What should we say before intubating someone who may never regain consciousness? Through a hypothetical major-burns case, Simon Carley explores honesty, reassurance and the opportunity for final conversations, asking whether comforting words serve the patient and family or the resuscitation team.
Little white lies in the resus room – St.Emlyn’s Read More
What does a positive or negative test result really tell us? Part two of the Risky Business series explores diagnostic thresholds, false positives and false negatives, and why the neat categories in a research table do not remove uncertainty for the clinician treating an individual patient.
Emergency Medicine, a risky business part 2. Read More
This 2012 journal club compares prasugrel with clopidogrel in acute coronary syndromes managed without revascularisation. Beyond the treatment comparison, it examines composite outcomes, all-cause mortality and confidence intervals, showing why the choice of endpoint can complicate interpretation of a clinical trial.
JC – Prasugrel vs Clopidogrel in ACS Read More
Are we diagnosing disease, or deciding when a probability is high enough to act? The opening Risky Business article uses myocardial infarction and pulmonary embolism to explore uncertainty, treatment harms and why stopping investigation is different from proving that disease is absent.
Emergency Medicine, a risky business part 1. You are not a diagnostician. Read More
What changed when UK paracetamol-overdose guidance was revised in 2012? This historical review discusses the move to a single treatment line, changes to acetylcysteine administration and the implications for admissions, treatment complications and reducing errors in a familiar emergency presentation.
Paracetamol 2012: less means more Read More
Persistent swelling after a shearing injury may be more than a simple haematoma. This 2012 overview introduces Morel-Lavallée lesions, their sometimes delayed presentation and the role of ultrasound, then discusses treatment options and the uncertainty surrounding how best to manage them.
Morel-Lavallee – Mushrooms in the valley Read More
When was the last time fundoscopy changed your management? Prompted by missed retinal findings in severe hypertension, Simon Carley reflects on declining confidence with direct ophthalmoscopy, alternative ways of examining the fundus and the value of practising and teaching basic clinical skills.
Clinical skills – Does anyone use Ophthalmoscopes anymore? Read More
What matters more in a fluid trial: haemodynamic targets or outcomes that matter to patients? This 2012 appraisal of CRYSTMAS examines hydroxyethyl starch versus saline in severe sepsis, questioning the analysis population, clinical relevance of the primary outcome and interpretation of mortality findings.
JC All I want for CRYSTMAS in ITU land…, are some more potatoes, and a drink! Read More
