Tag: Martin Bicket

HMOs: Headache

Review this presentation by Dr Martin Bicket with Dr Shona McIntyre for HMO teaching.

Apologies for the scratchy lofi audio quality Рsubtitles have been transcribed for clarity and it is recommended that you use this feature.



Key points

  1. Classic history for subarachnoid haemorrhage (SAH) is sudden onset, ‘thunderclap’, worst onset headache and clinicians should be sensitive to not lead the patient to include nor exclude these features
  2. Lumbar puncture cannot yet be completely excluded from the workup of (SAH) after negative CT brain, despite the Perry study; consult with senior staff
  3. Presence of risk factors like increasing age, immunosuppresion, malignancy, autoimmune or connective tissue disorders should lower the threshold for investigation in general
  4. Consider lumbar puncture in cases of suspected viral meningitis, particularly for those patients who are not progressing
  5. CT brain still has utility in general, even in the younger patient – consult with seniors as practice variation exists
  6. Do not forget extracranial causes of headache like giant cell arteritis / temporal arteritis and glaucoma

HMOs: Chest pain and ECGs

Chest pain accounts for a significant burden of ED workload.

Find below some resources on the approach to ECGs and chest pain.

Thanks to Dr Martin Bicket



Review the coronary artery territory diagram as mentioned by Martin:

Also try your ECG interpretation with the following ECGs:

HMO ECGs examples MB


Other specific ECG patterns to look out for:



Sgarbossa criteria for detection of ischaemia in left bundle branch block (LBBB)


Right ventricular and Posterior infarct patterns



ECG cases with Amal Mattu