Acute Medicine

Rick Body introduces his SMACC Gold 2014 talk, ‘The Heart Under Stress’, on using history, examination and troponin testing when assessing possible acute coronary syndrome. The accompanying post also reflects on turning research into an engaging conference presentation, with storytelling and humour alongside the clinical discussion.

Could a small chest drain with a Heimlich valve allow selected patients with pneumothorax to receive outpatient care? This 2013 journal club examines a systematic review, weighing encouraging reports against variable study quality, limited randomised evidence and unanswered questions about patient selection.

Could propofol have a role in refractory migraine? This 2013 journal club critiques an eight-patient case series, examining unclear recruitment, pain measurement during sedation and why larger, better-designed studies would be needed before drawing conclusions for practice.

Not all angioedema is driven by allergy. In this 2012 teaching case, Andy Volans explores recurrent swelling, bradykinin-mediated disease and airway risk, alongside the diagnostic clues and treatment options discussed at the time.

How impressive are relative reductions in bleeding when the absolute event rates are small? This 2012 appraisal of newer oral anticoagulants for venous thromboembolism examines a systematic review, the comparison with warfarin and concerns at the time about managing major bleeding.

This response to the 2012 NICE headache guidance considers its relevance to young people and adults presenting to emergency care. The discussion covers diagnostic features, imaging for reassurance, medication-overuse headache and the practical challenges of explaining assessment and treatment choices to patients.