EM DOCTORS

CAPNOGRAPHY

In the statue of David, Michelangelo presents a remarkable anatomical observation. When David’s arm hangs down under the influence of gravity, the veins become visible and prominent. When the arm is raised, the veins fade and become less apparent. This subtle detail reflects Michelangelo’s profound understanding of the human body, gained through years of studying anatomy. It reveals the care and precision he invested in his work. There is also a quiet lesson for medicine: when you wish to see the veins clearly to insert an IV line, remember gravity… and remember Michelangelo.

The most reliable clinical sign differentiating mpox from smallpox and chickenpox is enlarged lymph nodes, especially the submental, submandibular, cervical, and inguinal nodes.

Value of Anion Gap normal: 📌 8 - 12 mEq/L (if without potassium) 📌 12 - 16 mEq/L (if potassium is given)

Armoured (Reinforced) Endotracheal Tube vs Standard Endotracheal Tube When should an armoured endotracheal tube be used, and what are its advantages and disadvantages compared with a standard tube?

Failure to place a tracheal tube correctly after an RSI is not a disaster, but failure to recognize an incorrectly placed tube, or persistent attempts to secure an airway resulting in patient harm, is. The old adage ‘if in doubt, take it out’ should be followed.

From A to Z: How to Apply for MRCEM Primary Exam?

Electrode placement

Electrode placement

Adult: Pharmacological Agents for Procedural Sedation

Epley Maneuver

If blood is aspirated from the CSF after dural puncture with the spinal needle, what is the most appropriate next step? A. Change the angle of the spinal needle B. Inject the anesthetic solution immediately C. Continue to aspirate until CSF appears; if only…

If blood is aspirated from the CSF after dural puncture with the spinal needle, what is the most appropriate next step? A. Change the angle of the spinal needle B. Inject the anesthetic solution immediately C. Continue to aspirate until CSF appears; if only blood continues to be seen, abandon the puncture and select another level D. Abandon the procedure and select another level E. Aspirate for 1 minute further and then slowly inject the anesthetic

Chest X-ray after removal of 1.5 liters of pleural effusion.

Why other answers are wrong?... A. Urgent complete drainage in one session ❌ E. Continuous drainage until resolution ❌ Draining large effusions rapidly increases risk of re-expansion pulmonary oedema (RPO) and haemodynamic instability. EBM: BTS recommends staged drainage. (1.5 L\12-24hr) C. Discharge with outpatient review ❌ Large effusions in elderly patients should not be left untreated — risk of infection, further deterioration, and diagnostic delay. Needs therapeutic drainage and monitoring. D. Broad-spectrum antibiotics ❌ No evidence of infection: patient is afebrile, fluid is clear, and no neutrophilic exudate described. Antibiotics would be inappropriate.