📌 Show Notes

Hypotension on the Ward — Sepsis, Cardiogenic, or Bleeding?

Hypotension is one of the most time-critical problems you’ll encounter on the ward — but the real danger is not the number.

It’s the cause behind it.

In this episode, we break down how to approach low blood pressure under pressure, using a simple, structured framework that helps you think clearly at 2am.

Hypotension is not the diagnosis — it’s the warning.

In this episode of AcuteCast, we break down one of the most time-critical presentations in acute medicine: low blood pressure on the ward.

Is it sepsis?Cardiogenic shock?Or internal bleeding?

Because treating hypotension without understanding the cause can make things worse — not better.

Through a realistic night-shift scenario, we explore:

• How to recognise shock early

• The key differences between hypovolaemic, septic, and cardiogenic patterns

• Why “just give fluids” can be dangerous

• The most common on-call cognitive traps

• A simple bounded-action framework you can use immediately on the ward

This episode is about thinking clearly under pressure — and making the right decision before the patient deteriorates.

🎯 Key takeaway:Don’t treat the number. Identify the shock. Treat the cause.

Show notes: Raised troponin without chest pain: don’t panic and don’t dismiss. Learn how trend + context + ECG guide admit vs observe vs discharge.Episode 10 — Raised Troponin Without Chest Pain · Admit, Observe, or Discharge?

Troponin doesn’t diagnose NSTEMI — it detects myocardial injury. Your job is to explain the injury safely.

In this episode, we tackle a common dilemma: raised troponin without chest pain. We break down how senior clinicians use trend, context, and ECG to avoid two extremes: treating everyone as ACS, or dismissing the result as “just a leak”.

You’ll learn:

• Why one troponin is a number, and two troponins are a direction

• Contexts that commonly raise troponin (and still carry risk)

• How to avoid overcalling ACS vs missing atypical or silent MI

• A bounded-action framework for disposition: admit, observe, or discharge

• How to document reasoning clearly under pressure

Educational content only — not a substitute for local guidelines or senior clinical advice. For troponin decision tools and admission thresholds, visit the AcuteCast app.

Show notes: Collapse feels chaotic — but physiology has an order. Learn how seniors stabilise first, then diagnose safely.Episode 9 — The Collapsing Patient

Collapse feels like chaos — and chaos makes clinicians freeze, scatter, or chase the wrong problem.

In this episode, we cover a collapse scenario and the key principle: collapse is not a diagnosis, it’s a physiology problem. We focus on structured assessment under pressure, rapid reversible causes, and recognising dangerous syncope patterns that aren’t safe for discharge.

You’ll learn:

• Why ABC is the only anchor when everything speeds up

• The fast reversible checks that prevent missed catastrophes

• When “vasovagal” is not a safe assumption

• High-risk syncope patterns that demand escalation

• The senior question: “what will kill them first?”

Educational content only — not a substitute for local guidelines or senior clinical advice. For collapse checklists and safe escalation frameworks, visit the AcuteCast app.

Show notes: ABGs at 3am: stop chasing formulas. Learn the senior order: pH, CO2, oxygenation, then urgency and escalation.Episode 8 — ABGs at 3am · What Actually Matters

ABGs don’t confuse clinicians — time pressure and fatigue do.

In this episode, we simplify ABGs into what matters at 3am: urgency, pattern recognition, and the one question you must answer first — is this patient about to crash? We walk through a breathless COPD scenario and give a senior sequence for triage: pH first, then CO₂, then oxygenation, then the clinical explanation.

You’ll learn:

• Why ABGs are about triage, not formulas

• The senior order: pH → CO₂ → oxygenation → explanation

• How to recognise ventilatory failure and compensation failing

• The common errors: interpreting in the wrong order, repeating gases without action

• When escalation matters before the patient becomes exhausted
  

Educational content only — not a substitute for local guidelines or senior clinical advice. For ABG interpretation guides and real-case walkthroughs, visit the AcuteCast app.

Show notes: Hyperkalaemia can kill before the ECG changes. Learn how level, trend and cause define urgency — not reassurance.

Episode 7 — Hyperkalaemia on the Ward · When to Panic

Not all hyperkalaemia carries the same risk — and the worst delays happen when clinicians look for reassurance in the wrong place.

In this episode, we break down hyperkalaemia risk using a ward-based scenario: high potassium, repeat pending, patient “stable”, and a normal-looking ECG. We focus on what actually predicts danger: level, trend, and cause — and why a normal ECG is not a safety certificate.

You’ll learn:

• Why ECG changes aren’t guaranteed and shouldn’t be your gatekeeper

• How level, trend, and cause determine urgency

• Pseudohyperkalaemia vs true hyperkalaemia (and the danger of guessing)

• The most common traps: waiting for repeat bloods, trusting the ECG too much

• A senior mindset: protect the heart, then fix the potassium problem

Educational content only — not a substitute for local guidelines or senior clinical advice. For hyperkalaemia action prompts and ECG red flags, visit the AcuteCast app.

Show notes: Acute confusion isn’t “just delirium” until you explain it. Learn a senior approach to reversible causes, neuro risk, and medication traps.

Episode 6 — Acute Confusion · Infection, Stroke, Drugs, or Metabolic?

Delirium isn’t a diagnosis — it’s an emergency to explain.

In this episode, we tackle acute confusion on the ward and the cognitive trap of accepting the first easy label (“UTI delirium”). We build a senior approach to delirium: reversible threats first, a quick screen for focal neurology, medication and withdrawal checks, and recognising when sedation hides deterioration.

You’ll learn:

• Why “delirium secondary to infection” is an assumption, not an answer

• Fast reversible causes clinicians miss under pressure

• How to separate global delirium from focal neurological disease

• Medication and withdrawal triggers that are commonly overlooked

• When confusion is unsafe on the ward and needs escalation

Educational content only — not a substitute for local guidelines or senior clinical advice. For delirium checklists, escalation prompts, and structured reassessment, visit the AcuteCast app:

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

Hello.
This is AcuteCast.

AcuteCast is a podcast and app built for acute and on-call clinicians.

If you’ve ever been on call at night, you already know the problem.
The challenge isn’t knowing guidelines.
It’s deciding what actually matters first when everything feels urgent.

AcuteCast focuses on clinical reasoning under pressure.

Each episode uses a short, realistic case to explore what makes the situation dangerous, what juniors commonly focus on, and how senior clinicians think differently.

- No protocols.
- No drug doses.
- No guideline replacement.

Just clearer thinking for real on-call decisions.

Alongside the podcast, the AcuteCast app provides quick on-call reference tools, decision frameworks, and clinical pearls — designed for busy shifts, nights, and weekends: https://acute-cast--jgoncalo7.replit.app

All content is educational only and does not replace local guidelines or senior clinical advice.

If you work in emergency medicine, acute medicine, or ward cover, you’re welcome to explore AcuteCast.

Thank you.

Show notes: Sepsis pathways are the first move — not the finish line. The real danger is failure to reassess and missing non-response.Episode 5 — Sepsis · When the Pathway Is Wrong

Sepsis pathways save lives — but they can also create a false sense that the job is done.

In this episode, we explore a common trap: doing the sepsis pathway correctly, then relaxing… while the patient continues to deteriorate. We focus on the part that actually keeps patients alive: reassessment, response to treatment, source control, and actively considering sepsis mimics.

You’ll learn:

• Why pathways are a beginning, not an endpoint

• The most dangerous error in sepsis: failure to reassess

• How to judge response: physiology and trajectory, not tick-box completion

• Why source control matters more than “more time”

• Sepsis mimics that trigger the screen but need different escalation

Educational content only — not a substitute for local guidelines or senior clinical advice. For reassessment prompts, escalation tools, and case walkthroughs, visit the AcuteCast app.

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