ECG of the Week 9th November 2022

A 60 year old man, who speaks little English, is triaged as a category 2 for left sided chest pain after being brought to hospital by ambulance. He has a history of the following:

  1. CMML under surveillance (he says “no treatment, just blood tests”, but can’t tell you who his haematologist is)
  2. Kidney Dysfunction (he can’t elaborate further)
  3. Hypercholesterolaemia (takes a statin)
  4. Reflux (takes a PPI)

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Intranasal Topical Application of Tranexamic Acid in Atraumatic Anterior Epistaxis

Original paper





  • Intranasal topical TXA is associated with a lower rate of need for anterior nasal packing and a shortened stay in the ED

Bottom line

  • Topical TXA for epistaxis is slowly gaining traction despite recent negative study (NoPAC)
  • This RCT fits author’s own experience- ineffective for posterior bleeding, delayed presentations or traumatic epistaxis, but no harm and better tolerated than balloon tamponade device (RapidRhino etc)

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Lab case 385

21-year-old girl with history of type I DM. Her BSL level at home was 37 mmol/L. So, she self-administered 10 units of Actrapid. She rechecked her BSL 1 hour later and it was 38 mmol/L so she decided to present to ED. On arrival to ED her VBG showed the following:

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