Emergency Medicine Minute

Worsening hypoxia after successful naloxone reversal may represent pulmonary oedema as well as aspiration, with a proposed negative-pressure mechanism; respiratory support and positive pressure take priority over diuresis when fluid overload is not the problem.

Posterior and horizontal canal BPPV require different positional tests, nystagmus patterns and repositioning manoeuvres; characteristic torsional nystagmus supports posterior-canal disease, while down-beating nystagmus during midline head extension warrants caution and neurology involvement.

Delayed stroke can follow blunt cerebrovascular injury even when the initial neurological examination is normal. Screening with computed tomography angiography hinges on recognising injury patterns such as cervical spine, severe facial, upper rib and medial clavicle fractures, while screening strategy remains debated.

Focused cardiac ultrasound may reveal ventricular fibrillation despite a monitor showing pulseless electrical activity or asystole. A convincing finding during a planned pulse check identifies a potentially shockable rhythm and can prompt defibrillation.

Small changes in chest-compression hand position may alter which cardiac structures are compressed and the forward flow generated. Transoesophageal ultrasound and femoral pulse feedback offer anatomical and physiological clues, while the proposed leftward position remains emerging rather than established guidance.

Diuretics, gastrointestinal losses and temporary intracellular potassium shifts can all produce hypokalaemia, but they require different responses. ECG U waves and fused TU complexes identify greater arrhythmic risk, while potassium replacement should be matched to severity and considered alongside magnesium, admission needs and escalation for refractory ventricular fibrillation.

Emergency clinicians and departmental leaders get a human-factors reminder that access to food and fluids affects sustained attention, decision-making and communication. Senior staff can reduce risk by explicitly normalising and arranging brief supported breaks across the multidisciplinary team.

Emergency, trauma and prehospital clinicians get a concise framework for resuscitative thoracotomy in traumatic arrest. Mechanism, witnessed loss of pulses, CPR duration and signs of life guide selection, while aortic cross-clamping, direct haemorrhage control, open cardiac massage and staff sharps safety shape procedural preparation.

Emergency and toxicology teams get a focused comparison of intramuscular medicines for methamphetamine-associated agitation. In the study described, droperidol, olanzapine and midazolam achieved adequate sedation faster than lorazepam, which also required more rescue medication.

Emergency clinicians get a practical bite-and-sting review covering local reactions, anaphylaxis, bronchospasm, multiple-sting venom load, spider syndromes and bed bugs. The key distinction is allergy versus systemic toxicity: adrenaline treats sting-related anaphylaxis, while high sting burden should trigger assessment for rhabdomyolysis and organ dysfunction.