Venous HCO3 is higher than arterial HCO3 – correction
The Blood gas analysis page has been corrected to indicate that venous HCO3 is higher than arterial HCO3 (by about 1.7 mmol/L) – this was incorrect on one part of the page and correct in another.
Clinical skills
Serum lactate and Hartmann’s administration
The Metabolic acidosis page has been updated with some additional information about how large volumes of Hartmann’s solution may contribute to lactic acidosis. Zitek, T, Skaggs, ZD, Rahbar, A, et al. Does Intravenous Lactated Ringer’s Solution Raise Serum Lactate? J Emerg Med 2018
Lactic acidosis
The Metabolic acidosis page has been updated with some additional causes of lactic acidosis.
Patterns of LFT abnormality table
The table of patterns of LFT abnormality on the Liver function tests page has been extensively revised and updated.
AST/ALT ratio and LDH
The Liver function tests page has been updated with some additional information about the AST/ALT ratio and causes of LDH elevation.
Low volume blood tubes
Some additional information about low volume blood tubes in adults has been added to the Specimen collection page.
Prioritisation and decision making domain assessment criteria
The Clinical decision making page has been updated to include the ACEM prioritisation and decision making domain assessment criteria used in the clinical exam. The behaviours described make for good decision making in clinical practice.
Teaching ACEM domain assessment criteria
The Medical education page has been updated to include the ACEM scholarship and teaching domain assessment criteria used in the clinical exam. The behaviours described make for good teaching in practice.
Communication ACEM assessment criteria
The Communication page has been updated to include the ACEM communication domain assessment criteria used in the clinical exam. The behaviours described make for good communication in clinical practice.
ACEM Teamwork assessment criteria
The Teamwork page has been updated to include the ACEM teamwork and collaboration domain assessment criteria used in the clinical exam. The behaviours described make for good teamwork in clinical practice.
Transaminases
The Liver function tests page has been revised, particularly in relation to abnormalities of the transaminases.
Clinical uselessness of most blood gas calculations
Various pages relating to blood gas analysis have been updated to indicate the almost complete clinical uselessness of most of the calculations performed on blood gases. Many of the calculations produce highly inaccurate results and do not alter management (e.g. if someone has incomplete respiratory compensation for their metabolic acidosis, what do you do – … Read more
RBBB and LPHB ECG
An ECG of RBBB and LPHB has been added to the Disorders of cardiac conduction page.
Reducing cognitive error
The Clinical decision making page has been updated with more information about the different methods that can be used to reduce cognitive error.
Drug seeking behaviour
The Drug seeking behaviour page has been revised to emphasise the role of objective findings and functional pain assessment when considering management.
ECG of left atrial enlargement
A new ECG of left atrial enlargement has been added to The ECG and abnormal cardiac chambers page.
Incomplete RBBB ECG
The Disorders of cardiac conduction page has been updated with the addition of an ECG of incomplete RBBB.
NAC and HCO3 and IV contrast
Another nail in the coffin of CIN and it’s prevention. The Intravenous contrast page has been revised with removal of NAC and HCO3 as therapies to be considered for the prevention of a probably non-existent entity! Weisbord, SD, Gallagher, M, Jneid, H, et al. Outcomes after Angiography with Sodium Bicarbonate and Acetylcysteine. New England Journal … Read more
Urinary anion gap
The Metabolic acidosis page has been updated with modifications to the section on the urinary anion gap.
Intra-atrial block
A short segment about intra-atrial heart block has been added to the Bradycardias page, including links to and from the segment on p mitrale on The ECG and abnormal cardiac chambers page, with which it very significantly overlaps