Resuscitation

Just in case you were wondering, an irregularly irregular pulse has an LR+ of 25 for AFib.

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).

The Electrical cardioversion page has been updated with clearer guidance on the minimum paddle pressure that should be applied.

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

The Paracetamol page has been updated with information about the superiority of IV morphine over IV paracetamol (alone) in patients with sciatica. Serinken, M, Eken, C, Gungor, F, et al. Comparison of Intravenous Morphine Versus Paracetamol in Sciatica: A Randomized Placebo Controlled Trial. Academic Emergency Medicine 2016;23(6):674-78. 

The Assessment of sepsis and Management of sepsis pages have had a few minor modifications following the publication of the following review (which was more theoretical than clinical). Gotts, JE, Matthay, MA. Sepsis: pathophysiology and clinical management. BMJ 2016;353:i1585.

The Central venous catheter insertion technique page has been updated with additional information about the risk of US guided IJV catheter insertion in expert hands. Hourmozdi, JJ, Markin, A, Johnson, B, et al. Routine Chest Radiography Is Not Necessary After Ultrasound-Guided Right Internal Jugular Vein Catheterization. Critical Care Medicine 9000;Publish Ahead of Print. 

The segement on Video laryngoscopy on the Intubation equipment page has been revised to better outline the advantages and disadvantages of video laryngoscopy.

The Adjuncts to transfusion therapy page has been updated with additional information about a variety of haemostatic foams, sprays and dressings.

The segment on Ketamine on the Induction agents page has been revised and some additional information about the effect of ketamine on depression has been added.

The Mechanical cardiovascular support page has been updated with some minor additions to the segment on ECMO.

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.

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 .

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 .  

A segment on the principles of opioid therapy has been added to the Opioids page, including a table of morphine milligram equivalent doses.

The Assessment of shock page has been updated with a table indicating the approximate mortality rates associated with various degrees of hypotension in the ED.

The Assessment of intravascular volume page has been updated with additional information about pulse wave assessment and CVP measurement in the assessment of hypovolaemia.

The Complications of pacemakers page has been updated indicating that RBBB may still be normal in patients with RV pacing leads.