Start with ward arrest leadership, then move to refractory VF, dark urine in porphyria, and lithium's modern place in mood disorders.
Pads on early; shockable versus non-shockable drives the arrest plan.
Start with #137 BAMR: Cardiac arrests (part 1). It is the most useful listen today because it deals with the moment many clinicians face: arriving at a collapse, taking control, getting pads on, checking the rhythm early, and using what happened just before the arrest to guide the 4 Hs and 4 Ts. The HEMS debrief then adds resuscitation calls, including recurrent versus refractory ventricular fibrillation, pad position, compression fraction, ventilation, and when cath lab or ECPR thinking begins.
The rest of the list is mixed but worth opening. Zero to Finals is a reminder not to leave recurrent abdominal pain under a surgical or functional label when dark urine, neuropathy or blistering skin point towards porphyria. The lithium review is the one to save for later if mood disorders are in your practice, especially for its reset on bipolar disorder, acute mania and recurrent depression. Today's takeaway is practical: ask what happened just before collapse, and do not ignore dark urine or neuropathy when abdominal pain keeps coming back.
The best first listen today. It keeps ward cardiac arrest practical: take the lead, get pads on early, identify the rhythm, and use the minutes before collapse to make the 4 Hs and 4 Ts clinically useful rather than a memory test.
Best saved for after the ward-arrest episode, this one helps when VF keeps returning or will not terminate. It separates recurrent from refractory ventricular fibrillation, reminds you to check truly lateral pad placement, and keeps the focus on compression fraction, ventilation, early intraosseous access, and ECPR or cath lab thinking.
Recurrent abdominal pain looks different when dark urine, neuropathy or blistering skin are in the history. Open this for a clear reminder that urinary porphobilinogen matters during an acute attack, while photosensitive blistering points instead towards cutaneous porphyria and sun protection.
Less immediate for the next shift, but useful if mood disorders cross your practice. It puts lithium back into bipolar disorder, acute mania and recurrent depression, and flags adjunctive allopurinol as an evidence-supported off-label option in acute mania.
When the arrest bleep goes off, use the ward location and recent handover before you arrive. On arrival, take the lead, ask what happened immediately before collapse, and review the last observations, drug chart, and blood gas early. That turns the 4 Hs and 4 Ts into a targeted search instead of a recited list.
What should I do first when I reach a ward cardiac arrest?
Introduce the leader, confirm roles, get pads on, and identify the rhythm early so the team moves down the correct side of the ALS algorithm.
How do I stop the 4 Hs and 4 Ts becoming a memory exercise?
Ask what happened immediately before collapse, then use recent observations, the drug chart, blood gas, and bedside clues to narrow causes such as hypoxia, hyperkalaemia, toxins, thrombus, tamponade, or pneumothorax.
When should porphyria move up the differential in abdominal pain?
Move it up when recurrent abdominal pain sits with neuropathy, psychiatric symptoms, or dark urine, especially after unsafe medicines, alcohol, or fasting. Send urinary porphobilinogen during an acute attack.
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