Evidence-Based Medicine

What does cardiac movement on ultrasound mean when no pulse can be felt? This 2019 review explores pseudo-PEA, its distinction from cardiac standstill and reported outcomes, while highlighting the limited evidence for proposed treatment changes and the need for further research.

How do T-MACS, HEART, TIMI and EDACS compare with a troponin-only strategy for suspected cardiac chest pain? This review examines a multicentre study using one high-sensitivity troponin I assay, balancing diagnostic sensitivity and rule-out efficiency against missing data and limits to generalisability.

The October 2019 podcast roundup, accompanied by links to that month's reading. The notes point to CRASH-3 and tranexamic acid in head injury, lower-limb thromboprophylaxis, and reports from the RCEM, European Resuscitation Council and Tactical Trauma conferences.

Can clinical probability guide D-dimer thresholds and reduce imaging for suspected pulmonary embolism? Dan Horner appraises the PEGeD management study, examining follow-up outcomes, assay units, possible selection bias and the limited evidence for moderate-risk patients, with a perspective on applying the findings in different settings.

How do intranasal ketamine and fentanyl compare for children with painful limb injuries? This appraisal examines a small randomised trial reporting similar pain relief but more minor adverse events with ketamine, alongside concerns about sample size, trial design and applicability across different clinical settings.

Does knowing that a patient died change how we judge their earlier care? This appraisal examines a study in which clinicians rated the same cases with different outcomes, then considers what hindsight bias means for reflection, feedback and fair discussion of difficult emergency medicine cases.