Chest pain with a STEMI-negative ECG can still involve a culprit occlusion. Read anterior ST depression carefully: if maximal in V1–V4 without expected discordance, consider posterior or lateral OMI, add POCUS when skilled, and escalate with clear territory-based language.

Collapse soon after TAVR belongs on a monitor, even when the patient wakes quickly. Sinus arrest over 3 seconds, bifascicular block or recurrent symptomatic pauses should bring ECG review, medication checks, chronotropic support, pacing readiness and cardiology.

A difficult airway with tongue swelling, oral obstruction or severe hypoxia needs preparation before bravery. Nasal awake intubation depends on topicalisation and patent nare selection; the tube and scope must match, and sedation should follow successful placement.

Start here if agitation in an older adult still pushes the team towards the same sedatives used in younger patients. It keeps the first move anchored to delirium, baseline dementia and reversible triggers, then walks through environmental de-escalation and when quetiapine suits Parkinson’s disease or Lewy body dementia.

Intermediate-risk pulmonary embolism matters because initial stability can hide right heart strain, biomarker rise, and early deterioration. This episode is strongest on what current evidence does not show: thrombectomy may shrink right ventricular enlargement without proving better survival or less rescue treatment.

The reason not to dismiss a celebration episode is that it gathers practical reminders on syncope ECG red flags, naloxone, sepsis, burns, and uncommon diagnoses such as Lemierre syndrome. Worth opening when a familiar presentation starts behaving oddly.

The action is simple but often missed: 20 minutes of cool running water for a recent burn, ideally within 3 hours, followed by a non-adherent dressing and gauze. Open this one for a fast reset on pain reduction, limiting tissue damage, and why full-thickness burns are not excluded.

Central line choice is a long-term access decision, not just a quick procedure. When both neck veins are suitable, left internal jugular access may preserve the right side for later haemodialysis, CRRT, or ECMO and reduce downstream dialysis catheter problems.

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Stable epistaxis is usually controlled stepwise rather than packed on arrival. Clear clots, use topical anaesthetic with vasoconstrictor and a clamp for 15 minutes, then cauterise a visible point. Early ENT input matters when posterior bleeding is suspected or balloon packing is required.

D-dimer is a rule-out test, not a shortcut to certainty. Use it only when pre-test probability is low, apply the higher YEARS threshold in very low-risk pulmonary embolism, and do not let a blood test delay imaging when dissection or embolism is likely.