JVP

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The Cardiovascular examination page has been revised with additional information about the JVP including how 8cm (not 5cm) should be added to the height above the manubriosternal angle to estimate CVP.

P waves and bradycardias

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The Bradycardias and Other arrhythmias pages have been updated with the requirement for p waves to be present in heart block. The absence of p waves means the bradycardia is either junctional or idioventricular (although retrograde p waves may still be seen in junctional rhythms).

Opioid therapy for chronic back pain

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The Low back pain has been updated with information about the lack of significant clinical benefit of opioid therapy for chronic back pain. Abdel Shaheed, C, Maher, CG, Williams, KA, et al. Efficacy, tolerability, and dose-dependent effects of opioid analgesics for low back pain: A systematic review and meta-analysis. JAMA Internal Medicine 2016.

PE following #NOF

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The Femoral fractures page has been updated with information about the frequency and timing of PE following injury, with ~50% of PEs occurring within 24 hours. Kim, YJ, Choi, DH, Ahn, S, et al. Timing of pulmonary embolisms in femur fracture patients: Incidence and outcomes. J Trauma Acute Care Surg 2016;80(6):952-6.

Troponin rise after 30 Km run

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The Non ACS causes of elevated troponins has been modified to include additional information about the almost universal finding of elevated hsTroponins following a 30km run in well trained individuals. Klinkenberg, LJ, Luyten, P, van der Linden, N, et al. Cardiac Troponin T and I Release After a 30-km Run. Am J Cardiol 2016 . … Read more

Cervical spine injuries following civilian blast injuries

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The Spinal immobilisation page has been updated with information about the rarity of unstable cervical spine injuries following civilian (terrorist) blast injuries. Klein, Y, Arieli, I, Sagiv, S, et al. Cervical spine injuries in civilian victims of explosions: Should cervical collars be used? J Trauma Acute Care Surg 2016;80(6):985-8.