Chest pain doesn’t need to be crushing, central, or radiating to be cardiac. Yesterday, I saw a patient in clinic: • Sharp chest pain • Non-radiating • SOB on exertion • Fine at rest • Onset occurred at rest where simply standing up triggered it • Associated nausea • OBS all normal • Pain lasted ~1 minute each time • Patient could feel it in sync with his heartbeat Not textbook. Not dramatic. Easy to dismiss. But concerning. This is a reminder that cardiac pathology doesn’t read textbooks. We rely too much on “classic” presentations and risk missing early or atypical disease. I’m waiting for permission to share the ECG, once I have it, I’ll post it here. Let’s see what you think. 👀 What would be on your differential at this stage?

Please let me know what you thought about the course. If anything could be improved or if you would like to have some coaching around it

I did want to do a live presentation of the course but for some reason I am unable to do so please don't hesitate to drop me a message I have added bonus cheat sheet style diagrams to aid in your journey seperately. I will try again to do a live session.

If an adult has persistent unilateral ear discharge that smells foul, especially with hearing loss, think cholesteatoma this is not “recurrent otitis externa”. 🔴 Avoid ototoxic drops if there’s any chance of a perforated tympanic membrane 🔴 Don’t keep cycling antibiotics ✅ Refer to ENT urgently as this is a destructive condition, not a benign one Early suspicion = fewer complications (and fewer sleepless nights later) P.s. Cilodex (is non ototoxic)

Always check renal function before prescribing or adjusting medications especially antibiotics, anticoagulants and NSAIDs. An eGFR that’s borderline today may have been normal last week. 👉 Dose for the kidneys you have, not the ones you hope for 👉 Acute kidney injury is easy to miss if you don’t look Safe prescribing is good medicine.