How should clinicians balance missed acute coronary syndrome against the harms of unnecessary investigation? In notes accompanying his UMECS 2016 talk, Rick Body explores the limits of symptoms and clinical judgement, acceptable risk and the importance of including patients in chest-pain decisions.
Could a single high-sensitivity troponin I result help rule out acute coronary syndrome at presentation? This 2015 appraisal examines a diagnostic cohort study, distinguishing negative predictive value from sensitivity and asking how the findings fit with ECG interpretation, clinical risk and different patient populations.
The 2015 REVERT trial compared a modified Valsalva manoeuvre with the standard technique in adults with stable supraventricular tachycardia. This appraisal examines conversion to sinus rhythm, the need for further treatment and practical questions about applying the findings in the emergency department.
How much does describing chest pain as ‘typical’ tell us about the final diagnosis? Simon Carley reviews a 2015 observational study of clinician judgement, questioning the value of experience alone and examining how patient selection, specificity and the presentation of diagnostic performance affect interpretation.
How can emergency departments reduce delays for patients who need transfer for primary PCI? This 2015 account of Manchester’s DIDO-30 project examines early ECG recording, recognition and escalation, with practical ideas for improving pathways through staff feedback, shared responsibility and rehearsing the whole process.
Could an automated blood test make the original MACS chest pain rule practical to use? This 2015 research update explains validation with a new heart-type fatty acid binding protein assay, how the rule was recalibrated and why testing its effects in clinical practice was the next step.
Practical perspectives on trauma care and team leadership.
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