Evidence-Based Medicine

The August 2024 podcast round-up explores the timing of critical procedures, smoking cessation in the ED, intranasal ketorolac for renal colic and open peer review. The discussion connects these posts with questions about clinical judgement, resources and how we assess evidence.

Does a 2 g TXA bolus differ from a 1 g bolus followed by a 1 g infusion in traumatic brain injury? This appraisal examines a subgroup analysis of patients with CT-confirmed bleeding, separating its mortality and neurological findings from the limits of post hoc evidence.

A Critical Appraisal Nugget about Positive and Negative Predictive Value and their use when interpreting diagnostic tests.

A London Air Ambulance cohort study explores partial REBOA for trauma patients with life-threatening bleeding and recent or imminent cardiac arrest. This appraisal considers feasibility, survival and patient selection, alongside the limits of a small observational study and the training and systems needed to deliver the technique.

How well do MACS, T-MACS and HE-MACS perform in emergency department patients with suspected cardiac chest pain? This appraisal examines a systematic review of their diagnostic accuracy, differences between study populations and the importance of external validation, while acknowledging the St Emlyn's team's involvement in developing the scores.

Is persistent ventricular fibrillation the same as a rhythm that returns after a successful shock? This appraisal examines a secondary analysis of DOSE-VF, comparing outcomes in shock-refractory and recurrent VF and considering the implications for defibrillation strategy.