Validation of the MIRACLE Score for Prognostication After Out-of-hospital Cardiac Arrest.

Background: Out-of-hospital cardiac arrest (OHCA) is associated with very poor clinical outcomes. An optimal pathway of care is yet to be defined, but prognostication is likely to assist in the challenging decision-making required for treatment of this high-risk patient cohort. The MIRACLE score provides a simple method of neuro-prognostication but as yet it has not been externally validated.

Allegiance and Supremacy: Religion and the Royal Society's 3rd Charter of 1669.

This paper examines a neglected aspect of the history of the early Royal Society. Though it's first two Royal Charters of 1662 and 1663 did not contain any religious-political restrictions, its 3rd Royal Charter of 1669 did. For the grant of an investment property in Chelsea, and the right to appoint more than one Vice President, the 3rd Charter restricted the sale of the property in Chelsea back to the Crown, and all Presidents and Vice Presidents were required to swear the Anglican religious-political state oaths of Allegiance and Supremacy before admission to the positions.

Carotid Doppler flowmetry correlates poorly with thermodilution cardiac output following cardiac surgery.

Background: It remains unclear whether measuring carotid arterial flow by the time velocity integral using vascular Doppler ultrasound can be used to monitor cardiac output and volume responsiveness.

Methods: The carotid Doppler flow (time velocity integral and peak flow velocity variation) was assessed in triplicate by an intensivist with formal vascular ultrasound training. Thirty-three patients admitted following coronary by-pass surgery were studied before and after a passive leg-raising manoeuvre to investigate volume responsiveness (more than 10% increase in cardiac output) along with indices of arterial load measuring cardiac output by thermodilution.

Procedural sedation with propofol for emergency DC cardioversion.

Many emergency patients present with cardiac arrhythmias requiring emergency direct current countershock cardioversion (DCCV) as a part of their management. Almost all require sedation to facilitate the procedure. Propofol has been used for procedural sedation in Emergency Medicine since 1995.

Living for the weekend: electronic documentation improves patient handover.

With increasing shift work the importance of effective handover is becoming more widely recognised, resulting in the production of guidelines on written handover documentation. A particular area of poor compliance was handover from the week to weekend teams for medical inpatients, as shown through an audit cycle. Full implementation of any guidelines can be time and financially costly.