RCEM Learning

Early 14-day ambulatory ECG monitoring after unexplained syncope detects clinically significant arrhythmias more often and sooner than standard care, despite no reduction in recurrent syncope at one year; an unexpected mortality difference remains a secondary finding requiring further analysis.

Emergency and critical-care clinicians get a practical review of sepsis resuscitation, source control, vasopressor timing and oxygen targets. Repeated assessment of capillary refill, mental state, lactate, blood pressure and respiratory status guides the choice between further crystalloid and earlier noradrenaline, while diagnostic-support tools are kept subordinate to a broad clinical differential.

Emergency clinicians get a sepsis and learning-disability care update. It links definite, probable, possible and unlikely sepsis categories with antibiotic timing, cultures, lactate trends, diagnostic uncertainty, reasonable adjustments, capacity assessment, pain behaviours and carer involvement.

Emergency medicine reasoning across febrile infants, bruising, anaphylaxis, ketamine harm, diagnostic AI and asthma depends on using tools as support. The concrete habit is to document age, appearance, findings, assumptions and safety-netting before a pathway drives the decision.

Cardiac arrest debriefs should include the defibrillator pads, not only timings. The RCEM update puts true lateral pad placement under the axilla and anterior-posterior vector change after three failed shocks ahead of routine dual sequential defibrillation.

The pitfall is reaching for oral opioids in a child with limb pain or sending a sexual assault patient onwards before the first injury review. This update is worth opening for two practice changes: ibuprofen-first analgesia in selected injuries, and trauma-informed emergency care that actively checks bleeding, strangulation, prophylaxis, and safeguarding.