Minimum O2 flow rate through a Hudson mask is 5L/min.
The Oxygen therapy page has been updated with expanded details on the minimum O2 flow rate through a Hudson face mask.
Blood gas calculations require PaCO2 or PaO2 values, not venous PCO2 or PO2 values
The Blood gasses page has been updated to better reflect that, if you are going to do calculations on blood gas results at all, you need to use arterial O2, CO2 and HCO3 values. Better still, learn something else that is less prone to error, better validated and more clinically useful…..
PaO2 and PaCO2
All instances of PO2 and PCO2 in the manual have been updated to PaO2 and PaCO2 whenever relevant to prevent readers thinking that PO2 and PCO2 may mean venous PO2 or PCO2.
Ensuring extent of neuromuscular paralysis is measured and reversed prior to extubation
The Endotracheal extubation page has been updated with additional emphasis on ensuring the extent of neuromuscular paralysis is measured and reversed prior to extubation. In particular, do not assume neuromuscular blockade will have worn off after a few hours in ED patients.
Duration of action of rocuronium
The Non depolarising neuromuscular blocking agents page has been updated with additional information about the duration of action of rocuronium, particularly emphasising it is highly variable and may be very significantly prolonged.
