Features of benign murmurs
The features of benign murmurs have been revised on the Cardiac murmur differentiation page.
Updates
Clinical features of aortic stenosis
The Aortic stenosis page has been updated with a revision of the clinical features of AS.
Peripheral ischaemia
The features of peripheral ischaemia have been updated on the Peripheral ischaemia ischaemia.
JVP
The Cardiovascular examination page has been revised with additional information about the JVP including how 8cm (not 5cm) should be added to the height above the manubriosternal angle to estimate CVP.
P waves and bradycardias
The Bradycardias and Other arrhythmias pages have been updated with the requirement for p waves to be present in heart block. The absence of p waves means the bradycardia is either junctional or idioventricular (although retrograde p waves may still be seen in junctional rhythms).
Paddle pressure clarification
The Electrical cardioversion page has been updated with clearer guidance on the minimum paddle pressure that should be applied.
Vertical transmission rate of HCV
The Infectious hepatitis page has been updated with the estimated rate of vertical transmission of HCV (~0.2-0.3%).
Monoclonal antibodies in TTP
The Thrombotic microangiopathies page has been updated with information about the role of monoclonal antibodies as therapy.
Opioid therapy for chronic back pain
The Low back pain has been updated with information about the lack of significant clinical benefit of opioid therapy for chronic back pain. Abdel Shaheed, C, Maher, CG, Williams, KA, et al. Efficacy, tolerability, and dose-dependent effects of opioid analgesics for low back pain: A systematic review and meta-analysis. JAMA Internal Medicine 2016.
PE following #NOF
The Femoral fractures page has been updated with information about the frequency and timing of PE following injury, with ~50% of PEs occurring within 24 hours. Kim, YJ, Choi, DH, Ahn, S, et al. Timing of pulmonary embolisms in femur fracture patients: Incidence and outcomes. J Trauma Acute Care Surg 2016;80(6):952-6.
Acquired Factor VIII deficiency
The Disorders of clotting page has been updated and some additional information about acquired factor deficiencies has been added.
Iododerma
The Intravenous contrast page has been updated with information about the rare hypersensitivity reaction called iododerma.
Troponin rise after 30 Km run
The Non ACS causes of elevated troponins has been modified to include additional information about the almost universal finding of elevated hsTroponins following a 30km run in well trained individuals. Klinkenberg, LJ, Luyten, P, van der Linden, N, et al. Cardiac Troponin T and I Release After a 30-km Run. Am J Cardiol 2016 . … Read more
Cervical spine injuries following civilian blast injuries
The Spinal immobilisation page has been updated with information about the rarity of unstable cervical spine injuries following civilian (terrorist) blast injuries. Klein, Y, Arieli, I, Sagiv, S, et al. Cervical spine injuries in civilian victims of explosions: Should cervical collars be used? J Trauma Acute Care Surg 2016;80(6):985-8.
Fish hook removal
The Subcutaneous foreign bodies page has been updated with information about how to remove embedded fish hooks.
Computer assisted ECG diagnosis
The ECG in acute coronary syndromes page has been updated with information about the accuracy of computer assisted ECG diagnosis of STEMI.
Drugs that may increase QTc
The Ventricular arrhythmias page has been updated with additional information about drugs that may increase the QTc. QT interval and drug therapy. BMJ 2016;353
Direction fixed nystagmus
Details about direction fixed and direction changing nystagmus have been included on the Cerebellar function page.
Vertigo
The Vertigo page has been updated following the recent publication of the following article. Edlow, JA, Newman-Toker, D. Using the Physical Examination to Diagnose Patients with Acute Dizziness and Vertigo. Journal of Emergency Medicine. 2016;50(4):617-28.
Primary prevention of stroke
The Cerebrovascular disease page has been updated with additional information about the primary prevention of stroke. Steiger, N, Cifu, AS. Primary prevention of stroke. JAMA 2016;316(6):658-59.