Show notes: Breathlessness is a syndrome, not a diagnosis. Avoid anchoring on COPD and learn the safe four-way thinking: COPD, HF, PE, sepsis.

Episode 4 — The Breathless Patient · COPD, Heart Failure, PE, or Sepsis?

Breathlessness is dangerous not because it’s rare — but because it’s common. And common presentations are where clinicians stop thinking too early.

In this episode, we tackle the “COPD trap”: when a history of COPD closes your differential too soon. Using a night-shift scenario, we reframe breathlessness as a syndrome, not a diagnosis, and build a practical four-way decision approach: COPD, heart failure, PE, or sepsis.

You’ll learn:

• Why COPD is a risk factor, not an automatic answer

• What matters most early: physiology, chest findings, and trajectory

• The traps: wheeze = COPD, sats = safety, normal CXR = reassurance

• How seniors use discriminating questions to keep differentials open

• When to escalate before certainty based on physiology

Educational content only — not a substitute for local guidelines or senior clinical advice. For structured breathlessness frameworks, red flags, and case walkthroughs, visit the AcuteCast app.

https://acute-cast--jgoncalo7.replit.app

Show notes: Broad complex tachycardia at 2am: treat first, label later. VT until proven otherwise, and why “he’s talking” isn’t stability.Episode 3 — Broad Complex Tachycardia: Treat First, Label Later

Broad complex tachycardia is one of the most stressful rhythms you’ll see on call — because it feels like a test. On nights, you don’t want a test.

In this episode, we break down the safest on-call mindset for broad complex tachycardia: treat first, label later. We focus on risk asymmetry (why VT is the safest default assumption), what matters more than morphology in the first minutes, and how seniors separate signal from noise on the ECG.

You’ll learn:

• Why “he’s talking, so he’s stable” is a dangerous phrase

• How to assess tolerance fast: perfusion, trend, and physiology

• Decision-critical ECG features: AV dissociation, capture beats, fusion beats

• Bounded actions that reduce risk: pads on early, escalate early, reassess continuously

• The junior vs senior thinking shift that prevents catastrophic errors

Educational content only — not a substitute for local guidelines or senior clinical advice. For structured interpretation guides, red flags, and full case walkthroughs, visit the AcuteCast app.

https://acute-cast--jgoncalo7.replit.app

Show notes: AF with RVR isn’t always the problem — often it’s a stress signal. Learn how seniors prioritise tolerance, triggers, and escalation.

Episode 2 — AF with RVR · When the Rate Isn’t the Problem

Atrial fibrillation with a fast rate is one of the most common on-call calls — and one of the easiest places to treat the number instead of the physiology.

In this episode, we use a real night-shift style scenario (AF with RVR in a patient with pneumonia) to explore what “tolerating the rhythm” actually means, why “borderline” is not stable, and how senior clinicians look for drivers like hypoxia, infection, dehydration, and myocardial stress before getting stuck in rate-fixation.

You’ll learn:

• The first question to ask: stable vs unstable vs uncertain

• Why AF is often a stress signal, not the primary diagnosis

• Common cognitive traps (fixing the rhythm while the patient deteriorates)

• What to prioritise in the first minutes, without relying on protocols

Educational content only — not a substitute for local guidelines or senior clinical advice. For on-call AF frameworks and escalation prompts, visit the AcuteCast app.

https://acute-cast--jgoncalo7.replit.app

Show notes: Chest pain + normal ECG isn’t “low risk” — it’s a cognitive trap. Learn what matters first: story, trajectory, and risk.

Episode 1 — Chest Pain with a Normal ECG · Who Are We Missing?

A normal ECG can feel reassuring — but in acute medicine it’s often just a snapshot.

In this episode, we walk through a common on-call scenario: a patient with chest tightness, normal observations, and a normal ECG… and the cognitive trap that follows. We break down what the ECG can and cannot tell you, why chest pain is a moving story, and how senior clinicians think differently under pressure.

You’ll learn:

• Why “normal ECG” does not equal “low risk”

• The 3 things that matter most: story, trajectory, and risk context

• The most common junior pitfalls (anchoring, waiting for bloods, not reassessing

• A bounded-action decision framework for safer on-call judgement

Educational content only — not a substitute for local guidelines or senior clinical advice. For structured interpretation guides, red flags, and full case walkthroughs, visit the AcuteCast app.

https://acute-cast--jgoncalo7.replit.app