This article (NEJM- read full text for free from within Victorian public hospitals via clinicians health channel) is a major paper in critical care medicine in the last 12 months. thanks to everyone who took part in our journal club look at it. What do we conclude? Why should it not change our managment? Why can we not write it off altogether? All this after the jump...

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A great session today - thanks Lev and thanks to Simon Smith for special comments

Some of the original articles:

NEXUS criteria article                 Canadian C-Spine article                  Nexus Vs Canadian CSpine article

Lev's Spinal Presentation  Part 1  Part 2

This week we talked about GI bleeding.

Dr Lev Veniamanov gave a talk on proton pump inhibitors in acute upper GI bleeding (the gist is you can expect a decrease in rebleed rates but not in mortality, the risk from the drugs is low so even the modest benefit probably justifies their use however they are not a high priority when resuscitating a sick upper GI bleed patient).

Dr Hatem Elkady gave a talk on beta-blocker use in chronic liver disease (gist is they give a significant reduction in rates of variceal bleed with a number needed to treat of only around 10 however they have no role in acute bleeds).

Dr Saif Abdulrahman gave a talk on Vasopressin and related drugs. Vasopressin or Terlipressin have a role in acute variceal bleeding when octreotide (which has a better safety profile) and urgent endoscopy are not available. Vasopressin, Terlipressin and Desmopressin also have uses in salt/water management (Vasopressin is ADH) and in haemophillia and vWBD (by uncertain mechanism).

My clinical presentation is here. See if you can work out where the three cases are bleeding from.

After the jump is a quick and easy summary of what I have always found a bafflingly complex condition. Not anymore!

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