The BREACH podcast is 1 year old this week!

 

Thank you so much to everyone for supporting us, sharing on social media and telling your friends and colleagues. Our episodes have been downloaded 13,500 times and people from 97 countries have tuned in. It's wonderful to be part of the international FOAM movement.

 

We thought we'd celebrate by looking back through each of the 76 papers we've reviewed and choosing our favourite 10. This is a list of the most important, practice-changing, and interesting studies of the last year - enjoy!

 

Paper 10: Are biphasic allergic reactions real?

 

Clinically important biphasic reactions are exceptionally rare, and may not even exist. Prolonged monitoring is unlikely to be necessary in the majority of cases

 

Paper 9: Upside-down position for children with SVT

 

This study showed a high success rate with this manoeuvre, which is simple to do and to teach to parents (and quite possibly fun for the child!)

 

 

Paper 8: Could you manage a retrobulbar haemorrhage?

 

This paper found that most ED doctors were unaware of the need for intervention rather than imaging in this condition, and would not be happy to perform a lateral canthotomy as a sight-saving measure

 

 

Paper 7: Recovery time in children with concussion

 

If a child presents with features of concussion after a head injury, they can be advised that most of the symptoms will have resolved by 2 weeks in boys and younger children, or 4 weeks in adolescent girls.

 

 

Paper 6: Chest drains for small traumatic pneumothoraces?

 

An ‘occult’ pneumothorax or haemothorax seen only on CT can in many cases be treated conservatively

 

 

Paper 5: Do patients need to fast before procedural sedation?

 

During procedural sedation, aspiration is a risk that is trivially small and is not reduced by fasting. This study does not support delaying sedation to meet established fasting guidelines in children

 

 

Paper 4: Stop testing the urine of elderly patients!

 

Do not test the urine of patients without symptoms of a UTI. You may find evidence of asymptomatic bacteriuria, but this does not need an antibiotic prescription in most cases. 

 

Paper 3: Ultrasound for small bowel obstruction

 

Ultrasound is nearly as accurate as CT for the diagnosis of small bowel obstruction. It is unlikely to replace CT, but is much better than X-ray for assessing this condition.

 

 

Paper 2: Posterior stroke: a simple approach

 

Consider posterior stroke in every dizzy patient. Ask about timing and triggers rather than trying to define what they mean by dizzy. Sudden onset constant dizziness = labyrinthitis or posterior stroke; triggered dizzy episodes = BPPV or postural hypotension; random dizzy episodes = vestibular migraine, Meniere's or posterior TIA

 

 

Paper 1: Risk of AKI in septic patients after contrast CT

 

This study found no evidence to support the practice of withholding contrast for fear of precipitating AKI in septic patients

 

 

 

Bonus paper: Martial arts to control external bleeding

 

This technique offers a fast and efficient way to stem blood loss from limb wounds, and lets you use ninja skills in the ED - give it a try!

 

 

Bonus paper: Captain Morgan for hip dislocations

 

This technique allows you to apply a lot of force to the hip in a controlled manner, without getting yourself into precarious positions. Give it a try!