Emergency Medicine Minute

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.

Emergency and critical-care teams get a compact airway-preparation update. First-pass success is treated as a patient-safety target, with video laryngoscopy, bougie use, preoxygenation, suction, positioning, medicines, rescue equipment and the SOAPME pause supporting the first attempt.

Prehospital, toxicology and emergency teams get a found-down case involving GHB toxicity, hypoxaemia, shock, vomiting and abrupt shifts between coma and agitation. It prioritises assisted ventilation, suction readiness, parallel diagnostic assessment, focused toxidrome examination and clear documentation of the pre-sedation neurological state.

An older woman with repeated urinary tract infections needs a prevention conversation, not only another acute prescription. Vaginal oestrogen is presented as a locally acting option with low systemic absorption and a practical three-times-weekly regimen.