Critical Care

Simon and Iain review the blog's April 2023 posts, discussing high-acuity, low-occurrence procedures and blood transfusion. They also reflect on a conference that did not take place and the wider world of free open-access medical education.

A discussion of the 2023 joint Royal College statement on emergency contrast CT and renal function. It examines delays while awaiting creatinine results, decisions in life- or limb-threatening situations, and the caveat that a senior decision maker should be involved.

Personal preparation for high-acuity, low-occurrence procedures goes beyond learning the physical technique. Part two of the HALO series explores decision triggers, managing stress, self-talk, mental rehearsal and focus, with an emphasis on deliberate practice before a crisis.

How did trauma transfusion move from whole blood to crystalloid and component therapy, then back towards whole blood? This 2023 narrative review follows the key studies behind that evolution and considers prehospital transfusion, different injury patterns and the questions still unanswered.

Part one of the HALO series examines how to learn the physical skills needed for high-acuity, low-occurrence procedures. It compares training models, including task trainers and cadaver courses, and stresses the importance of practising what happens after the initial incision.

Can remifentanil replace neuromuscular blockade for rapid sequence induction? Dan Horner appraises a randomised trial in operating-room patients at risk of aspiration, examining first-attempt intubation without major complications, the non-inferiority design and how the findings translate to emergency care.