Browse every lesson assigned to this course. Mini-sections remain grouped inside the six learning phases rather than opening as separate pages.
Critical Care / Sepsis
Sepsis is not infection plus feeling unwell. It is organ dysfunction caused by infection — and the patients who die of it are disproportionately the ones who never looked septic.
Critical Care / Sepsis
SIRS was removed from the definition of sepsis and kept as a way of screening for it. That is not a demotion — it is a description of what it was always good at. SIRS tells you to look. It does not tell you what you have found.
Critical Care / Sepsis
There is no treatment for multiple organ dysfunction syndrome. There is treatment for what caused it, and support for the organs while they recover — which is why everything that matters in this topic happens before it arrives.
Neurologic
The bleed on the first scan is not the bleed the patient ends up with. It expands over the following hours — and almost everything done urgently in this condition exists to stop that happening.
Neurologic
The treatment window has widened enormously in the last few years — which means the assumption that a late presentation is beyond help has become one of the main reasons late patients go untreated.
Neurologic
Compensation does not run out gradually. A patient absorbs a growing mass with almost no change — and then decompensates over minutes. Which means the reassuring observations beforehand were accurate, and useless.
Neurologic
Five minutes is the number. And the commonest reason this condition is not controlled is not that the wrong drug was chosen — it is that not enough of the right one was given.
Neurologic
The respiratory failure is expected. So the emergency is not the breathlessness — it is arriving at the breathlessness without ever having had the conversation.
Neurologic
Weakness that started in the feet and is now at the hips will not stop because it has reached a convenient place. Around a third of these patients need ventilating — and the ones who do are identifiable hours beforehand.
Neurologic
Not every new deficit is a relapse. Infection, fever and heat unmask old damage — and treating that as a relapse means giving steroids to someone whose actual problem is an untreated infection.
Neurologic
The lungs are normal. It is the muscles that move them that are failing — which means the oxygen saturation you are watching will stay reassuring right up until the patient stops breathing.
Neurologic
This medication is time-critical in the way insulin is time-critical. A dose given an hour late is not a late dose — it is an hour in which the patient may be unable to move, swallow or speak.
Neurologic
The injury cuts the line between the body and the brain. So a problem below the lesion produces a symptom above it — and the symptom no longer points at the problem.
Musculoskeletal / Trauma
The operation fixes the bone. It does not fix why they fell, and it does not fix what happens to them in the fortnight afterwards — and that is where most of the harm is.
Musculoskeletal / Trauma
Whether this person walks again is largely decided in the first fortnight — by how the limb is positioned, and by whether anybody takes seriously a pain in a leg that is no longer there.
Musculoskeletal / Trauma
The six Ps are memorised by everybody and they are the wrong thing to wait for — because the last of them arrive after the limb has already been lost, and the pulse is usually still there.
Musculoskeletal / Trauma
A young patient becomes confused a day or two after a femoral fracture, and it is put down to opioids or a bang on the head. The rash that would have settled it arrives late, if at all.
Musculoskeletal / Trauma
It is largely preventable, the prophylaxis is prescribed, and it still happens — because prescribed and given are different things, and nobody audits the stocking that was taken off for a wash.
Immune / Infectious
The science settled years ago. What has not settled is whether the people explaining it believe it — and a patient told the risk is very low has been told something quite different from what the evidence actually says.
Integumentary / Burns
Almost nothing about a burn is what it looks like when you first see it. The airway is patent until it is not, the burn is shallower than it will become, and the oxygen saturation is reporting a number it is not equipped to measure.
Respiratory
Almost everything that works in this condition looks like undertreatment — small breaths, a carbon dioxide left deliberately high, fluid withheld from a shocked-looking patient, and sixteen hours face-down.
Respiratory
The arrest is loud and the outcome is decided quietly — by the proportion of time hands are actually on the chest, and by what happens in the three days afterwards.
Endocrine
Withholding pain relief to protect the diagnosis has been shown not to work, and it is still happening — while the abdomen itself tells you least in exactly the patients most likely to be dying.
Endocrine
It is a signal rather than a diagnosis — and the test everybody orders to confirm it cannot confirm it, while the answer is usually sitting in the bowel history.
Endocrine
The liver was doing more jobs than anyone lists, and they stop together — so the presentation is a scatter of problems that do not obviously look like liver disease at all.
Endocrine
Giving the steroid to someone who did not need it costs almost nothing. Withholding it from someone who did can kill them within hours. There is no version of this where waiting is the safer option — and waiting is still what usually happens.
Endocrine
The hormone level is no higher than in ordinary thyrotoxicosis, so the laboratory cannot make this diagnosis. What makes it storm is that the patient has decompensated — and the decision to treat has to be made before anything comes back.
Geriatrics / Palliative
She came in walking. Nothing that happened was a mistake, no complication was ever recorded, and she left unable to manage at home.