Browse every lesson assigned to this course. Mini-sections remain grouped inside the six learning phases rather than opening as separate pages.
Fluids / Electrolytes / Acid–Base
Almost all of it is given by us, on purpose, for good reasons — and a patient can be visibly swollen and intravascularly dry at the same time, which is how both errors happen in the same bed.
Fluids / Electrolytes / Acid–Base
It makes the patient pass urine, which makes them dry, which stops the kidney excreting calcium — so it accelerates itself. Which is why the first treatment is not a calcium drug at all, but fluid.
Fluids / Electrolytes / Acid–Base
The treatment that works fastest does not lower the potassium at all, and the treatment that lowers it does not remove it — so a patient can look treated while the potassium is still in them and a second problem is quietly building.
Fluids / Electrolytes / Acid–Base
It is almost entirely something we do to people — and the earliest warning is not a number but the absence of a reflex, which nobody will notice unless they deliberately go and look for it.
Fluids / Electrolytes / Acid–Base
It is almost always a disease of people who were thirsty and could not do anything about it — which makes it, when it develops in hospital, a measure of us rather than of them.
Fluids / Electrolytes / Acid–Base
Mostly a slow problem of the failing kidney — with acute exceptions that arrive within hours, and one of them comes from the treatment room in a tube, given by a nurse, for constipation.
Fluids / Electrolytes / Acid–Base
Most of the calcium on the report is stuck to protein and does nothing — so a patient can be tetanic with an entirely normal result, because what changed was the binding rather than the amount.
Fluids / Electrolytes / Acid–Base
Replacement that keeps failing is not a dosing problem — it is almost always a magnesium problem. And the replacement itself is one of the few drugs on the ward that can stop a heart if it is given wrongly.
Fluids / Electrolytes / Acid–Base
It is the deficiency that explains the other deficiencies — and it is the one test that is not on the panel, so it stays invisible until somebody deliberately asks for it.
Fluids / Electrolytes / Acid–Base
The most feared complication is caused by the treatment rather than the disease — and almost nobody who causes it decided to. It happens while the fluid is working.
Fluids / Electrolytes / Acid–Base
This is the one you can see coming. Start feeding somebody who has not eaten and the phosphate will fall — reliably, on a timetable — which means it can be prevented rather than detected.
Fluids / Electrolytes / Acid–Base
The signs you were taught are the ones that fail first — and the patient whose blood pressure is still normal may already have lost a litre.
Fluids / Electrolytes / Acid–Base
The anion gap is the tool that tells you which kind you are dealing with — and it is systematically wrong in exactly the patients who most need it, because almost nobody corrects it for albumin.
Fluids / Electrolytes / Acid–Base
A high pH is the one result nobody treats as alarming — which is why an alkalosis can sit on top of a dangerous acidosis and hide it completely, and why the gap must be calculated even when the blood is alkaline.
Fluids / Electrolytes / Acid–Base
Oxygenation and ventilation are different problems, and the saturation only measures one of them — so oxygen can correct the number everybody is watching while the thing that is actually failing gets quietly worse.
Fluids / Electrolytes / Acid–Base
Breathing too fast is almost never the diagnosis. It is the body reporting something else — and the explanation reached for first is the one that requires no investigation and describes the patient's character rather than their physiology.
Perioperative
A pressure that looks acceptable on a chart may be a long way below where this particular patient's organs are used to being perfused — and the damage it does announces itself days later, under other names.
Perioperative
Sedation comes first, the falling saturation comes last, and the sign in between is how rousable the patient is — which is the one observation nobody writes down as a number.
Perioperative
The fast is a proxy for an empty stomach. It is performed for roughly twice as long as any guideline asks, it does real harm while it is happening, and a very common new class of drug has quietly broken the assumption it rests on.
Perioperative
It is named after its late sign. The temperature rises last, and by the time it does the diagnosis has usually been available for some time in a number nobody associates with the name.
Perioperative
Patients rank it among the outcomes they most want to avoid — sometimes above pain — and it is one of the few complications with a validated risk score that tells you in advance exactly how much prevention to give.
Respiratory
The antiviral clock starts at symptom onset — and what time that was is a nursing question. Nobody else in the building is going to ask it.
Respiratory
Clinical stability is six numbers a nurse records. Under the current guideline, those six numbers decide when the antibiotics stop.
Respiratory
Two different conditions share one name. Give the wrong one's treatment and you don't just fail to cure — you build a resistant organism.
Respiratory
Count the reliever. It is the vital sign nobody charts, and it predicts who dies — while the chest going quiet predicts who is about to.
Respiratory
Eighty-eight to ninety-two is a range with a floor as well as a ceiling. Both ends are nurse errors, and the reason you were taught for the ceiling is largely wrong.
Respiratory
Antibiotics do not sterilise a closed space full of pus. This is the pneumonia that stops getting better — and the number that changes the plan is a pH.
Respiratory
The number in the drainage chamber is not a record of what happened. It is the trigger for the operating theatre — and the person reading it is you.
Respiratory
The fluid is a sign, not a diagnosis. Drain it without sampling it and you have relieved the symptom and thrown away the answer.
Respiratory
Air in the pleural space is either something you can watch or something you must decompress in the next minute. The discriminator is the patient, not the film — and under current guidance that is now true of the stable ones too.
Respiratory
It arrives as one unexplained vital sign in a patient whose risk factor is already written in your chart. The same chart is where the prevention was either given or missed.
Respiratory
What kills on day one is found by looking and listening. What kills on day three is pain. Both belong to the nurse.
Respiratory
Respiratory failure asks two questions. The monitor answers one of them and is completely silent on the other — and it is the silent one that kills patients who look fine on the screen.
Cardiovascular
Cardiovascular Disorders I — Coronary & Heart Failure
Cardiovascular; Respiratory
Cardiovascular Disorders I — Coronary & Heart Failure | Acute Respiratory & Cardiac Emergencies
Cardiovascular
Stable angina is defined by being predictable. The emergency is not the pain — it is the change in the pattern, and the history you take is the test that finds it.
Cardiovascular
The stent fixes the symptom. Almost everything that changes whether this patient lives is done by the patient, over years, with a nurse's help.
Cardiovascular
Cardiovascular Disorders I — Coronary & Heart Failure
Cardiovascular; Respiratory
The rhythm is the visible part. The stroke it is silently preparing is the part that disables the patient — and time spent in atrial fibrillation is itself the disease progressing.
Cardiovascular; Respiratory
A regular tachycardia sitting at almost exactly 150 is atrial flutter until you have proved otherwise — and it carries the same stroke risk as atrial fibrillation, which is the part most often forgotten.
Cardiovascular; Respiratory
The degree gives it a name. The level decides whether it is harmless or lethal — and the dangerous ones are dangerous even while the patient looks perfectly well.
Cardiovascular; Respiratory
Most of them mean nothing. The skill is knowing which ones do — and that answer is almost never in the beat itself.
Cardiovascular; Respiratory
The same number can be elite fitness or an emergency. The rate is not the diagnosis — what the patient can do at that rate is.
Cardiovascular; Respiratory
The first-line treatment costs nothing, needs no drug and no cannula — and it is performed badly often enough that most patients go on to receive one they did not need.
Cardiovascular; Respiratory
Everything in the algorithm matters. Only one thing decides the outcome — how many seconds pass before the first shock, and the person standing there is the one who determines that.
Cardiovascular; Respiratory
The same rhythm on the monitor is two entirely different emergencies, treated in opposite ways. Your fingers on the pulse decide which one you are in.
Cardiovascular
The clock started when the pain started — not when you saw it. Sensation and movement are the two findings that decide whether this limb is saved.
Cardiovascular
Thromboangiitis obliterans — the one vascular disease where the treatment is not a drug, and cutting down is not a partial success.
Cardiovascular
The skin changes are not a skin problem. They are the leg telling you where it is heading — and the last stage at which you can still change the destination.
Cardiovascular
The bedside signs are unreliable and one of them has been formally abandoned — and the test used to rule it out gets less sensitive in exactly the patients most likely to have it.
Cardiovascular
The leg is what brings them in. The heart and the brain are what will kill them — and the leg was the warning nobody acted on.
Cardiovascular
"Cosmetic" is a funding category, not a clinical one. These are stage two of a progressive disease — and one of them can bleed enough to kill somebody.
Cardiovascular
Compression is the treatment. The dressing is just the dressing — and an ulcer that is being dressed but not compressed is not being treated at all.
Cardiovascular
Acute and chronic aortic regurgitation are two different diseases sharing one name — and the dangerous one has the quieter murmur and the faster heart.
Cardiovascular
The murmur has been there for years. The symptom is the event — and the drugs that help most cardiac patients can kill this one.
Cardiovascular
Fever with a new murmur is endocarditis until proven otherwise — and the most consequential thing a nurse does in this disease is take the blood cultures before the antibiotics.
Cardiovascular
Primary or secondary — that one question decides the whole treatment. And an ejection fraction of 60 % is not a normal result here.
Cardiovascular
The left ventricle is fine. Everything that goes wrong happens upstream — and what tips the patient over is a shortened diastole.
Cardiovascular
The commonest valve abnormality and usually harmless — the one murmur that behaves backwards, and a small subset that genuinely is not benign.
Cardiovascular
A young patient with chest pain, a troponin rise and normal coronary arteries — and the danger is that they feel well enough to go back to training.
Cardiovascular
The pain that changes with posture — and the thing to fear is not the pericarditis, it is the tamponade that can follow it quietly.
Endocrine
Insulin here is not a treatment that can be paused. It is replacement of a hormone the patient no longer makes — and when it stops, ketoacidosis starts.
Endocrine
This is no longer a glucose disease with complications. It is a cardiovascular, kidney and metabolic disease in which glucose is one variable — and the drugs are now chosen by which organ is at risk, not by the A1C.
Endocrine
The glucose is the least dangerous number on the chart — the ketones decide when treatment stops, and the potassium decides whether the patient survives it.
Endocrine
The problem is water, not sugar — and in this condition the speed of the correction is more dangerous than the derangement being corrected.
Endocrine
The number tells you how low the patient is. It does not tell you how bad this is — and the patient who has stopped feeling it is the one in most danger.
Endocrine
It is diagnosed by what the gland is doing, but it harms through the heart — and every treatment that fixes the gland takes weeks. The beta-blocker is what protects the patient today.
Endocrine
Everything about this disease is slow — including the evidence that you have treated it. The TSH answers six weeks late, and most of the harm comes from not waiting for it.
Gastrointestinal / Hepatobiliary
Almost everyone with this symptom is fine — which is exactly why the few who are not get missed. And the drug that treats it only works if it is taken before food.
Gastrointestinal / Hepatobiliary; Endocrine
The haemoglobin is the slowest number on the chart. In acute bleeding it describes a few hours ago — and the patient losing blood fastest may have the most normal value of all.
Gastrointestinal / Hepatobiliary
This is not an acid disease that happens to have causes. It is a disease with two causes, and the acid is only the medium — which is why treating the acid without removing the cause is why ulcers come back.
Gastrointestinal / Hepatobiliary
Nausea is not one thing. Four different pathways can trigger it, and a drug only works if it blocks the one that is actually firing — which is why the ondansetron is not working is usually a statement about the choice, not the dose.
Gastrointestinal / Hepatobiliary
What the patient came in with is rarely what harms them. Vomiting is dangerous for what it removes and for what it is trying to tell you — and the drug that stops it can quietly do neither.
Gastrointestinal / Hepatobiliary
Obstruction is a plumbing problem and can often wait. Strangulation is dying bowel and cannot. Almost everything that separates the two is observed at the bedside — and the change that matters is in the character of the pain, not its score.
Gastrointestinal / Hepatobiliary
The scarring is not the event. The first decompensation is — and both halves of that are actionable: it can often be prevented, and when it happens it almost always has a precipitant that somebody can find.
Gastrointestinal / Hepatobiliary
One stone, one anatomical tree, and several different diseases — and what separates them is not the pain. It is the fever, the jaundice, and the clock.
Gastrointestinal / Hepatobiliary; Endocrine
Three things this disease was always treated with have been revised in the direction of doing less — the fluids, the fasting, the antibiotics. The watching has not been relaxed at all.
Renal / Genitourinary
Incontinence is not a diagnosis — it is a symptom with types, and the type decides the treatment. Which is why pads and a catheter is not a plan, and why the first question is always whether the bladder is empty or full.
Renal / Genitourinary
Acute retention announces itself with pain and gets attended to. Chronic retention does not announce itself at all — and it is the silent one that destroys kidneys.
Renal / Genitourinary
A great many positive urine cultures in hospital are not infections — and treating them harms the patient. The skill this topic actually tests is knowing when NOT to.
Renal / Genitourinary
Half the definition of this condition is a measurement most wards do not actually make. Creatinine gets checked daily; urine output gets recorded as passing urine — and the earlier of the two signs is the one being thrown away.
Renal / Genitourinary
It is staged by two numbers, not one — and the second is the one nobody measures. Most people with this disease will die of cardiovascular causes rather than reach dialysis, which is why its treatment has become cardiovascular.
Geriatrics / Palliative
Delirium is not a behaviour problem. It is acute brain failure with a cause — and the version that gets missed is the quiet one, because a patient who makes no demands does not look like an emergency.
Geriatrics / Palliative
Distress in dementia is communication, not a symptom to be sedated. And the drug most often reached for raises mortality — while in one common type of dementia it can be catastrophic.
Geriatrics / Palliative
A fall is an event with a cause, not an accident. And the most useful question in this topic takes four seconds and is almost never asked: have you fallen in the past year?
Geriatrics / Palliative
Frailty is not the same as being old, being ill, or being disabled. It is reduced reserve — and it is why the same minor infection that inconveniences one eighty-year-old ends another one's independence.
Perioperative
A pain score is a report, not a target. And the patients most likely to be left in pain are the ones least able to give you one — or least likely to be believed when they do.
Perioperative
Chronic pain is not acute pain that went on longer. It is a different mechanism — and the last decade has shown, at real cost to real patients, what happens when it is managed as though it were the same thing.