US for ureteric colic
The Loin pain page has been updated with additional information including the technique to visualise ureteric calculi with US.
Bob Dunn
Pre PCI beta blockers
The Management of acute coronary syndromes page has been updated with additional information about the role of pre-PCI beta blockers. Roolvink, V, Ibanez, B, Ottervanger, JP, et al. Early Administration of intravenous Beta blockers in patients with ST-elevation myocardial infarction before primary PCI. Journal of the American College of Cardiology 2016.
Myoglobin in ACS
The Other cardiac biomarkers page has been updated with additional information about the role of myoglobin in excluding ACS in low risk patients. Meek, R, Braitberg, G, Cullen, L, et al. Outcome at 30 days for low-risk chest pain patients assessed using an accelerated diagnostic pathway in the emergency department. Emerg Med Australas 2016.
Risk stratification for ACS in patients < 40 years of age
The Risk stratification in suspected ACS page has been updated with additional information about the characterstics of patients with ACS who are < 40 years of age.
Inferior MI ECG changes
The ECG in acute coronary syndromes page has been updated with additional information about determining which artery is likely the source of the culprit lesion in inferior MI.
Ulcer size increases rebleeding risk
The Upper GI haemorrhage page has been updated and the size of the ulcer added as a risk factor for rebleeding. Camus, M, Jensen, DM, Kovacs, TO, et al. Independent risk factors of 30-day outcomes in 1264 patients with peptic ulcer bleeding in the USA: large ulcers do worse. Alimentary Pharmacology & Therapeutics 2016:n/a-n/a. . … Read more
Early second shock in in-hospital cardiac arrest
The Advanced cardiac life support page has been revised to increase the emphasis on the utility of an early second shock in in-hospital cardiac arrest. Bradley, SM, Liu, W, Chan, PS, et al. Defibrillation time intervals and outcomes of cardiac arrest in hospital: retrospective cohort study from Get With The Guidelines-Resuscitation registry. BMJ 2016:i1653.
Lignocaine and amiodarone in cardiac arrest
The Advanced cardiac life support page has been revised to increase the emphasis on the utility of lignocaine or amiodarone in witnessed cardiac arrest. Kudenchuk, PJ, Brown, SP, Daya, M, et al. Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest. N Engl J Med 2016 .
Scurvy
A new segment on Scurvy has been added to the Anaemia page. Even though scurvy also has skin, bone and CNS features the reason it has been put there is that anaemia is the most consistent finding in scurvy.
ECG of hyperventilation T wave changes
The ECG in acute coronary syndromes page has been updated with an ECG demonstrating T inversion secondary to hyperventilation.
Causes of T wave inversion
The ECG in acute coronary syndromes page has been updated with a short segment on non ACS causes of T wave inversion.
S4 restricted medications
The Drug dosing & administration page has been updated with additional information about S4 restricted drugs.
Idarucizumab
The Reversal of anti-coagulation page has been updated with a segment on idarucizumab and its role in reversing dabigatran toxicity.
Avoiding claims of impropriety
The Clinical skills page has been updated with a segment on how to avoid claims of impropriety during physical examination.
Hepatitis B
The Infectious hepatitis page has been updated with an extensive revision of the Hepatitis B segment.
Chronic pain
The Chronic pain page has been updated following the publication of the CDC Guidelines for the use of opioids in chronic pain. Dowell, D, Haegerich, TM, Chou, R. CDC Guideline for Prescribing Opioids for Chronic Pain-United States, 2016. JAMA 2016 .
Principles of opioid therapy
A segment on the principles of opioid therapy has been added to the Opioids page, including a table of morphine milligram equivalent doses.
Normal echocardiographic measurements
The Echocardiography page has been updated with a reminder to interpret ‘normal’ echocardiographic measurements considering the body habitus and activity level of the patient. Many athletes have increased IVC, LV wall and aortic root diameter measurements.
Mesenteric ischaemia
The Mesenteric ischaemia page has been extensively revised following the publication of the following review article. Campion, EW, Clair, DG, Beach, JM. Mesenteric Ischemia. New England Journal of Medicine 2016;374(10):959-68.
Maxillary sinusitis
The Acute sinusitis page has been revised including the addition of the NNT of 20 for antibiotics in maxillary sinusitis.