Emergency Medicine

How much difference does an individual emergency physician make? Simon Carley uses the idea of a personal number needed to treat to explore teamwork, meaningful outcomes and professional worth, before proposing a more useful comparison: whether you are improving on your own previous practice.

Does the benefit of tranexamic acid vary with a trauma patient's risk of death? This 2012 journal club discusses a CRASH-2 subgroup analysis, its implications for patient selection and the uncertainties then surrounding use before arrival at hospital.

How seriously should we take ST depression when the patient is now pain-free? This hypothetical cardiology case explores dynamic ECG changes, serial troponin results and clinical context, then reviews the 2012 evidence on when patients with NSTEMI should undergo coronary intervention.

How should traumatic cardiac arrest differ from a standard resuscitation algorithm? Natalie May reflects on a difficult early experience and reviews the 2012 debate around reversible causes, chest compressions, ultrasound and emergency thoracotomy, including the uncertainty created by small observational studies.

Could some children needing wound care avoid procedural sedation? Simon Carley's 2012 reflection describes how LAT gel changed practice in his department, while distinguishing relief of pain from management of fear and distress, and considering when additional sedation may still be needed.

Does this patient need an arterial blood gas, and what will you do with the result? This 2012 discussion challenges routine arterial sampling, considers venous gases and pulse oximetry, and argues for choosing investigations that answer a specific clinical question while minimising avoidable pain.