Prompted by NICE guidance published in 2012, this discussion asks how emergency departments can improve care for people with painful sickle cell crises. It explores stigma, trust in patients' accounts of pain, individual care plans and collaboration across the emergency and haematology teams.
What can bedside echocardiography contribute when aortic dissection is suspected? This 2012 journal club appraises a retrospective study of type A dissection, questioning patient selection, specialist expertise and whether results from a cardiac centre can support decisions in a general emergency department.
When a child vomits after a head injury, how should that influence the decision to scan or observe? This 2012 discussion compares CHALICE, PECARN and CATCH, focusing on isolated vomiting, differences between study populations and the gap between identifying low risk and managing everyone else.
Did the 6S trial change the case for starch-based resuscitation fluids? This 2012 journal club reviews hydroxyethyl starch versus Ringer's acetate in severe sepsis, examining randomisation, blinding and the mortality findings, and asking how the results should influence interpretation of the crystalloid–colloid debate.
Should superficial venous thrombosis be observed or treated with anticoagulation? This 2012 discussion considers what ultrasound adds, unpacks the composite outcome in CALISTO and weighs treatment benefits against bleeding and burden, emphasising the importance of explaining uncertainty when making decisions with patients.
Should patients in below-knee plaster casts receive heparin to prevent venous thromboembolism? This 2012 reflection examines a published evidence review, contrasting the frequency of detected DVT with rarer serious outcomes and asking how treatment harms and individual risk should influence practice.
Practical perspectives on trauma care and team leadership.
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